首页|妇科手术患者静脉血栓栓塞症的危险因素评估和改良评估模型建立

妇科手术患者静脉血栓栓塞症的危险因素评估和改良评估模型建立

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目的:探讨妇科手术患者静脉血栓栓塞症(VTE)的危险因素和改良VTE评估模型对妇科手术患者VTE发生风险的预测价值。方法:选择2020 年1 月1 日至2022 年12 月31 日妇科手术后并发VTE患者41 例为血栓组,按照1 ∶ 4 的比例抽取同期妇科手术患者164 例作为非血栓组。运用单因素及多因素Logistic回归分析妇科手术后并发VTE的危险因素,构建改良VTE危险因素快速评估模型(简称改良VTE评估表),应用受试者工作特征(ROC)曲线分析其对妇科手术患者VTE的预测价值,并与Caprini血栓风险评估模型(简称Caprini量表)进行比较。结果:①多因素Logistic回归分析结果示,年龄≥60 岁、体质量指数(BMI)≥28 kg/m2、恶性肿瘤、手术时间>3 小时、血栓病史、手术前后D-二聚体(D-D)差值增大是影响妇科手术后并发 VTE 的独立危险因素(OR>1,P<0。05)。②改良 VTE 评估表的 ROC 曲线下面积(AUC)为 0。963,约登指数 81。10%、敏感度87。80%、特异度93。29%;Caprini量表的AUC为0。888,约登指数63。41%、敏感度73。17%、特异度90。24%。改良VTE评估表和Caprini量表分别可将 92。68%和 85。37%的VTE患者评估为高危或极高危,但差异无统计学意义(P<0。05)。结论:对于影响妇科手术患者VTE的6 项独立危险因素临床上应重点关注。改良VTE评估表与Caprini量表对VTE识别水平相当,但其简单、易操作,具有更好的实用性,有一定的临床推广价值。
Evaluation of Risk Factors of Venous Thromboembolism in Patients Undergo-ing Gynecological Surgery and Establishment of a Modified Score Model
Objective:To study the risk factors of venous thromboembolism(VTE)and the predictive value of the improved VTE score model to identify the risk of VTE in gynecological surgery patients.Methods:From Janu-ary 1,2020 to December 31,2022,41 patients with VTE after gynecological surgery were selected as the VTE group,and a total of 164 patients with adjacent gynecological surgeries during the same period were selected as the non-VTE group with a ratio of 1 :4.Univariate and multivariate Logistic regression analysis were used to ana-lyze the risk factors of VTE after gynecological surgery,and a modified VTE risk factor rapid assessment model(referred to as the improved VTE score model)was constructed.The receiver operating characteristic(ROC)curve was used to study the predictive value for VTE for in gynecological surgery,and compared with the Caprini score model(Caprini table for short).Results:①Multivatiate Logistic regression analysis showed that there were independent risk factors for postoperative VTE in gynecology surgery(OR>1,P<0.05),including age≥60 years,BMI≥28 kg/m2,malignant tumors,surgery time>3 hours,history of thrombosis,and the increased D-di-mer difference before and after surgery.②The Area under Curve(AUC)of ROC was 0.963 in the improved VTE score model with a Youden index 81.10%,sensitivity 87.80%and specificity 93.29%.The AUC of the Caprini score model was 0.888 with Youden index 63.41%,sensitivity 73.17%and specificity 90.24%.The improved VTE score model the Caprini score model identified 92.68%and 85.37%of VTE patients as high-risk or ex-tremely high-risk,respectively,but the difference was not statistically significant(P<0.05).Conclusions:More attention should be paid to the six independent risk factors for postoperative VTE in gynecology surgery.The two score models showed a similar identified level.However,the improved VTE score model is more simple and easier to operate,has better practicality,and has certain clinical promotion value.

Gynecological surgeryRisk factorsVenous thromboembolismRisk assessment

赵晓鹏、李丹妮、白俊、陈俊瑶、覃心菱、朱虹丽、刘丽秀、李楠、李小宁、王海静

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陕西中医药大学附属医院妇科生殖医学中心,陕西 咸阳 712100

陕西中医药大学第一临床医学院,陕西 咸阳 712100

妇科手术 危险因素 静脉血栓栓塞症 风险评估

2023年咸阳市卫健委中医药科研课题

XYWJ-ZYKY-2023-002

2024

实用妇产科杂志
四川省医学会

实用妇产科杂志

CSTPCD北大核心
影响因子:2.564
ISSN:1003-6946
年,卷(期):2024.40(1)
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