發(fā)布時(shí)間：2018-03-09 14:15

  本文選題：住院患者　切入點(diǎn)：靜脈血栓栓塞癥　出處：《河北醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：靜脈血栓栓塞癥(venous thromboembolism,VTE)作為外科領(lǐng)域常見疾病之一,其發(fā)病率呈上升趨勢,尤以住院患者為重。VTE除了有較高的致死率,其并發(fā)癥也嚴(yán)重影響患者生活質(zhì)量,給患者及社會(huì)帶來極大的經(jīng)濟(jì)負(fù)擔(dān)。因此,有關(guān)VTE病因、診斷及治療的研究大量涌現(xiàn),也取得較大成果。根據(jù)大宗文獻(xiàn)報(bào)道,急性VTE診斷前嚴(yán)重威脅患者生命,隨時(shí)有致命性肺栓塞風(fēng)險(xiǎn)。急性VTE在明確診斷后只有極少患者接受治療后不遺留并發(fā)癥,對(duì)于大多患者而言,無論其接受保守治療、開刀手術(shù)或介入治療,大多會(huì)留有不同程度后遺癥,甚或危及生命。因此,VTE這類疾病重在預(yù)防。有關(guān)VTE的預(yù)防也有相關(guān)文獻(xiàn)闡述,但目前我國對(duì)于該疾病的認(rèn)知還遠(yuǎn)遠(yuǎn)不夠,無法按照相關(guān)指南進(jìn)行實(shí)施,使其發(fā)病率在逐年上升。因此,如何提高人民對(duì)VTE該類疾病的認(rèn)識(shí)成為臨床熱點(diǎn)問題,從而降低該病的發(fā)生率。而對(duì)于明確診斷的VTE患者接受何種治療方案,出院后那些因素可影響其并發(fā)癥的發(fā)生,也在不斷的探討及提升過程中。目的:回顧性分析住院患者攜帶靜脈血栓栓塞高危風(fēng)險(xiǎn)因素及接受預(yù)防情況,探討不同治療方案及出院后服藥依從性對(duì)其預(yù)后的影響。方法:選取2015年2月至2016年8月本中心收治的78例住院患者繼發(fā)VTE,通過下肢靜脈超聲、下肢深靜脈順行造影或計(jì)算機(jī)斷層肺動(dòng)脈造影明確診斷,根據(jù)Padua評(píng)分標(biāo)準(zhǔn)對(duì)有內(nèi)科住院史的患者攜帶的危險(xiǎn)因素進(jìn)行評(píng)分,應(yīng)用Caprini評(píng)分標(biāo)準(zhǔn)對(duì)有外科住院史的患者攜帶的危險(xiǎn)因素進(jìn)行評(píng)分,并分別記錄其是否接受預(yù)防措施,若接受預(yù)防措施,則明確記錄接受預(yù)防措施的相關(guān)情況。分別記錄所有患者本次住院接受的治療情況及入院時(shí)患健側(cè)大小腿周徑差與出院時(shí)患健側(cè)大小腿周徑差的差值。以電話或門診的方式進(jìn)行隨訪,記錄患者出院后服藥依從性及患者下肢癥狀及體征。根據(jù)Villalta評(píng)分標(biāo)準(zhǔn)評(píng)估患者血栓形成后綜合征(post-thrombotic syndrome,PTS)發(fā)生率及嚴(yán)重程度,并記錄發(fā)生大出血、復(fù)發(fā)等并發(fā)癥情況。結(jié)果:78例VTE患者發(fā)病前6周內(nèi)均有住院史,有外科住院史者63例,其中行婦科非腫瘤手術(shù)7例,行顱腦外科手術(shù)7例,行骨科手術(shù)17例,行腫瘤手術(shù)13例,行剖宮產(chǎn)手術(shù)9例,行普通外科手術(shù)6例,行靜脈曲張手術(shù)4例;有內(nèi)科住院史者15例,其中有活動(dòng)性腫瘤史3例,有腦梗塞史4例,有感染史1例,有婦科病史1例,有心內(nèi)科病史4例,有妊娠史1例,有其他內(nèi)科病史1例。接受預(yù)防措施比例為37.18%,接受足量預(yù)防患者僅占21.79%。住院期間7例患者行導(dǎo)管接觸溶栓(catheter directed thrombolysis,CDT),38例患者接受外周系統(tǒng)溶栓、33例患者接受單純抗凝治療,15例患者置入下腔靜脈濾器。所有患者出院時(shí)癥狀均得到改善,出入院時(shí)患健側(cè)大小腿周徑差具有統(tǒng)計(jì)學(xué)意義(P0.05)。對(duì)于中心型、混合型深靜脈血栓形成(deep vein thrombosis,DVT)患者,各治療方案組間患肢癥狀緩解無統(tǒng)計(jì)學(xué)差異(P0.05)。78例患者獲得隨訪,隨訪時(shí)間4~22個(gè)月,平均隨訪時(shí)間為12.77±5.23月。41例患者服藥依從性較好;37例患者未規(guī)律監(jiān)測凝血調(diào)整用藥,其中16例患者出院后自行停止抗凝治療。15例患者發(fā)展成PTS,輕度病變?yōu)?1例,中度病變?yōu)?例,3例患者復(fù)發(fā),3例患者死亡,2例因原發(fā)病惡化,1例因腦干出血。結(jié)論:根據(jù)本中心統(tǒng)計(jì)的數(shù)據(jù),靜脈血栓栓塞高危風(fēng)險(xiǎn)因素比例與指南有所偏差。目前我國未能對(duì)住院患者進(jìn)行恰當(dāng)?shù)腣TE風(fēng)險(xiǎn)因素評(píng)估并對(duì)其進(jìn)行分級(jí)。攜帶VTE風(fēng)險(xiǎn)因素的住院患者未能得到有效的預(yù)防。明確診斷的VTE患者在病情許可下建議行導(dǎo)管接觸性溶栓治療。出院后服藥依從性影響患者預(yù)后及相關(guān)并發(fā)癥的發(fā)生。
