外科术后合并急性PTE患者的临床特点及预后的多中心数据分析  

Multicenter data analysis of clinical characteristics and prognosis of postoperative acute pulmonary embolism

作　　者：张宇 席霖枫 陈虹[3] 董春玲 施熠炜[5] 许小毛[6] 王茂筠[7] 黄强 张帅 张竹 高倩 刘敏[8] 谢万木 翟振国 Zhang Yu;Xi Linfeng;Chen Hong;Dong Chunling;Shi Yiwei;Xu Xiaomao;Wang Maoyun;Huang Qiang;Zhang Shuai;Zhang Zhu;Gao Qian;Liu Min;Xie Wanmu;Zhai Zhenguo(National Center for Respiratory Medicine,State Key Laboratory of Respiratory Health and Multimorbidity,National Clinical Research Center for Respiratory Diseases,Institute of Respiratory Medicine,Chinese Academy of Medical Sciences,Center of Respiratory Medicine,Department of Pulmonary and Critical Care Medicine,China-Japan Friendship Hospital,Beijing 100029,China;Capital Medical University,China-Japan Friendship Hospital,Beijing 100029,China;Department of Pulmonary and Critical Care Medicine,The First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China;Department of Pulmonary and Critical Care Medicine,The Second Hospital of Jilin University,Changchun 130021,China;Department of Pulmonary and Critical Care Medicine,The First Hospital of Shanxi Medical University,Taiyuan 030607,China;Department of Pulmonary and Critical Care Medicine,Beijing Hospital,Beijing 100005,China;Department of Pulmonary and Critical Care Medicine,West China Hospital of Sichuan University,Chengdu 610041,China;Department of Radiology,China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]国家呼吸医学中心,呼吸和共病全国重点实验室,国家呼吸疾病临床研究中心,中国医学科学院呼吸病学研究院中日友好医院呼吸中心,中日友好医院呼吸与危重症医学科,北京100029 [2]首都医科大学中日友好临床医学院,北京100029 [3]重庆医科大学第一医院呼吸与危重症医学科,重庆400016 [4]吉林大学白求恩第二医院呼吸与危重症医学科,长春130021 [5]山西医科大学第一医院呼吸与危重症医学科,太原030607 [6]北京医院呼吸与危重症医学科,北京100005 [7]四川大学华西医院呼吸与危重症医学科,成都610041 [8]中日友好医院影像科,北京100029

出　　处：《中华血管外科杂志》2025年第1期36-43,共8页Chinese Journal of Vascular Surgery

基　　金：国家重点研发计划(2023YFC2507200,2016YFC0905600);中国医学科学院医学与健康科技创新工程项目(2021-I2M-1-061)。

摘　　要：目的探究真实世界中外科术后合并急性肺血栓栓塞症(PTE)患者的临床特征、治疗方案及临床结局,并分析住院死亡相关的危险因素。方法采用回顾性队列研究方法,基于中国肺血栓栓塞症注册登记研究(CURES),收集CURES队列中2016年1月1日至2021年12月31日入组的外科术后合并急性PTE患者的临床资料,包括患者基线资料、手术类型、静脉血栓栓塞症相关风险因素、治疗方案及住院结局。采用Logistic回归模型分析外科术后合并急性PTE患者住院死亡的相关风险因素。结果研究共纳入917例在外科术后3个月内发生急性PTE的患者。合并疾病以心血管疾病(33.9%,311/917)、肿瘤(26.0%,238/917)为主。骨科手术史的患者占比最高,为28.4%(260/917)。女性患者中妇产科手术史的比例也相对较高,为28.1%(140/498)。PTE危险分层高危及中危患者占比分别为10.0%(92/917)及33.7%(309/917)。97.2%(891/917)的患者接受抗凝治疗,7.4%(68/917)及1.3%(12/917)的患者分别接受静脉溶栓及介入治疗。不同手术类型患者PTE住院期间治疗情况显示,胃肠手术史患者接受抗凝治疗占比最低,为92.8%(90/97);脑部手术史患者均未行溶栓治疗,其他手术类型患者溶栓治疗占比为5.0%~13.3%。胃肠手术及腹部脏器手术史患者PTE住院死亡率最高,分别为5.2%(5/97)和4.4%(2/45);血管外科手术史患者无住院死亡病例;其他手术类型患者中,住院死亡率为1.1%~2.9%。骨科手术、脑部手术及心脏或胸部手术史患者的出血发生率较高,为3.8%~4.8%。Logistic多因素分析提示肿瘤(OR=3.80,95%CI:1.31~11.04,P=0.014)、心脏骤停(OR=49.27,95%CI:7.75~313.30,P<0.001)、血小板≤100×109/L(OR=5.69,95%CI:1.25~26.02,P=0.025)为外科术后合并PTE患者发生住院死亡的独立风险因素。结论外科术后合并PTE患者共病多,不同类型手术患者存在治疗及结局的差异。肿瘤、心脏骤停及血小板≤100×10^(9)/L是外科术后合并PTObjectiveTo investigate the clinical characteristics,treatment,and prognosis of patients with postoperative acute pulmonary thromboembolism(PTE),and to analyze the risk factors associated with in-hospital mortality.MethodsThe retrospective cohort study was conducted.This study was based on the China Pulmonary Thromboembolism Registry Study(CURES),which was a nationwide,multicenter,observational,and prospective study.Patients with acute PTE occurring within three months post-surgery from January 1,2016 to December 31,2021 were retrospectively selected from the CURES cohort.Baseline characteristics,surgical types,venous thromboembolism(VTE)-related risk factors,treatment patterns,and in-hospital outcomes were collected and analyzed.Logistic regression analysis was used to evaluate the risk factors associated with in-hospital mortality in patients with postoperative acute PTE.ResultsA total of 917 patients who experienced acute PTE within three months after surgery were included in the study.The most common comorbidities were cardiovascular disease(33.9%,311/917)and malignancies(26.0%,238/917).Patients with orthopedic surgery represented the largest proportion at 28.4%(260/917).Among female patients,the proportion with gynecological surgery was also relatively high at 28.1%(140/498).High-risk and intermediate-risk patients for PTE stratification accounted for 10.0%(92/917)and 33.7%(309/917),respectively.Anticoagulation therapy was administered to 97.2%(891/917)of the total patients,while 7.4%(68/917)and 1.3%(12/917)of the patients received thrombolytic and interventional therapies,respectively.The treatment pattern for different types of surgical patients during hospitalization revealed that those with gastrointestinal surgery had the lowest rate of anticoagulation therapy at 92.8%(90/97);none of the patients with a history of neurosurgery underwent thrombolytic therapy,while the rates for other surgical types ranged from 5.0%to 13.3%.The highest mortality rates were observed in patients with a history of gastrointe

关 键 词：静脉血栓栓塞症 肺血栓栓塞症 急性 外科手术 血栓预防 抗凝治疗 

分 类 号：R56[医药卫生—呼吸系统]