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基于Caprini风险评估模型的静脉血栓栓塞症危险因素分析
Analysis of risk factors of venous thromboembolism based on Caprini Risk Assessment Model

陈亚萍 王婷婷 张洋 邓海波 徐园 王晓杰 马玉芬

Chen Yaping, Wang Tingting, Zhang Yang, Deng Haibo, Xu Yuan, Wang Xiaojie,Ma Yufen

【摘要】目的 基于Caprini 风险评估模型对静脉血栓栓塞症(venous thromboembolism,VTE)的风 险因素进行分析和研究,为护士在临床中识别患者VTE风险提供依据。方法 采用便利抽样的方法, 选取2015 年1 月—2016 年12 月在中国医学科学院北京协和医院的329 例VTE 患者为研究对象,使用 Caprini 风险评估模型对其进行评估,分析VTE 形成的主要危险因素,并将不同性别、不同部位血栓、不 同年龄组的危险因素进行比较分析,探讨其特点。结果 在Caprini 风险评估模型条目的前10 位危险因 素依次为:卧床时间>72 h、BMI≥25 kg/m2、年龄41~60岁、年龄61~74岁、大手术(>45 min)、下肢水肿、 大手术(1 个月内)、卧床的内科患者、年龄≥ 75 岁和肺功能异常(COPD)。进一步分析发现,男性与女性 相比,肺功能异常(COPD)是重要危险因素(χ2=7.695,P=0.006);近端血栓与远端血栓相比较,大手术(> 45 min)和下肢水肿是重要危险因素(χ2 值分别为17.699、30.853;P< 0.001);对于老年患者,卧床时间> 72 h是重要危险因素(χ2=5.583,P=0.015);对于中青年患者,深静脉血栓/ 肺栓塞病史是重要危险因素 (χ2=5.584,P=0.018)。结论 年龄> 40 岁的患者均有可能发生VTE,男性肺功能异常(COPD)者更易形 成VTE;大手术(>45 min)和下肢水肿虽在Caprini 风险评估模型中分值较低,但对形成近端血栓更有意 义,因此不可忽视;老年患者卧床时间> 72 h 时更易形成血栓;中青年患者需警惕血栓复发,VTE 风险 评估需对不同个体的特点进行评估。
【摘要】Objective To analyze and explore the risk factors of venous thromboembolism( VTE) based on the Caprini Risk Assessment Model, so as to provide basis for nurses to identify the risk factors of VTE. Methods From January 2015 to December 2016, a total of 329 patients who were diagnosed with VTE in Peking Union Medical College Hospital were selected as the research subjects by convenience sampling method. All the research subjects were assessed using Caprini Risk Assessment Model, analyzing the major risk factors for VTE. The risk factors of different gender, different site of thrombosis and different age group were compared and analyzed, and the characteristics of the risk factors were discussed. Results The top 10 risk factors in Caprini Risk Assessment Model were: bed time > 72 h, BMI ≥ 25 kg/m2, age between 41 to 60 years old, age between 61 to 74 years old, surgery( > 45 minutes), lower extremity edema, surgery( within 1 month), medical patient in bed, age ≥ 75 years old and abnormal lung function( COPD). Further analysis found that abnormal lung function( COPD) was an important risk factor for men( χ2=7.695, P=0.006); surgery( > 45 minutes) and lower extremity edema were important risk factors for distal deep vein thrombosis( χ2=17.699, 30.853; P < 0.001); bedridden time > 72 h was an important risk factor for the elderly( χ2=5.583, P=0.015); deep vein thrombosis/pulmonary embolism history was an important risk factor for the young( χ2=5.584, P=0.018). Conclusions VTE probably occur in patients over 40 years old, and male patients with abnormal lung function( COPD). Large operations( >45 min) and lower extremity edema have a lower score in the Caprini Risk Assessment Model, however, they are meaningful for the formation of proximal thrombosis, which could not be ignored. The elderly patients are more likely to form thrombosis when their bed time is more than 72 hours. Young and middle-aged patients need to be vigilant for recurrent thrombosis. VTE risk assessment needs to be evaluated for the characteristics of different individuals.

【关键词】静脉血栓栓塞; Caprini 风险评估模型; 危险因素
【关键词】Venous thromboembolism; Caprini risk assessment model; Risk factors