中国组织工程研究

中国组织工程研究 ›› 2016, Vol. 20 ›› Issue (17): 2474-2480.doi: 10.3969/j.issn.2095-4344.2016.17.006

• 人工假体 artificial prosthesis • 上一篇    下一篇

基于Caprini血栓风险模型评估膝关节镜手术患者深静脉血栓形成的风险性

徐留海，曾 勇，黄 卫，王茂朋，阙详勇，易春艳   

  1. 三峡大学仁和医院骨科，湖北省宜昌市   443001
  • 收稿日期:2016-02-26 出版日期:2016-04-22 发布日期:2016-04-22
  • 通讯作者: 曾勇，副主任医师，三峡大学仁和医院骨科，湖北省宜昌市 443001
  • 作者简介:徐留海，男，湖北省宜昌市人，2004年武汉大学医学院毕业，主治医师，主要从事骨关节疾病相关研究。
  • 基金资助:

    湖北省卫生计生委科研项目(WJ2015084)

Risk of deep venous thrombosis among patients undergoing knee arthroscopy based on Caprini risk assessment

Xu Liu-hai, Zeng Yong, Huang Wei, Wang Mao-peng, Que Xiang-yong, Yi Chun-yan   

  1. Department of Orthopedics, Renhe Hospital of Three Gorges University, Yichang 443001, Hubei Province, China
  • Received:2016-02-26 Online:2016-04-22 Published:2016-04-22
  • Contact: Zeng Yong, Associate chief physician, Department of Orthopedics, Renhe Hospital of Three Gorges University, Yichang 443001, Hubei Province, China
  • About author:Xu Liu-hai, Attending physician, Department of Orthopedics, Renhe Hospital of Three Gorges University, Yichang 443001, Hubei Province, China
  • Supported by:

    the Sciencific Research Project of Health and Family Planning Commission of Hubei Province, No. WJ2015084

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479

被引次数

22

摘要：

文章快速阅读：

 

文题释义：
深静脉血栓形成：是指血液在深静脉内不正常地凝结，属静脉回流障碍性疾病, 可发生于全身各部位静脉,以下肢深静脉为多，临床上常无症状。一旦发生会导致下肢肿痛及表浅静脉的曲张，不及时治疗则栓子会随血流运行最终导致肺栓塞，极大的危害患者的生命安全。当前深静脉血栓在非骨科大手术患者中的临床检出率低、误诊漏诊率高是国内骨科术后患者深静脉血栓诊疗的普遍现状。
Caprini血栓风险评估模型: 由Caprini等研制，于2009年发布最新修订版本。该量表包含了约40个不同的危险因素，每个危险因素根据危险程度的不同赋予1-5分，得到患者的总评分，根据总评分将患者的深静脉血栓发生风险分为4个等级。可对患者深静脉血栓进行危险分层，针对不同危险分层采取相应预防措施。国外相关研究已表明此量表的有效性。而目前国内关于Caprini风险评估模型的研究较少，尚无运用到膝关节镜手术患者下肢深静脉血栓形成风险的研究。
 
