某三甲医院下腔静脉滤器安置与未回收患者5年回顾性分析
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摘要
目的了解某三甲医院连续5年下腔静脉滤器(IVCF)的安置与回收情况,并分析滤器未回收的原因。方法回顾性分析2012-2016年806例安置IVCF患者的临床资料,包括一般资料、血栓分型、滤器类型、放置原因、回收现状等,对未回收滤器的患者进行随访,分析滤器未回收的原因。结果深静脉血栓(DVT)患者滤器置入率为26.84%(806/3 003);滤器的类型:可回收型96.28%、临时型0.87%、永久型2.85%;滤器回收率22.21%,回收时间(13.65±4.19)d,不同年龄分层、不同疾病患者滤器回收率差异有统计学意义(P<0.01);滤器未回收的原因前5位是:再次肺栓塞风险(40.72%)、年龄偏大(34.54%)、发生并发症无法回收(20.88%)、经济困难(13.66%)、合并肿瘤(12.11%);86.08%(334/388)的患者并不知晓未回收IVCF的危害。结论滤器低回收率与患者年龄、合并恶性肿瘤、发生并发症等因素相关。医务人员应审慎地评估长期留置滤器的获益与风险,提高滤器回收率,同时需加强对长期留置滤器患者的随访,防范远期并发症发生。
Objective To understand the indwelling and recycle of inferior vena cava filter(IVCF),and to analyze the reasons of filter non-recycle in a class 3 Ahospital during 5 consecutive years.Methods The clinical data in 896 cases of IVCF indwelling were retrospectively analyzed,including the general data,thrombus classification,filter type,indwelling reason,recycling status,etc.The patients with non-recycle filters conducted follow-up.The reasons of filter non-recycle were analyzed.Results The filter indwelling rate in the patients with DVT was 26.84%(806/3 003),the filter types:retrievable type 96.28%,temporary type0.87%and permanent type 2.85%;the filter recycle rate was 22.21%,the recycle time was(13.65±4.19)d,the filter recycle rate had statistical difference among different age stratification and whether suffering from malignant tumor(P<0.01):the top 5 places for the filter non-recycle reasons:risk of pulmonary embolism again(40.72%),older age(34.54%),can not recycle due to complication occurrence(20.88%),economic difficulty(13.66%)and complicating tumor(12.11%);86.08%(334/388)of the patients did not know the hazard of IVCF non-recycle.Conclusion The low recycle rate of filters is correlated with the factors of patient′s age,complicating malignant tumor and complications occurrence.Medical staffs should carefully assess the benefit and risk of long-term indwelling filter,increase the filter recycle rate,at the same time,it needs to strengthen the follow-up of the patients with long-term indwelling filter and prevent the occurrence of longterm complications.
Objective To understand the indwelling and recycle of inferior vena cava filter(IVCF),and to analyze the reasons of filter non-recycle in a class 3 Ahospital during 5 consecutive years.Methods The clinical data in 896 cases of IVCF indwelling were retrospectively analyzed,including the general data,thrombus classification,filter type,indwelling reason,recycling status,etc.The patients with non-recycle filters conducted follow-up.The reasons of filter non-recycle were analyzed.Results The filter indwelling rate in the patients with DVT was 26.84%(806/3 003),the filter types:retrievable type 96.28%,temporary type0.87%and permanent type 2.85%;the filter recycle rate was 22.21%,the recycle time was(13.65±4.19)d,the filter recycle rate had statistical difference among different age stratification and whether suffering from malignant tumor(P<0.01):the top 5 places for the filter non-recycle reasons:risk of pulmonary embolism again(40.72%),older age(34.54%),can not recycle due to complication occurrence(20.88%),economic difficulty(13.66%)and complicating tumor(12.11%);86.08%(334/388)of the patients did not know the hazard of IVCF non-recycle.Conclusion The low recycle rate of filters is correlated with the factors of patient′s age,complicating malignant tumor and complications occurrence.Medical staffs should carefully assess the benefit and risk of long-term indwelling filter,increase the filter recycle rate,at the same time,it needs to strengthen the follow-up of the patients with long-term indwelling filter and prevent the occurrence of longterm complications.
引文
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[9]Prepic Study Group.Eight-year follow-up of patients with permanent vena cava filters in the prevention of pulmonary embolism:the PREPIC(Prevention du Risque d′Embolie Pulmonaire par Interruption Cave)randomized study[J].Circulation,2005,112(3):416-422.
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[12]DESO S E,IDAKOJI I A,KUO W T.Evidence-based evaluation of inferior Vena Cava filter complications based on filter type[J].Semin Intervent Radiol,2016,33(2):93-100.
