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采用改良Caprini评分系统确定外科手术患者静脉血栓栓塞的危险因素

Determination of Risk Factors for Venous Thromboembolism by an Adapted Caprini Scoring System in Surgical Patients.

作者信息

Hanh Bui My, Cuong Le Quang, Son Nguyen Truong, Duc Duong Tuan, Hung Tran Tien, Hung Duong Duc, Giang Tran Binh, Hiep Nguyen Hoang, Xuyen Hoang Thi Hong, Nga Nguyen Thi, Chu Dinh-Toi

机构信息

Tuberculosis and Lung Disease Department, Hanoi Medical University, Hanoi 100000, Vietnam.

Department of Neurology, Hanoi Medical University, Hanoi 100000, Vietnam.

出版信息

J Pers Med. 2019 Jul 17;9(3):36. doi: 10.3390/jpm9030036.

Abstract

Venous thromboembolism (VTE) is a frequent preventable complication among surgical patients. Precise risk assessment is a necessary step for providing appropriate thromboprophylaxis and reducing mortality as well as morbidity caused by VTE. We carried out this work to define the rate of VTE postoperatively, following a Caprini score, and to determine VTE risk factors through a modified Caprini risk scoring system. This multicenter, observational, cohort study involved 2,790,027 patients who underwent surgery in four Vietnamese hospitals from 01/2017 to 12/2018. All patients who were evaluated before surgery by using a Caprini risk assessment model (RAM) and monitored within 90 days after surgery. The endpoint of the study was ultrasound-confirmed VTE. Our data showed that the 90-day postoperative VTE was found in 3068 patients. Most of VTE (46.97%) cases were found in the highest risk group (Caprini score > 5). A total of 37.19% were observed in the high risk group, while the rest (15.84%) were from low to moderate risk groups. The likelihood of occurring VTE was heightened 2.83 times for patients with a Caprini score of 3-4, 4.83 times for a Caprini score of 5-6, 8.84 times for a score of 7-8, and 11.42 times for a score of >8, comparing to ones with a score of 0 to 2 (all values < 0.05). Thus, the frequency of postoperative VTE rises substantially, according to the advanced Caprini score. Further categorizing patients among the highest risk group need delivering more appropriate thromboprophylaxis.

摘要

静脉血栓栓塞症(VTE)是外科手术患者中常见的可预防并发症。精确的风险评估是提供适当的血栓预防措施以及降低VTE所致死亡率和发病率的必要步骤。我们开展这项工作是为了根据Caprini评分确定术后VTE的发生率,并通过改良的Caprini风险评分系统确定VTE的危险因素。这项多中心、观察性队列研究纳入了2017年1月至2018年12月在越南四家医院接受手术的2,790,027例患者。所有患者在手术前均使用Caprini风险评估模型(RAM)进行评估,并在术后90天内进行监测。研究的终点是超声确诊的VTE。我们的数据显示,3068例患者出现了术后90天VTE。大多数VTE病例(46.97%)出现在最高风险组(Caprini评分>5)。高风险组观察到的病例占37.19%,其余(15.84%)来自低至中度风险组。与Caprini评分为0至2的患者相比,Caprini评分为3 - 4的患者发生VTE的可能性增加2.83倍,评分为5 - 6的患者增加4.83倍,评分为7 - 8的患者增加8.84倍,评分为>8的患者增加11.42倍(所有P值<0.05)。因此,根据Caprini评分的升高,术后VTE的发生率大幅上升。对最高风险组的患者进一步分类需要提供更合适的血栓预防措施。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d2d4/6789529/d4a4dd4cb23f/jpm-09-00036-g001.jpg

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