背景：膝关节镜手术后容易发生下肢深静脉血栓。而当前深静脉血栓缺乏特异性的临床表现，临床上急需一种快速、方便、可靠的风险评估工具来评估高危人群，以便预防和干预。国外Caprini血栓风险评估量表评估血栓发生风险的有效性已被大量研究所证实，当前国内研究较少。
目的：验证Caprini血栓风险评估模型预测膝关节镜手术患者下肢深静脉血栓形成风险的有效性，探讨膝关节镜手术患者预防深静脉血栓形成的有效策略。
方法：采用随机对照研究设计，连续性收集2008年1月至2015年6月三峡大学仁和医院骨科膝关节镜手术患者中确诊的49例深静脉血栓形成患者作为病例组，随机选择同时期入院的98例未发生深静脉血栓形成的膝关节镜手术患者作为对照组。按照Caprini风险评估量对两组患者进行深静脉血栓形成风险评估、危险度分级，探讨危险度分级与深静脉血栓形成发病风险的相关关系。
结果与结论：①基本情况比较：深静脉血栓形成组患者的术侧肢体止血带应用时间、吸烟者所占比例、深静脉血栓形成和(或)肺血栓栓塞症疾病史患者所占比例则高于对照组(P < 0.05)；②深静脉血栓形成组患者Caprini评分明显高于对照组(P < 0.001)；深静脉血栓形成组患者中极高危患者所占比例最高(53%)，其次为高危(25%)，高危及以上合计占78%，对照组中高危所占比例最多(32%)，其次为低危(29%)，两组患者危险度分级的构成之间差异有显著性意义(P < 0.001)；③深静脉血栓形成组及对照组中，均有患者深静脉血栓形成和(或)肺血栓栓塞症疾病史与Caprini评分呈的正相关关系(P < 0.05)；而深静脉血栓形成患者中Caprini评分还与术侧肢体止血带应用时间呈正相关关系(P < 0.05)。④Caprini危险度分级与深静脉血栓形成发病风险的Logistic回归分析显示：随着Caprini危险度分级的升高患者深静脉血栓形成的发病风险也明显增高，高危和极高危重症患者深静脉血栓形成的发病风险分别是低危患者的2.130和11.786倍；⑤提示基于Caprini血栓风险评估模型可以较好的预测膝关节镜手术患者术后深静脉血栓形成的发病风险。
中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程
ORCID: 0000-0003-3219-7672(曾勇)

关键词: 骨科植入物, 人工假体, 关节镜术后, 深静脉血栓形成, 风险评估, 随机对照研究

Abstract:

BACKGROUND: After arthroscopic knee surgery, deep vein thrombosis easily occurs. Currently, there were no specific clinical manifestations in deep vein thrombosis, so a fast, convenient and reliable risk assessment tool was needed to evaluate the clinical high-risk groups for prevention and intervention. The effectiveness of Caprini Risk Assessment Scale used in thrombosis risk assessment has been confirmed by a large number of researches, but the current domestic research is less. 

OBJECTIVE: To verify the validity of Caprini risk assessment scale in evaluations of high deep venous thrombosis risk patients among knee arthroscopy patients, and to explore effective strategies for prevention of deep vein thrombosis in patients undergoing knee arthroscopic surgery.
METHODS: A case-control study design was used to collect 49 deep vein thrombosis patients admitted to the Department of Orthopedics, Renhe Hospital of Three Gorges University from January 2008 to June 2015 as case group, and randomly selected 98 patients admitted during the same period of non-deep vein thrombosis patients as control group. Caprini risk assessment scale was used to assess risk assessment and risk grading of deep venous thrombosis, and to explore the correlation between risk classification and risk of deep vein thrombosis.
RESULTS AND CONCLUSION: (1) Basic conditions comparison: application time of tourniquet, the proportion of smoking patients, and proportion of deep venous thrombosis and (or) the history of pulmonary thromboembolism were higher in the case group than in the control group (P < 0.05). (2) Caprini score was significantly higher in the case group than in the control group (P < 0.001). In the case group, the proportion of very high risk patients (53%) was highest, followed by high risk (25%), totally 78%. In the control group, the proportion of high risk patients (32%) was highest, followed by low risk (29%). Significant differences in above risk degree analysis were identified between the two groups (P < 0.001). (3) Deep venous thrombosis and (or) the history of pulmonary thromboembolism was positively correlated with Caprini score in the case and control groups (P < 0.05). Caprini score was positively associated with application time of tourniquet in the case group (P < 0.05). (4) Logistic regression analysis of Caprini risk classification and the risk of deep vein thrombosis: with increased caprini risk classification, the risk of deep vein thrombosis increased significantly. The risk of deep venous thrombosis in patients with high risk and very high risk was 2.130 and 11.786 times of patients with low risk, respectively. (5) These results indicate that Caprini risk assessment model can effectively assess the risk of deep vein thrombosis among patients receiving knee arthroscopy.
中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Arthroscopes, Venous Thrombosis, Pulmonary Embolism, Tissue Engineering