临床决策支持系统对住院患者静脉血栓栓塞症防控的作用  

Role of clinical decision support system in the prevention and control of venous thromboembolism in hospitalized patients

作　　者：何嘉豪 江倩[2] 莫展杰 陈舒敏 任妮 邱曦 唐一瑛 林小靖 刘春丽[2] He Jiahao;Jiang Qian;Mo Zhanjie;Chen Shumin;Ren Ni;Qiu Xi;Tang Yiying;Lin Xiaojing;Liu Chunli(Department of Respiratory and Critical Care Medicine,People′s Hospital of Yangjiang,Yangjiang Hospital of Guangdong Medical University,Yangjiang 529500,China;Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital of Guangzhou Medical University,National Center for Respiratory Medicine,Guangzhou Institute of Respiratory Health,National Key Laboratory of Respiratory Diseases,Guangzhou 510120,China)

机构地区：[1]阳江市人民医院、广东医科大学附属阳江医院呼吸与危重症医学科,阳江529500 [2]广州医科大学附属第一医院呼吸与危重症医学科、国家呼吸医学中心广州呼吸健康研究院呼吸疾病全国重点实验室,广州510120

出　　处：《国际呼吸杂志》2025年第1期56-63,共8页International Journal of Respiration

基　　金：广东省自然科学基金(2023A1515010443);广州市科技局重点研发计划(2023B03J1387);呼吸疾病全国重点实验室自主项目(SKLRD-Z202313)。

摘　　要：目的探讨临床决策支持系统(CDSS)辅助医生进行静脉血栓栓塞症(VTE)风险评价对VTE防控质量的影响,以及CDSS替代医生进行VTE风险评价的可能性。方法本研究为双向性队列研究。采用整群抽样法,回顾性选取2020年7月至8月广州医科大学附属第一医院呼吸与危重症医学科患者740例、胸外科患者784例,共1524例作为对照组;前瞻性选取2022年7月至8月广州医科大学附属第一医院呼吸与危重症医学科患者685例、胸外科患者719例,共1404例作为试验组。对照组不做干预,试验组使用CDSS进行风险评估,医生根据评估结果决定是否干预及如何干预,收集2组医生对患者VTE评估的结果、预防措施实施信息、药物和物理预防禁忌证,以及是否有院内VTE发生等信息,比较2组间的差异。结果试验组男912例(65.0%),女492例(35.0%),年龄(56.60±14.13)岁;对照组男981例(64.4%),女543例(35.6%),年龄(56.61±14.02)岁。2组性别、年龄差异无统计学意义(χ^(2)=0.11,P=0.740;t=0.35,P=0.738)。内科患者中试验组VTE风险评估率高于对照组[100.00%(685/685)比17.16%(127/740),χ^(2)=1954.20,P<0.001],试验组VTE高风险比例低于对照组[37.37%(256/685)比65.35%(83/127),χ^(2)=812.00,P<0.001],试验组出血高风险比例高于对照组[33.20%(85/256)比27.71%(23/83),χ^(2)=339.00,P<0.001]。外科患者中试验组和对照组所有患者均进行了VTE风险评估;试验组VTE高风险比例高于对照组[48.12%(346/719)比9.44%(74/784),χ^(2)=278.73,P<0.001],试验组VTE中风险比例高于对照组[31.02%(223/719)比5.61%(44/784),χ^(2)=165.67,P<0.001],试验组VTE低风险比例低于对照组[20.86%(150/719)比84.95%(666/784),χ^(2)=620.72,P<0.001];试验组和对照组出血高风险比例差异无统计学意义[10.02%(57/569)比5.08%(6/118),χ^(2)=2.86,P=0.114]。内科患者试验组药物预防实施率、物理预防实施率和联合预防实施率均低于对照组(χ^(2)值分别为174.00、132.69、172.23,均P<0.ObjectiveTo investigate the impact of the risk assessment of venous thromboembolism(VTE)assisted by the clinical decision support system(CDSS)on the quality of VTE prevention and control,and to explore the possibility of CDSS as a substitute for VTE risk evaluation by physicians.MethodsThis was a two-way cohort study retrospectively involving 740 patients from Department of Respiratory and Critical Care Medicine and 784 patients from Department of Thoracic Surgery admitted in the First Affiliated Hospital of Guangzhou Medical University from July 2020 to August 2020 by the whole cohort sampling,with 1,524 participants in the control group.From July 2022 to August 2022,a total of 685 patients from Department of Respiratory and Critical Care Medicine and 719 patients from Department of Thoracic Surgery were prospectively selected in the same medical institution,with 1,404 participants in the experimental group.No intervention was given to participants in the control group,and risk assessment by CDSS was performed in the experimental group.Whether to intervene and how to intervene were decided by physicians based on the assessment results.VTE assessment findings,information on the implementation of preventive measures,contraindications to medication and physical prevention,and occurrence of in-hospital VTEs were compared between the two groups.ResultsThere were 912(65.0%)male and 492(35.0%)female patients with a mean age of 56.60±14.13 years in the experimental group.The control group consisted of 981(64.4%)male and 543(35.6%)female patients with a mean age of 56.61±14.02 years.There were no significant differences in gender and age between groups(χ^(2)=0.11,P=0.740;t=0.35,P=0.738).Among respiratory medical patients,the VTE risk assessment rate in the experimental group was significantly higher than that of the control group(100.00%[685/685]vs 17.16%[127/740],χ^(2)=1954.20,P<0.001).The high-risk proportion of VTE in the experimental group was significantly lower than that of the control group(37.37%[256/685]vs 6

关 键 词：静脉血栓栓塞 风险评估 临床决策支持系统 

分 类 号：R54[医药卫生—心血管疾病]