Caprini风险评估模型对重症患者静脉血栓栓塞症的预测价值研究
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摘要
目的回顾性验证Caprini风险评估模型在评估重症患者静脉血栓栓塞症(VTE)发病风险的有效性。方法采用病例对照研究设计,收集2012年10月至2017年10月于华北理工大学附属医院ICU中被确诊患有VTE的72例重症患者作为病例组,按照与病例组2:1的比例随机选择同时期的144例未患VTE的重症患者作为对照组,回顾性收集患者的一般情况、既往病史、治疗方式等临床资料,依据Caprini评估模型对患者进行评分及危险度分级,探讨不同危险度分级与患者VTE发病风险的关系,采用多因素Logistic回归分析重症患者发生VTE的主要风险因素。结果病例组Caprini评分(10.50±2.91)高于对照组(6.64±2.51),差异有统计学意义(P<0.05)。病例组与对照组Caprini危险度分级的构成之间差异有统计学意义(P<0.05),极高危患者发生VTE的风险为非极高危患者的17倍。回归分析显示下肢肿胀、恶性肿瘤(既往或现患)、需要卧床(>3 d)、卒中(<1个月)以及髋、骨盆或下肢骨折等5个因素是重症患者发生VTE的主要危险因素。结论 Caprini风险评估模型对重症患者VTE发病风险具有较好的预测性,值得在临床上推广应用。
Objective To retrospectively validate the effectiveness of the Caprini risk assessment model in assessing the risk of venous thromboembolism(VTE) in critically ill patients. Methods A case-control study design was designed to collect 72 critically ill patients diagnosed with VTE in the ICU of the affiliated hospital of north China university of science and technology from October 2012 to October 2017 as the case group, and 144 patients who had not had VTE in the same period were randomly selected as the control group. The clinical data, laboratory examinations, treatment and other related data were collected retrospectively. The patients were scored according to the Caprini evaluation model and the risk was graded to explore the different risk grading and classification. The relationship between the risk of VTE in patients was analyzed by multivariate logistic regression to analyze the main risk factors for VTE in critically ill patients. Results The Caprini score(10.50±2.91) in the case group was higher than that in the control group(6.64±2.51), and the difference was statistically significant(P<0.05). There was a statistically significant difference between the case group and the control group(P<0.05). The risk of VTE in the very high-risk patients was 17 times higher than that of the non-very high-risk patients. Regression analysis showed that lower extremity swelling, malignant tumors(previous or current), bed rest(>3 days), stroke(<1 month),and hip, pelvic or lower extremity fractures were the main risk factors for VTE in critically ill patients. Conclusion The Caprini risk assessment model has a good predictive value for the risk of VTE in critically ill patients and is worthy of clinical application.
Objective To retrospectively validate the effectiveness of the Caprini risk assessment model in assessing the risk of venous thromboembolism(VTE) in critically ill patients. Methods A case-control study design was designed to collect 72 critically ill patients diagnosed with VTE in the ICU of the affiliated hospital of north China university of science and technology from October 2012 to October 2017 as the case group, and 144 patients who had not had VTE in the same period were randomly selected as the control group. The clinical data, laboratory examinations, treatment and other related data were collected retrospectively. The patients were scored according to the Caprini evaluation model and the risk was graded to explore the different risk grading and classification. The relationship between the risk of VTE in patients was analyzed by multivariate logistic regression to analyze the main risk factors for VTE in critically ill patients. Results The Caprini score(10.50±2.91) in the case group was higher than that in the control group(6.64±2.51), and the difference was statistically significant(P<0.05). There was a statistically significant difference between the case group and the control group(P<0.05). The risk of VTE in the very high-risk patients was 17 times higher than that of the non-very high-risk patients. Regression analysis showed that lower extremity swelling, malignant tumors(previous or current), bed rest(>3 days), stroke(<1 month),and hip, pelvic or lower extremity fractures were the main risk factors for VTE in critically ill patients. Conclusion The Caprini risk assessment model has a good predictive value for the risk of VTE in critically ill patients and is worthy of clinical application.
引文
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[7]徐留海,曾勇,黄卫,等.基于Caprini血栓风险模型评估膝关节镜手术患者深静脉血栓形成的风险性[J].中国组织工程研究,2016,(17):2474-80.
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[9]Xu JX,Dong J,Ren H,et al.Incidence and risk assessment of venous thromboembolism in cancer patients admitted to intensive care unit for postoperative care[J].J buon,2018,23(1):248-54.
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[11]鲁力.重症患者深静脉血栓风险Caprini评分与APACHEⅡ评分及其预后的关系[A].中华医学会、中华医学会重症医学分会.中华医学会第五次全国重症医学大会论文汇编[C].中华医学会、中华医学会重症医学分会,2011:1.
[2]Arabi YM,Khedr M,Dara SI,et al.Use of intermittent pneumatic compression and not graduated compression stockings is associated with lower incident VTE in critically ill patients:a multiple propensity scores adjusted analysis[J].Chest,2013,144(1):152-9.
[3]Kahn SR,Lim W,Dunn AS,et al.Prevention of VTE in nonsurgical patients:Antithrombotic Therapy and Prevention of Thrombosis,9th ed:American College of Chest Physicians Evidence-Based Clinical Practice Guidelines[J].Chest,2012,141(2 Suppl):e195S-e226S.
[4]Arcelus JI,Candocia S,Traverso CI,et al.Venous thromboembolism prophylaxis and risk assessment in medical patients[J].SeminThromb Hemost,1991,17 Suppl 3:313-8.
[5]Zhou H,Wang L,Wu X,et al.Validation of a venous thromboembolism risk assessment model in hospitalized chinese patients:a casecontrol study[J].J AtherosclerThromb,2014,21(3):261-72.
[6]Lobastov K,Barinov V,Schastlivtsev I,et al.Validation of the Caprini risk assessment model for venous thromboembolism in high-risk surgical patients in the background of standard prophylaxis[J].JVascSurg Venous LymphatDisord,2016,4(2):153-60.
[7]徐留海,曾勇,黄卫,等.基于Caprini血栓风险模型评估膝关节镜手术患者深静脉血栓形成的风险性[J].中国组织工程研究,2016,(17):2474-80.
[8]Minet C,Potton L,Bonadona A,et al.Venous thromboembolism in the ICU:main characteristics,diagnosis and thromboprophylaxis[J].Crit Care,2015,19:287.
[9]Xu JX,Dong J,Ren H,et al.Incidence and risk assessment of venous thromboembolism in cancer patients admitted to intensive care unit for postoperative care[J].J buon,2018,23(1):248-54.
[10]ICU患者深静脉血栓形成预防指南[A].浙江省医学会危重病学分会.2009年浙江省危重病学学术年会论文汇编[C].浙江省医学会危重病学分会,2009:6.
[11]鲁力.重症患者深静脉血栓风险Caprini评分与APACHEⅡ评分及其预后的关系[A].中华医学会、中华医学会重症医学分会.中华医学会第五次全国重症医学大会论文汇编[C].中华医学会、中华医学会重症医学分会,2011:1.