解放军总医院住院患者静脉血栓栓塞症的流行病学调查

发布时间：2018-10-10 12:37

【摘要】：[目的]静脉血栓栓塞症(venous thromboembolism, VTE)包括深静脉血栓形成(deep venous thrombosis, DVT)和肺血栓栓塞症(pulmonary thromboembolism,PTE),该疾病的特点是高发病率、高病死率,且漏诊率较高。目前国内缺乏关于VTE的大样本流行病学调查资料,尤其缺乏尸检流行病学资料。本研究拟采用回顾性病历分析的方法调查解放军总医院近年来经病理诊断及临床诊断确诊的VTE患者的患病率、病死率、疾病特点及医院对VTE的预防、诊断及治疗情况,以期为国内广大医务工作者更好的认识VTE这一疾病提供有价值的参考依据。[方法]①病理流行病学调查部分:逐份查阅解放军总医院南楼住院部2006年1月1日至2015年12月31日期间的所有死亡病历,筛选出其中接受尸检的患者。逐份查阅尸检报告,统计经尸检确认的PTE患者人数。对于确诊的PTE患者,详细查阅死亡病历,记录所有PTE患者的尸检详情及临床特征;用Caprini模型评估患者住院期间的血栓形成风险;并就医院对PTE的预防、诊断、治疗情况进行评估。②临床流行病学调查部分:通过解放军总医院电子病历检索系统,检索该医院2006年1月1日至2015年12月31日的所有住院病历,筛选出其中经临床诊断确诊的VTE患者,统计VTE的患病率及其分布情况。对于院内新发的PTE病例,详细分析其疾病特点、发病相关的危险因素分布情况及医院的防诊治情况。[结果]研究期间解放军总医院南楼住院部共入选278例尸检患者,尸检率26.3%。尸检共检出9例PTE患者,其中7例为死亡相关性PTE。尸检病例中的PTE患病率为3.2%,死亡相关性PTE占比为2.5%。全部7例死亡相关性PTE患者的栓塞部位均为骑跨肺动脉主干及左右肺动脉的“Y”字形血栓。医院对PTE患者的药物预防率为33.3%,无一例患者生前被确诊PTE。研究期间解放军总医院通过临床诊断确诊的VTE病例共计4360人次(VTE总患病率4.86‰),其中单纯性PTE665人次,单纯性DVT3322人次,同时合并PTE和DVT的病例373人次,PTE总患病率为1.16‰,DVT总患病率为4.12‰。非手术科室的VTE平均患病率高于手术科室(5.78‰ vs3.67‰,P0.05)。临床死亡患者中PTE的患病率为2.6%,死亡相关性PTE占比为2.4%。研究期间共发生院内新发PTE136例,手术科室的新发PTE病例多于非手术科室(70例vs 66例)。院内新发PTE病例住院期间的病死率为62.5% (85例),栓塞部位以累积一叶或一叶以上肺动脉的大面积栓塞为主(73.2%),医院对院内新发PTE患者的药物预防率为33.3%。[结论]本研究中尸检患者的PTE患病率低于西方国家报道的水平,这一结果提示种族因素可能对PTE的患病率产生较大影响。院内新发PTE病死率高,预防率低,应引起临床医生的高度关注。
[Abstract]:[objective] Venous thromboembolism (venous thromboembolism, VTE) includes deep venous thrombosis (deep venous thrombosis, DVT) and pulmonary thromboembolism (pulmonary thromboembolism,PTE), which is characterized by high incidence, high mortality and high missed diagnosis rate. At present, there is a lack of large sample epidemiological data on VTE in China, especially autopsy epidemiological data. This study aims to investigate the prevalence, mortality, disease characteristics and prevention, diagnosis and treatment of VTE patients diagnosed by pathology and clinical diagnosis in PLA General Hospital in recent years by retrospective analysis of medical records. In order to provide valuable reference for medical workers in China to better understand the disease of VTE. [methods] 1Pathology epidemiology investigation part: the medical records of all death cases from January 1, 2006 to December 31, 2015 in the inpatient department of Nanlou Hospital of PLA General Hospital were reviewed, and the autopsy patients were screened out. The autopsy reports were reviewed and the number of PTE patients confirmed by autopsy was counted. For the confirmed PTE patients, the death records were reviewed in detail, the autopsy details and clinical features of all PTE patients were recorded, the risk of thrombus formation during hospitalization was assessed by Caprini model, and the prevention and diagnosis of PTE in hospital, Evaluation of treatment. 2 Clinical Epidemiology Survey part: through the Electronic Medical record Retrieval system of the General Hospital of the people's Liberation Army, all the medical records of the hospital from January 1, 2006 to December 31, 2015, were retrieved, The prevalence and distribution of VTE were analyzed among the patients with VTE diagnosed by clinical diagnosis. The characteristics of the disease, the distribution of the related risk factors, the prevention and treatment of the hospital were analyzed in detail for the new cases of PTE in hospital. [results] 278 autopsy patients were selected in the Department of South Building of PLA General Hospital during the study, and the autopsy rate was 26.3%. A total of 9 cases of PTE were detected by autopsy, of which 7 cases were death related PTE.. The prevalence of PTE in autopsy cases was 3.2%, and the proportion of death related PTE was 2.5%. The embolism site of all 7 death related PTE patients was "Y"-shaped thrombus which straddled the main pulmonary artery and left and right pulmonary arteries. The drug prevention rate of PTE patients in hospital was 33. 3%. None of the patients was diagnosed with PTE. before death. During the study period, 4360 cases of VTE were diagnosed by clinical diagnosis in PLA General Hospital (the total prevalence rate of VTE was 4.86 鈥，

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