[13]GEISBSCH P,BENENATI J F,PEA C S,et al.Retrievable inferior vena cava filters:factors that affect retrieval success[J].Cardiovasc Intervent Radiol,2012,35(5):1059-1065.
[14]中华医学会骨科学分会.中国骨科大手术静脉血栓栓塞症预防指南[J].中华骨科杂志,2016,36(2):65-71.
[15]WASSEF A,LIM W,WU C.Indications,complications and outcomes of inferior vena cava filters:A retrospective study[J].Thromb Res,2017(153):123-128.
[16]TSUI B,TIANZHI A,MOON E,et al.Retrospective review of 516implantations of option inferior Vena Cava filters at a single health care system[J].J Vasc Interv Radiol,2016,27(3):345-353.
[17]赵伯翔,顾建平,何旭,等.下腔静脉滤器长期留置并发症CT随访的单中心研究[J].介入放射学杂志,2016,25(11):944-948.
[18]SUTPHIN P D,REIS S P,MCKUNE A,et al.Improving inferior Vena Cava filter retrieval rates with the define,measure,analyze,improve,control methodology[J].JVasc Int Radiol,2015,26(4):491-498.
[2]STEIN P D,KAYALI F,OLSON R E.Twenty-one-year trends in the use of inferior vena cava filters[J].Arch Intern Med,2004,164(14):1541-1545.
[3]MELTZER A J,GRAHAM A,KIM J H,et al.Clinical,demographic,and medicolegal factors associated with geographic variation in inferior vena cava filter utilization:an interstate analysis[J].Surgery,2013,153(5):683-688.
[4]YARMOHAMMADI H,BEKWELEM W,BUNNEY A,et al.Hemopericardium from inferior cava filter strut fracture and embolization[J].J Cardiovasc Comput Tomogr,2016,10(1):91-92.
[5]JIA Z Z,WU A,TAM M,et al.Caval penetration by inferior Vena Cava filters:a systematic literature review of clinical significance and management[J].Circulation,2015,132(10):944-952.
[6]ANGEL L F,TAPSON V,GALGON R E,et al.Systematic review of the use of retrievable inferior vena cava filters[J].J Vasc Interv Radiol,2011,22(11):1522-1530.
[7]KALIM S,AKHTAR M S.Use of computed tomographic pulmonary angiography for the diagnosis of pulmonary embolism;are we overdoing it?[J].J Ayub Med Coll Abbottabad,2014,26(1):76-79.
[8]中华医学会放射学分会介入学组.下腔静脉滤器置入术和取出术规范的专家共识[J].中华放射学杂志,2011,45(3):297-300.
[9]Prepic Study Group.Eight-year follow-up of patients with permanent vena cava filters in the prevention of pulmonary embolism:the PREPIC(Prevention du Risque d′Embolie Pulmonaire par Interruption Cave)randomized study[J].Circulation,2005,112(3):416-422.
[10]KEARON C,AKL E A,ORNELAS J,et al.Antithrombotic therapy for VTE disease:CHEST guideline and expert panel report[J].Chest,2016,149(2):315-352.
[11]刘建龙,张蕴鑫.建立下腔静脉滤器新理念[J].中国普通外科杂志,2017,26(6):680-685.
[12]DESO S E,IDAKOJI I A,KUO W T.Evidence-based evaluation of inferior Vena Cava filter complications based on filter type[J].Semin Intervent Radiol,2016,33(2):93-100.
[13]GEISBSCH P,BENENATI J F,PEA C S,et al.Retrievable inferior vena cava filters:factors that affect retrieval success[J].Cardiovasc Intervent Radiol,2012,35(5):1059-1065.
[14]中华医学会骨科学分会.中国骨科大手术静脉血栓栓塞症预防指南[J].中华骨科杂志,2016,36(2):65-71.
[15]WASSEF A,LIM W,WU C.Indications,complications and outcomes of inferior vena cava filters:A retrospective study[J].Thromb Res,2017(153):123-128.
[16]TSUI B,TIANZHI A,MOON E,et al.Retrospective review of 516implantations of option inferior Vena Cava filters at a single health care system[J].J Vasc Interv Radiol,2016,27(3):345-353.
[17]赵伯翔,顾建平,何旭,等.下腔静脉滤器长期留置并发症CT随访的单中心研究[J].介入放射学杂志,2016,25(11):944-948.
[18]SUTPHIN P D,REIS S P,MCKUNE A,et al.Improving inferior Vena Cava filter retrieval rates with the define,measure,analyze,improve,control methodology[J].JVasc Int Radiol,2015,26(4):491-498.