Lu Yun, Chen Feng-Ying, Cai Lan, Huang Chun-Xia, Shen Xue-Fang, Cai Li-Qin, Li Xiao-Ting, Fu Yong-Yan, Wei Juan
The Fifth Ward of Surgery, Kunshan Hospital of Traditional Chinese Medicine, Kunshan 215300, Jiangsu Province, China.
Department of Nursing, Traditional Chinese Medicine Hospital of Kunshan, Kunshan 215300, Jiangsu Province, China.
World J Clin Cases. 2022 Apr 6;10(10):3035-3046. doi: 10.12998/wjcc.v10.i10.3035.
Venous thromboembolism (VTE) is a major cause of unexpected and perioperative in-hospital deaths. It is characterized by high morbidity, high mortality, high misdiagnosis rate, and high missed diagnosis rates. VTE is a common postoperative complication in cancer patients. VTE is preventable, and early identification of risk factors leading to VTE and appropriate early preventive actions can reduce its occurrence and mortality. Presently, there is no uniform standard for the prevention and control of VTE in clinical practice, and hospitals in China lack mature and effective protocols for the assessment, prevention, and treatment of VTE.
To explore whether an early warning program could influence the occurrence of deep vein thrombosis (DVT) postoperatively.
This is a comparative retrospective cohort study, which enrolled patients who underwent laparotomic or laparoscopic gastrointestinal tumor resection for gastrointestinal cancer between January 2016 and December 2019. Patients were divided into a control group and an early warning group depending on whether or not the early warning program was implemented. A venous thromboembolism prevention and control team was established. The outcomes included the occurrence of DVT, the correct rate of VTE assessment, the coagulation indicators, and the mastery of VTE knowledge by the nurses.
A total of 264 patients were included in this study, with 128 patients in the control group and 136 patients in the early warning group. The occurrence rate of DVT in the early warning group was 6.6% (9/136), compared with 14.1% (18/128) in the control group ( < 0.05). The correct rates of VTE risk assessment by the nurses and standard implementation rate of VTE preventive measures were 86.8% 65.6% and 80.2% 57.8% in early warning and control groups, respectively (all < 0.001). The independent factors associated with postoperative DVT occurrence were age (OR = 1.083, 95%CI: 1.070-3.265, = 0.032), Hyperlipidemia (OR = 1.127, 95%CI: 1.139-2.564, = 0.042), preoperative high VTE risk (OR = 2.131, 95%CI: 1.085-5.178, = 0.001), time of operation (OR = 2.268, 95%CI: 2.005-5.546, = 0.026) and not adoption of early warning prevention (OR = 3.747, 95%CI: 1.523-6.956, = 0.017).
The early warning strategy was independently associated with the decreasing occurrence of VTE, and it might be suitable for protection from VTE in patients undergoing gastrointestinal cancer surgery.
静脉血栓栓塞症（VTE）是意外死亡和围手术期院内死亡的主要原因。其特点是发病率高、死亡率高、误诊率高和漏诊率高。VTE是癌症患者常见的术后并发症。VTE是可预防的，早期识别导致VTE的危险因素并采取适当的早期预防措施可降低其发生率和死亡率。目前，临床实践中VTE的预防和控制尚无统一标准，我国医院缺乏成熟有效的VTE评估、预防和治疗方案。
探讨早期预警方案是否会影响术后深静脉血栓形成（DVT）的发生。
这是一项比较性回顾性队列研究，纳入了2016年1月至2019年12月期间因胃肠道癌接受开腹或腹腔镜胃肠道肿瘤切除术的患者。根据是否实施早期预警方案将患者分为对照组和早期预警组。成立了静脉血栓栓塞预防与控制小组。观察指标包括DVT的发生情况、VTE评估的正确率、凝血指标以及护士对VTE知识的掌握情况。
本研究共纳入264例患者，其中对照组128例，早期预警组136例。早期预警组DVT发生率为6.6%（9/136），对照组为14.1%（18/128）（P<0.05）。早期预警组和对照组护士对VTE风险评估的正确率及VTE预防措施的标准执行率分别为86.8%对65.6%和80.2%对57.8%（均P<0.001）。与术后DVT发生相关的独立因素为年龄（OR=1.083，95%CI：1.070-3.265，P=0.032）、高脂血症（OR=1.127，95%CI：1.139-2.564，P=0.042）、术前VTE高风险（OR=2.131，95%CI：1.085-5.178，P=0.001）、手术时间（OR=2.268，95%CI：2.005-5.546，P=0.026）以及未采取早期预警预防措施（OR=3.747，95%CI：1.523-6.956，P=0.017）。
早期预警策略与VTE发生率降低独立相关，可能适用于胃肠道癌手术患者预防VTE。
