住院患者静脉血栓栓塞症单中心初步统计分析

发布时间：2018-03-09 14:15

本文选题：住院患者　切入点：静脉血栓栓塞症　出处：《河北医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：静脉血栓栓塞症(venous thromboembolism,VTE)作为外科领域常见疾病之一,其发病率呈上升趋势,尤以住院患者为重。VTE除了有较高的致死率,其并发症也严重影响患者生活质量,给患者及社会带来极大的经济负担。因此,有关VTE病因、诊断及治疗的研究大量涌现,也取得较大成果。根据大宗文献报道,急性VTE诊断前严重威胁患者生命,随时有致命性肺栓塞风险。急性VTE在明确诊断后只有极少患者接受治疗后不遗留并发症,对于大多患者而言,无论其接受保守治疗、开刀手术或介入治疗,大多会留有不同程度后遗症,甚或危及生命。因此,VTE这类疾病重在预防。有关VTE的预防也有相关文献阐述,但目前我国对于该疾病的认知还远远不够,无法按照相关指南进行实施,使其发病率在逐年上升。因此,如何提高人民对VTE该类疾病的认识成为临床热点问题,从而降低该病的发生率。而对于明确诊断的VTE患者接受何种治疗方案,出院后那些因素可影响其并发症的发生,也在不断的探讨及提升过程中。目的:回顾性分析住院患者携带静脉血栓栓塞高危风险因素及接受预防情况,探讨不同治疗方案及出院后服药依从性对其预后的影响。方法:选取2015年2月至2016年8月本中心收治的78例住院患者继发VTE,通过下肢静脉超声、下肢深静脉顺行造影或计算机断层肺动脉造影明确诊断,根据Padua评分标准对有内科住院史的患者携带的危险因素进行评分,应用Caprini评分标准对有外科住院史的患者携带的危险因素进行评分,并分别记录其是否接受预防措施,若接受预防措施,则明确记录接受预防措施的相关情况。分别记录所有患者本次住院接受的治疗情况及入院时患健侧大小腿周径差与出院时患健侧大小腿周径差的差值。以电话或门诊的方式进行随访,记录患者出院后服药依从性及患者下肢症状及体征。根据Villalta评分标准评估患者血栓形成后综合征(post-thrombotic syndrome,PTS)发生率及严重程度,并记录发生大出血、复发等并发症情况。结果:78例VTE患者发病前6周内均有住院史,有外科住院史者63例,其中行妇科非肿瘤手术7例,行颅脑外科手术7例,行骨科手术17例,行肿瘤手术13例,行剖宫产手术9例,行普通外科手术6例,行静脉曲张手术4例;有内科住院史者15例,其中有活动性肿瘤史3例,有脑梗塞史4例,有感染史1例,有妇科病史1例,有心内科病史4例,有妊娠史1例,有其他内科病史1例。接受预防措施比例为37.18%,接受足量预防患者仅占21.79%。住院期间7例患者行导管接触溶栓(catheter directed thrombolysis,CDT),38例患者接受外周系统溶栓、33例患者接受单纯抗凝治疗,15例患者置入下腔静脉滤器。所有患者出院时症状均得到改善,出入院时患健侧大小腿周径差具有统计学意义(P0.05)。对于中心型、混合型深静脉血栓形成(deep vein thrombosis,DVT)患者,各治疗方案组间患肢症状缓解无统计学差异(P0.05)。78例患者获得随访,随访时间4~22个月,平均随访时间为12.77±5.23月。41例患者服药依从性较好;37例患者未规律监测凝血调整用药,其中16例患者出院后自行停止抗凝治疗。15例患者发展成PTS,轻度病变为11例,中度病变为4例,3例患者复发,3例患者死亡,2例因原发病恶化,1例因脑干出血。结论:根据本中心统计的数据,静脉血栓栓塞高危风险因素比例与指南有所偏差。目前我国未能对住院患者进行恰当的VTE风险因素评估并对其进行分级。携带VTE风险因素的住院患者未能得到有效的预防。明确诊断的VTE患者在病情许可下建议行导管接触性溶栓治疗。出院后服药依从性影响患者预后及相关并发症的发生。
[Abstract]:Venous thromboembolism (venous thromboembolism VTE) as the surgical field of one of the common diseases, the incidence rate is rising, especially in hospitalized patients for.VTE but has a high fatality rate, complications also seriously affect the quality of life of patients, bring great economic burden to patients and society. Therefore, the etiology of VTE, research the diagnosis and treatment of large numbers, also made great achievements. According to the large literature, the diagnosis of acute VTE before a serious threat to the lives of patients, at any time the risk of fatal pulmonary embolism after definite diagnosis of acute VTE. Only a few patients treated without complications, for most patients, regardless of their acceptance of surgery or conservative treatment. Interventional therapy, most of them would have a different degree of sequelae, or even life-threatening. Therefore, this kind of disease prevention. VTE prevention on VTE also have the relevant literatures on, but at present In our country the disease cognition is not enough, can not be carried out in accordance with the relevant guidelines, so the incidence increased year by year. Therefore, how to improve people's understanding of VTE this kind of disease has become a hot topic in clinical research, so as to reduce the incidence of the disease. The diagnosis of VTE patients accepted treatment, discharge after those factors can influence the occurrence of complications, and also discussed the improvement process. Objective: To retrospectively analyze the risk factors of hospitalized patients with venous thromboembolism with and accept prevention, impact of medication compliance on the prognosis of different treatment regimens and after discharge. Methods: from February 2015 to August 2016 the center a total of 78 cases of hospitalized patients with secondary VTE, the