内科住院患者的静脉血栓栓塞预防：一项回顾性病历审查。

Venous thromboembolism prophylaxis in medical inpatients: a retrospective chart review.

作者信息

Rahim Sherali A, Panju Akbar, Pai Menaka, Ginsberg Jeffrey

机构信息

University of Toronto, Toronto, ON, Canada.

出版信息

Thromb Res. 2003;111(4-5):215-9. doi: 10.1016/j.thromres.2003.09.010.

DOI:10.1016/j.thromres.2003.09.010

PMID:14693166

Abstract

BACKGROUND

Venous thromboembolic disease (VTE) is a major cause of morbidity and mortality in hospitalized patients. Most hospitalized patients with a fatal pulmonary embolism are medical patients who do not have a history of recent surgery [BMJ 302 (1991) 709; J. R. Soc. Med. 82 (1989) 198]. There is evidence suggesting that VTE prophylaxis is indicated in many high risk medical patients [Chest 119 (2001) 132S; NEJM 341 (1999) 793]. However, previous studies have shown that only about one third of high risk medical patients receive VTE prophylaxis [Ann. Intern. Med. 115 (1991) 591; Chest 106 (1994) 13; Chest 107 (1995) 296]. The objective of this study was to determine the frequency of use of VTE prophylaxis in medical inpatients at two teaching hospitals in Hamilton, Ontario.

METHODS

A retrospective chart review of consecutive patients admitted to medical wards at two acute care sites of McMaster University affiliated teaching hospitals between October 10, 2001 and December 11, 2001 was performed. For each patient, demographic data, risk factors for VTE, method of VTE prophylaxis and contraindications to VTE prophylaxis were recorded.

RESULTS

756 patient charts were reviewed and 310 (41%) were excluded because the primary diagnosis required anticoagulation, the patients were being treated with anticoagulation (warfarin or heparin) before admission or the patient was admitted to the intensive care unit. Of the remaining 446 patients, 146 (33%) received some form of VTE prophylaxis. Of the patients receiving prophylaxis, 4% had early ambulation, 9% wore anti-embolic stockings (AES), 1% used intermittent pneumatic compression, 23% used unfractionated heparin and 3% used low molecular weight heparin. Two hundred five (46%) patients had one identifiable VTE risk factor and 63 (14%) had two or more risk factors. Patients with more VTE risk factors were more likely to receive prophylaxis.

INTERPRETATION

One third of medical inpatients at two teaching hospitals in Hamilton received some form of VTE prophylaxis.

摘要

背景

静脉血栓栓塞性疾病（VTE）是住院患者发病和死亡的主要原因。大多数发生致命性肺栓塞的住院患者是内科患者，他们近期没有手术史[《英国医学杂志》302（1991）709；《皇家医学会杂志》82（1989）198]。有证据表明，许多高危内科患者需要进行VTE预防[《胸部》119（2001）132S；《新英格兰医学杂志》341（1999）793]。然而，以往研究表明，只有约三分之一的高危内科患者接受了VTE预防[《内科学年鉴》115（1991）591；《胸部》106（1994）13；《胸部》107（1995）296]。本研究的目的是确定安大略省汉密尔顿市两家教学医院内科住院患者使用VTE预防措施的频率。

方法

对2001年10月10日至2001年12月11日期间在麦克马斯特大学附属教学医院两个急症护理点内科病房连续收治的患者进行回顾性病历审查。记录每位患者的人口统计学数据、VTE危险因素、VTE预防方法及VTE预防的禁忌症。

结果

共审查了756份患者病历，310份（41%）被排除，原因是主要诊断需要抗凝、患者入院前正在接受抗凝治疗（华法林或肝素）或患者入住重症监护病房。在其余446名患者中，146名（33%）接受了某种形式的VTE预防。在接受预防的患者中，4%进行了早期活动，9%穿着抗栓袜（AES），1%使用了间歇性气动压迫，23%使用了普通肝素，3%使用了低分子量肝素。205名（46%）患者有一个可识别的VTE危险因素，63名（14%）有两个或更多危险因素。VTE危险因素较多的患者更有可能接受预防。