院内获得性肺栓塞患者的临床特征及预后情况分析  

Analysis of clinical characteristics and prognosis in patients with hospital-acquired pulmonary embolism

作　　者：邢云超 陈学明[1] 冯海[1] Xing Yunchao;Chen Xueming;Feng Hai(Department of Vascular Surgery,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院血管外科,北京100050

出　　处：《国际外科学杂志》2025年第3期163-169,共7页International Journal of Surgery

摘　　要：目的:分析院内获得性肺栓塞(HA-PE)的临床特点及其院内死亡相关的危险因素。方法:采用回顾性队列分析的研究方法,收集2015年1月—2021年12月首都医科大学附属北京友谊医院普外科病房收治的60例原发病拟手术治疗且住院期间确诊HA-PE患者的临床及随访资料,其中男性18例,女性42例;年龄(69.7±10.9)岁,年龄范围45~91岁。收集并记录患者的临床资料。符合正态分布的计量资料以均数±标准差(±s)表示,偏态分布的计量资料以M(Q1,Q3)表示,计数资料以例数和百分比(%)表示。采用单因素Logistic回归分析筛选出HA-PE患者死亡相关的危险因素,将危险因素使用多因素Logistic回归模型分析HA-PE患者死亡相关的独立危险因素。结果:14例患者因肺栓塞而未接受原发病手术,从住院到发生肺栓塞的时间间隔为7.0(4.0,10.0)d。20例患者接受了下腔静脉滤器置入,所有下腔静脉滤器均为可回收式,血栓稳定后10例患者成功取出下腔静脉滤器,滤器放置时间为(19.6±3.4)d。所有患者的简化的肺栓塞严重指数(sPESI)评分均为高危。6例患者发生院内肺栓塞死亡。多因素分析发现,胸闷及憋气(OR=1.83,95%CI:1.45~10.15,P=0.039),TNI升高(OR=1.75,95%CI:1.46~7.78,P=0.036)和血小板重度减少(OR=3.6,95%CI:2.46~6.06,P=0.009)是患者院内肺栓塞死亡的独立危险因素。结论:HA-PE患者院内死亡率与原发性肺栓塞相当,在接受规范治疗后,1年内肺栓塞复发及死亡率都很低。胸闷及憋气、TNI升高以及血小板重度减少为HA-PE患者院内肺栓塞死亡的独立危险因素。Objective:To investigate the clinical characteristics of hospital-acquired pulmonary embolism(HA-PE)and identify the risk factors associated with in-hospital mortality.Methods:The retrospective cohort study was used.The clinical and follow-up data were collected of 60 patients with primary diseases who were admitted to the General Surgery Ward of Beijing Friendship Hospital affiliated to Capital Medical University from January 2015 to December 2021.These patients were planned for surgical treatment and were diagnosed with HA-PE during their hospitalization.A total of 60 patients were included in the study,comprising 18 males and 42 females.The age was(69.7±10.9)years,ranging from 45 to 91 years.Baseline clinical parameters were collected and recorded.Measurement data with normal distribution were expressed as mean±standard deviation(±s),measurement data with skewed distribution were expressed as M(Q1,Q3),and count data were expressed as examples and percentages(%).Univariate Logistic regression analysis was used to screen out the risk factors related to in-hospital PE mortality,and multivariate logistic regression model was used to analyze the independent risk factors related to death of HA-PE patients.Results:Fourteen patients did not undergo surgery for primary disease due to HA-PE,the time from admission to HA-PE diagnosis was 7.0(4.0,10.0)days.20 patients were underwent implantation of an inferior vena cava filter,all filters used were retrievable.Successful removal of filters was achieved in 10 patients,the duration of filter placement was recorded as(19.6±3.4)days.All patients had high-risk sPESI scores,and 6 patients died from HA-PE during their hospitalization period.Multivariate analysis revealed that symptoms such as chest tightness and dyspnea(OR=1.83,95%CI:1.45-10.15,P=0.039);Elevated TNI levels(OR=1.75,95%CI:1.46-7.78,P=0.036)and severe thrombocytopenia(OR=3.6,95%CI:2.46-6.06,P=0.009)were independently correlated with in-hospital PE mortality.Conclusions:The in-hospital mortality rate of HA-PE pa

关 键 词：肺栓塞 医院死亡率 预后 危险因素 

分 类 号：R563.5[医药卫生—呼吸系统]