Autar血栓风险评估量表评估骨科关节置换患者深静脉血栓形成风险的研究
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摘要
目的早期识别骨科关节置换患者深静脉血栓形成的风险有助于降低其血栓形成的发生率。文中旨在验证Autar风险评估量表预测骨科关节置换患者深静脉血栓形成风险的有效性。方法收集2014年11月至2016年2月期间10家医院骨科关节置换患者病例资料,以其中确诊为深静脉血栓形成的72例患者作为病例组,选择同时期入院的144例非深静脉血栓形成患者作为对照组,收集患者病史、实验室检查等相关临床资料,依据Autar风险评估工具对患者进行评分分组。采用多因素Logistic回归模型分析深静脉血栓形成危险分层与深静脉血栓形成发生风险之间的关系。结果研究共纳入216例患者。病例组患者Autar平均评分[(17.09±2.83)分]高于对照组[(14.25±2.46)分],差异有统计学意义(P<0.05)。Autar量表在关节置换患者中应用ROC曲线下面积为0.789(95%CI:0.719~0.858)。当其ROC曲线截断点为15时,Autar量表的灵敏度及特异度分别为88.57%、57.90%。Autar量表中年龄>70岁、BMI>30、绝对卧床、静脉曲张、下肢受伤、骨科手术是骨科关节置换手术患者DVT发生的主要高危因素。Logistic回归分析结果显示病例组与对照组两组在Autar风险评估等级分布的差异有统计学意义(P<0.05)。与低危组相比,中危组的骨科关节置换患者深静脉血栓形成风险无统计学意义(OR=1.178,95%CI:0.733~1.490,P=0.053),高危组的骨科关节置换患者深静脉血栓形成风险更高(OR=5.356,95%CI:3.577~7.132,P<0.001)。结论 Autar风险评估量表评定为高风险的骨科关节置换患者是DVT发生的高危人群。随着风险分层的等级增加,骨科关节置换患者DVT发生风险随之增加。因此,Autar风险评估量表适合骨科关节置换患者进行DVT风险的评估。
Objective Early identification of deep vein thrombosis(DVT) risk in patients with joint arthroplasty helps to reduce the incidence of DVT.The study aimed to investigate the effectiveness of Autar risk assessment model in assessing DVT risk in patients with joint arthroplasty.Methods 72 patients with DVT from 10 hospitals from November 2014 to February 2016 were selected as the case group,and 144 non-DVP patients who hospitalized during the same period served as the control group.The medical history,laboratory tests and other related clinical data of the patients were collected,and Autar risk assessment scale was used to evaluate the patients.Multiple logistic regression was applied to analyze the relationship between the risk scale of DVT and the risk of DVT formation.Results 216 patients were included in the research.The Autar score of DVT patients(17.09±2.83) in case group was higher than that of control group(14.25±2.46) and the difference is of statistical significance(P<0.05).The area under the ROC curve of Autar scale in case group was 0.789(95%CI:0.719,0.858,P<0.05).When the ROC curve cutoff point was 15,the sensitivity and the specificity of Autar scale were 88.57% and 57.90% respectively.In Autar scale,the main risk factors of DVT incidence were age≥70 years old,BMI≥30,strict bed rest,varicose veins,lower limb injuries and orthopedic surgery.The result of logistic regression analysis showed the difference of Autar risk rating between these two groups was of statistical significance(P<0.05).In comparison with low risk group,the DVT risk of patients with joint arthroplasty at medium risk was of no significant difference(OR=1.178,95% CI:0.733-1.490,P=0.053) while that of patients with joint arthroplasty at high risk was of significant difference(OR=5.536,95% CI:3.577-7.132,P<0.001).Conclusion Autar DVT risk assessment scale assessed patients with joint arthroplasty at high risk are high risk group of DVT.The risk of DVT increases with the risk rating in patients with joint arthroplasty.Therefore,Autar risk assessment scale can be applied in the assessment of DVT risk in patients with joint arthroplasty.
Objective Early identification of deep vein thrombosis(DVT) risk in patients with joint arthroplasty helps to reduce the incidence of DVT.The study aimed to investigate the effectiveness of Autar risk assessment model in assessing DVT risk in patients with joint arthroplasty.Methods 72 patients with DVT from 10 hospitals from November 2014 to February 2016 were selected as the case group,and 144 non-DVP patients who hospitalized during the same period served as the control group.The medical history,laboratory tests and other related clinical data of the patients were collected,and Autar risk assessment scale was used to evaluate the patients.Multiple logistic regression was applied to analyze the relationship between the risk scale of DVT and the risk of DVT formation.Results 216 patients were included in the research.The Autar score of DVT patients(17.09±2.83) in case group was higher than that of control group(14.25±2.46) and the difference is of statistical significance(P<0.05).The area under the ROC curve of Autar scale in case group was 0.789(95%CI:0.719,0.858,P<0.05).When the ROC curve cutoff point was 15,the sensitivity and the specificity of Autar scale were 88.57% and 57.90% respectively.In Autar scale,the main risk factors of DVT incidence were age≥70 years old,BMI≥30,strict bed rest,varicose veins,lower limb injuries and orthopedic surgery.The result of logistic regression analysis showed the difference of Autar risk rating between these two groups was of statistical significance(P<0.05).In comparison with low risk group,the DVT risk of patients with joint arthroplasty at medium risk was of no significant difference(OR=1.178,95% CI:0.733-1.490,P=0.053) while that of patients with joint arthroplasty at high risk was of significant difference(OR=5.536,95% CI:3.577-7.132,P<0.001).Conclusion Autar DVT risk assessment scale assessed patients with joint arthroplasty at high risk are high risk group of DVT.The risk of DVT increases with the risk rating in patients with joint arthroplasty.Therefore,Autar risk assessment scale can be applied in the assessment of DVT risk in patients with joint arthroplasty.