lower extremity venous ultrasound, lower extremity deep venous antegrade angiography or computed tomography pulmonary angiography diagnosis, according to the Padua score standard Score on the risk factors of hospitalized patients with a history of carry, on risk factors of hospitalized patients with a history of using Caprini to carry the scoring standard for evaluation, and record the acceptance of preventive measures, if take preventive measures, a clear record received preventive measures. All patients were recorded in the hospital and when the patient was hospitalized for contralateral leg circumferences had contralateral leg circumference difference size difference and discharge. Follow up by telephone or clinic, records of patients after discharge compliance of patients with lower extremity symptoms and signs. According to the Villalta standard for evaluation evaluation of patients with post thrombotic syndrome (post-thrombotic syndrome, PTS) incidence and severity, and record the occurrence of major bleeding, recurrence and other complications. Results: 78 cases of VTE patients were hospitalized within 6 weeks before the onset of history, surgical 63 cases of history, including 7 cases of non tumor surgery for gynecological, 7 cases underwent brain surgery and 17 cases underwent Department of orthopedics surgery, 13 cases underwent tumor surgery, 9 cases of cesarean section, 6 cases undergoing general surgery, 4 cases of varicose vein surgery; 15 patients hospitalized in the Department of history. The activity of tumor in 3 cases, cerebral infarction in 4 cases, infection in 1 cases, with gynecological disease in 1 cases, 4 patients had medical history, 1 cases of pregnancy history, other medical history. 1 cases accepted preventive measures the proportion is 37.18%, only 21.79%. patients receive sufficient prevention during hospitalization 7 patients underwent catheter directed thrombolysis (catheter directed thrombolysis, CDT), 38 patients received peripheral system thrombolysis, 33 patients received anticoagulant therapy, 15 cases of inferior vena cava filter placement. All patients' symptoms were improved, the hospital had contralateral leg circumference difference was statistically significant (P0.05). The center type, mixed type of deep vein thrombosis (deep vein, thrombosis, DVT) patients, each treatment group limb symptoms had no significant difference (P0.05) of.78 patients were followed up for 4~22 months, the average follow-up time was 12.77 + 5.23 months.41 patients medication compliance is good; 37 patients without regular monitoring coagulation medication adjustment, of which 16 patients were discharged after treatment to stop anticoagulation in.15 patients developed PTS, mild lesions in 11 cases, moderate lesions in 4 cases, 3 cases of recurrence, 3 patients died, 2 patients with primary disease deterioration, 1 patients with brainstem hemorrhage. Conclusion: according to the statistical data center, risk factors for venous thromboembolism and the proportion of guide deviation. At present our country failed to assess risk factors in hospitalized patients with VTE proper and classified. To hospitalized patients carrying VTE risk factors effectively. Prevention. VTE patients with definite diagnosis recommend catheter contact thrombolysis under the condition of the disease. After discharge, medication compliance will affect the prognosis and related complications.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R543.6

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