三种血栓风险评估表对骨科大手术患者深静脉血栓形成的预测价值研究

发布时间：2018-07-07 16:47

本文选题：骨科大手术 + 深静脉血栓形成　；参考：《重庆医科大学》2017年硕士论文

【摘要】：目的通过病例回顾研究,比较三种血栓风险评估表对骨科大手术患者术后深静脉血栓形成(DVT)的预测价值,筛选出一种适宜骨科大手术患者使用的血栓风险评估表,为骨科医护人员选择血栓评估表提供依据。方法采用回顾性病例对照研究,选取2014年6月至12月在重庆某三甲医院行骨科大手术的185例患者为研究对象,收集患者一般资料,对所有患者分别使用Wells、Caprini、Autar三种血栓风险评估表进行评估并记录结果,以多普勒超声检查结果为诊断标准,将确诊为DVT的患者作为DVT组,其余患者作为非DVT组,通过ROC曲线分析,以评估表的灵敏度、特异度和曲线下面积为指标来评价三种血栓风险评估表对骨科大手术人群DVT的预测价值。结果根据纳入排除标准共收集185例临床病例资料,48例发生DVT,发生率是25.9%,2例患者同时并发了肺栓塞。Wells、Caprini、Autar三种血栓风险评估表的ROC曲线下面积(AUC)分别为0.958、0.680、0.723,均有统计学意义(P0.05),表明三种血栓风险评估表对骨科大手术患者DVT的发生均有一定的预测能力,而Wells评估表的AUC与Caprini、Autar两种评估表AUC比较的差异有统计学意义(P0.05),Autar评估表与Caprini评估表AUC比较的差异无统计学意义(P0.05),表明Wells评估表的预测价值更高。Wells评估表在最佳诊断界值1.5分时,其对应的灵敏度为0.958,特异度为0.898;Caprini评估表在最佳诊断界值9.5分时,灵敏度、特异度分别为0.625、0.693;Autar评估表在最佳诊断界值14.5时,灵敏度为0.875,特异度0.518。结论骨科大手术后DVT发生率较高。Wells、Caprini和Autar三种评估表对骨科大手术患者DVT的发生均有一定的预测能力,其中预测价值最高的是wells评估表。但因其涉及条目以DVT症状、体征为主,更适合辅助骨科临床医生对DVT患者进行诊断和鉴别诊断;Caprini评估表和Autar评估表则更关注DVT的危险因素,有利于及时发现患者高危因素,更适用于DVT风险评估。Caprini评估表中涉及多项实验室检查项目,如有缺项,可能导致危险因素评估不全,而Autar评估表中项目均容易快速获取,且包含了风险分级和预防措施指引,因此更适宜骨科护理工作者使用。
[Abstract]:Objective to compare the predictive value of three thrombotic risk assessment tables for deep venous thrombosis (DVT) in patients undergoing major orthopedic surgery, and to select a suitable thrombotic risk assessment table for major orthopedic surgery patients. To provide basis for orthopaedic medical staff to select thrombus assessment form. Methods A retrospective case-control study was conducted. 185 patients undergoing major orthopedic surgery in a third Class A Hospital in Chongqing from June to December 2014 were selected as the subjects, and the general data of the patients were collected. All patients were assessed and recorded with Wellsberg Caprinitar three thrombotic risk assessment tables. The patients diagnosed with DVT were selected as DVT group and the rest as non-DVT group by ROC curve analysis, using Doppler ultrasound as diagnostic criteria. The predictive value of three kinds of thrombotic risk assessment tables for large orthopedic surgery population DVT was evaluated by the sensitivity, specificity and area under curve of the evaluation table. Results according to the exclusion criteria, a total of 185 cases of DVT were collected. The incidence of DVT was 25.9%. The area under the ROC curve (AUC) of the three risk assessment tables of pulmonary embolism, Wellsberg Caprinius Autar was 0.958 卤0.680 / 0.723, respectively, with statistical significance. (P0.05), which indicated that the three thrombus risk assessment tables had certain predictive ability for DVT in patients undergoing major orthopedic surgery. However, there was significant difference between AUC of Wells evaluation table and AUC of Caprinius Autar evaluation table (P0.05). There was no significant difference between AUC evaluation table and Caprini evaluation table (P0.05), which indicated that the predicted value of Wells evaluation table was higher than that of Caprini-Autar evaluation table. Wells evaluation table had a higher predictive value at 1.5 minutes of the best diagnostic threshold, and there was no significant difference between AUC and Caprini evaluation table (P0.05). The corresponding sensitivity was 0.958, and the specificity was 0.875 and the specificity was 0.518 when the best diagnostic threshold was 9.5 minutes. Conclusion the incidence rate of DVT after major orthopedic surgery is higher. Wellsberg Caprini and Autar have certain predictive ability for the occurrence of DVT in orthopaedic major surgery patients. The highest predictive value is the wells evaluation table. However, because the items involved are mainly symptoms and signs of DVT, it is more suitable to assist orthopedic clinicians in diagnosis and differential diagnosis of DVT patients. However, the evaluation form of Caprini and Autar are more concerned about the risk factors of DVT, which is helpful to discover the high risk factors of patients in time. It is more suitable for the risk assessment of DVT.Caprini assessment form, which involves many laboratory inspection items. If there is a missing item, it may lead to incomplete assessment of risk factors, while the items in the Autar assessment form are easy to obtain quickly and contain guidelines on risk classification and preventive measures. Therefore, it is more suitable for orthopedic nursing workers to use.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.6

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