引文
[1]Büyükyilmaz F,Sendir M,Autar R,et al.Risk level analysis for deep vein thrombosis(DVT):A study of Turkish patients undergoing major orthopedic surgery[J].J Vasc Nurs,2015,33(3):100-105.
[2]Russell RD,Huo MH.Apixaban and rivaroxaban decrease deep venous thrombosis but not other complications after total hip and total knee arthroplasty[J].J Arthroplasty,2013;28:1477-1481.
[3]Sheth NP,Lieberman JR,Della Valle CJ.DVT prophylaxis in total joint reconstruction[J].Orthoped Clin N Am,2010,41:273-280.
[4]Autar R.Nursing assessment of clients at risk of deep vein thrombosis(DVT):the Autar DVT scale[J].J Advanced Nurs,1996,23:763-770.
[5]Autar R.The management of deep vein thrombosis:the Autar DVT risk assessment scale re-visited[J].J Orthop Nurs,2003,7(3):114-124.
[6]Autar R.Evidence for the prevention of venous thromboembolism[J].Br J Nurs,2006,15(18):980-986.
[7]张成欢,刘云.骨科手术患者相关血栓形成风险评估的研究进展[J].医学研究生学报,2015,28(4):445-448.
[8]Oger E.Incidence of venous thromboembolism:A communitybased study in Western France[J].Thromb Haemost,2000,83(5):657-660.
[9]Propel C,Bounameaux H.Doppler ultrasound and D-dimer:friend or foe?[J]Hamostaseology,2012,32(1):28-36.
[10]Susan M,Eman T,El awady M.Validity and reliability assessment of Autar DVT scale[J].Int J Acade Res,2012,2(1):48-55.
[11]吴明隆.问卷统计分析实务——SPSS操作与应用[M].重庆:重庆大学出版社,2010.
[12]杨双利.三种压疮危险评估表对肿瘤患者压疮预测能力的比较[D].广西医科大学,2013.
[13]钮艳芳,吕晶,王从军,等.骨科下肢大手术围手术期深静脉血栓分级预防护理的应用研究[J].中外医疗,2015,36(15):121-123.
[14]罗雪芬,赖家湖.风险评估及临床护理干预对骨科手术后患者深静脉血栓形成的影响[J].齐鲁护理杂志,2015,21(12):36-37.
[15]梁妮,李春容.Autar量表在骨科大手术患者深静脉血栓形成风险评估中的应用[J].护理实践与研究,2013,10(2):49-50.
[2]Russell RD,Huo MH.Apixaban and rivaroxaban decrease deep venous thrombosis but not other complications after total hip and total knee arthroplasty[J].J Arthroplasty,2013;28:1477-1481.
[3]Sheth NP,Lieberman JR,Della Valle CJ.DVT prophylaxis in total joint reconstruction[J].Orthoped Clin N Am,2010,41:273-280.
[4]Autar R.Nursing assessment of clients at risk of deep vein thrombosis(DVT):the Autar DVT scale[J].J Advanced Nurs,1996,23:763-770.
[5]Autar R.The management of deep vein thrombosis:the Autar DVT risk assessment scale re-visited[J].J Orthop Nurs,2003,7(3):114-124.
[6]Autar R.Evidence for the prevention of venous thromboembolism[J].Br J Nurs,2006,15(18):980-986.
[7]张成欢,刘云.骨科手术患者相关血栓形成风险评估的研究进展[J].医学研究生学报,2015,28(4):445-448.
[8]Oger E.Incidence of venous thromboembolism:A communitybased study in Western France[J].Thromb Haemost,2000,83(5):657-660.
[9]Propel C,Bounameaux H.Doppler ultrasound and D-dimer:friend or foe?[J]Hamostaseology,2012,32(1):28-36.
[10]Susan M,Eman T,El awady M.Validity and reliability assessment of Autar DVT scale[J].Int J Acade Res,2012,2(1):48-55.
[11]吴明隆.问卷统计分析实务——SPSS操作与应用[M].重庆:重庆大学出版社,2010.
[12]杨双利.三种压疮危险评估表对肿瘤患者压疮预测能力的比较[D].广西医科大学,2013.
[13]钮艳芳,吕晶,王从军,等.骨科下肢大手术围手术期深静脉血栓分级预防护理的应用研究[J].中外医疗,2015,36(15):121-123.
[14]罗雪芬,赖家湖.风险评估及临床护理干预对骨科手术后患者深静脉血栓形成的影响[J].齐鲁护理杂志,2015,21(12):36-37.
[15]梁妮,李春容.Autar量表在骨科大手术患者深静脉血栓形成风险评估中的应用[J].护理实践与研究,2013,10(2):49-50.