CAJ | 학술논문

目的了解北京地区慢性阻塞性肺疾病急性加重(AECOPD)住院患者静脉血栓栓塞症(VTE)的发生及预防情况.方法回顾性分析2011年9月1日至2012年3月31日北京17家二级或三级医院AECOPD住院患者的临床资料.入选患者至少存在以下一项因素:(1)Ⅱ型呼吸衰竭；(2)使用有创或无创机械通气治疗；(3)因肺部感染住院；(4)卧床时间≥3d；(5)心功能不全.参与调查医师均经过统一培训,采用统一的调查表调查患者VTE危险因素合并情况、住院期间VTE合并和预防情况等.参考Caprini VTE风险积分,将患者分为低危组(≤3分),中危组(4～6分)及高危组(≥7分),比较分析不同危险分层患者VTE合并及预防情况.结果共入选636例患者,男416例,女220例,平均年龄(74.9±9.3)岁.其中133例(21.0％)患者接受下肢静脉超声检测,92例发现深静脉血栓形成(DVT),其中2例同时合并肺血栓栓塞症(PTE).VTE合并率为14.5％ (92/636),且随年龄增加而增高(趋势性检验P=0.044)；无下肢肿胀或疼痛症状者显著高于有症状者(21.1％比8.0％,P =0.000)；高危组合并率最高(17.9％,14/78),其次是低危组(16.0％,26/163),中危组最低(13.2％,52/395),但组间差异(P =0.450)及趋势性检验(P=0.946)均无统计学意义.544例未合并VET的患者接受抗凝药物和(或)机械预防者仅占19.1％ (104/544)；低危组、中危组和高危组VTE预防率分别为17.5％、18.4％和26.6％,但组间差异(P=0.266)及趋势性检验(P =0.201)均无统计学意义.结论北京地区AECOPD住院患者VTE合并率较高,VTE预防率较低.
목적 료해북경지구만성조새성폐질병급성가중(AECOPD)주원환자정맥혈전전새증(VTE)적발생급예방정황.방법 회고성분석2011년9월1일지2012년3월31일북경17가이급혹삼급의원AECOPD주원환자적림상자료.입선환자지소존재이하일항인소:(1)Ⅱ형호흡쇠갈；(2)사용유창혹무창궤계통기치료；(3)인폐부감염주원；(4)와상시간≥3d；(5)심공능불전.삼여조사의사균경과통일배훈,채용통일적조사표조사환자VTE위험인소합병정황、주원기간VTE합병화예방정황등.삼고Caprini VTE풍험적분,장환자분위저위조(≤3분),중위조(4～6분)급고위조(≥7분),비교분석불동위험분층환자VTE합병급예방정황.결과 공입선636례환자,남416례,녀220례,평균년령(74.9±9.3)세.기중133례(21.0％)환자접수하지정맥초성검측,92례발현심정맥혈전형성(DVT),기중2례동시합병폐혈전전새증(PTE).VTE합병솔위14.5％ (92/636),차수년령증가이증고(추세성검험P=0.044)；무하지종창혹동통증상자현저고우유증상자(21.1％비8.0％,P =0.000)；고위조합병솔최고(17.9％,14/78),기차시저위조(16.0％,26/163),중위조최저(13.2％,52/395),단조간차이(P =0.450)급추세성검험(P=0.946)균무통계학의의.544례미합병VET적환자접수항응약물화(혹)궤계예방자부점19.1％ (104/544)；저위조、중위조화고위조VTE예방솔분별위17.5％、18.4％화26.6％,단조간차이(P=0.266)급추세성검험(P =0.201)균무통계학의의.결론 북경지구AECOPD주원환자VTE합병솔교고,VTE예방솔교저.
Objective To explore the proportion and prevention status of venous thromboembolism (VTE) among hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in Beijing.Methods Based on a multi-center retrospective study,a total of 636 hospitalized AECOPD patients from 17 class 2/3 hospitals in Beijing were examined from September 1,2011 to March 31,2012.They fulfilled one of the following criteria:respiratory failure type Ⅱ,on invasive or non-invasive mechanical ventilation,hospitalization for pulmonary infection,bedridden duration ≥ 3 days and congestive heart failure.All investigators received standardized training and used a standardized questionnaire to collect data on VTE risk factors,the diagnosis of VTE and the utilization of VTE prophylaxis.According to Caprini score,they were categorized into 3 groups of lower risk (Caprini score ≤3),moderate risk (Caprini score 4-6) and high risk (≥7) to compare the intergroup differences in the VTE proportion and the utilization of VTE prophylaxis.Results A total of 636 patients were assessed.There were 416 males and 220 females with a mean (SD) age of 74.9 ± 9.3 years.Among them,133 patients received lower extremity venous ultrasonic examination and 92 were diagnosed with deep venous thrombosis (DVT) including 2 patients with pulmonary thromboembolism (PTE).Thus the overall incidence of VTE was 14.5％ (92/636) and increased with age (Ptrend =0.044).The proportion of VTE in asymptomatic patients was higher in those symptomatic ones (21.1％ vs 8.0％,P =0.000).And it was the highest in high risk group,followed by lower risk and moderate risk groups at 17.9％ (14/78),16.0％ (26/163) and 13.2％ (52/395) respectively,There was no statistical significance (P =0.450 for group difference,Ptrend =0.946).Among 544 patients without VTE,only 19.1％ (104/544)employed the pharmacologic and/or mechanical methods for preventing VTE.The prevention proportion gradually increased with rising Caprini score,i.e.17.5％,18.4％ and 26.6％ for lower,moderate and higher risk group respectively.There was no statistical significance (P =0.266 for group difference,Ptrend =0.201).Conclusions The proportion of VTE is relatively higher.However,the preventive methods are significantly underutilized among hospitalized AECOPD patients in Beijing.