[Abstract]:Venous thromboembolism (venous thromboembolism VTE) as the surgical field of one of the common diseases, the incidence rate is rising, especially in hospitalized patients for.VTE but has a high fatality rate, complications also seriously affect the quality of life of patients, bring great economic burden to patients and society. Therefore, the etiology of VTE, research the diagnosis and treatment of large numbers, also made great achievements. According to the large literature, the diagnosis of acute VTE before a serious threat to the lives of patients, at any time the risk of fatal pulmonary embolism after definite diagnosis of acute VTE. Only a few patients treated without complications, for most patients, regardless of their acceptance of surgery or conservative treatment. Interventional therapy, most of them would have a different degree of sequelae, or even life-threatening. Therefore, this kind of disease prevention. VTE prevention on VTE also have the relevant literatures on, but at present In our country the disease cognition is not enough, can not be carried out in accordance with the relevant guidelines, so the incidence increased year by year. Therefore, how to improve people's understanding of VTE this kind of disease has become a hot topic in clinical research, so as to reduce the incidence of the disease. The diagnosis of VTE patients accepted treatment, discharge after those factors can influence the occurrence of complications, and also discussed the improvement process. Objective: To retrospectively analyze the risk factors of hospitalized patients with venous thromboembolism with and accept prevention, impact of medication compliance on the prognosis of different treatment regimens and after discharge. Methods: from February 2015 to August 2016 the center a total of 78 cases of hospitalized patients with secondary VTE, the lower extremity venous ultrasound, lower extremity deep venous antegrade angiography or computed tomography pulmonary angiography diagnosis, according to the Padua score standard Score on the risk factors of hospitalized patients with a history of carry, on risk factors of hospitalized patients with a history of using Caprini to carry the scoring standard for evaluation, and record the acceptance of preventive measures, if take preventive measures, a clear record received preventive measures. All patients were recorded in the hospital and when the patient was hospitalized for contralateral leg circumferences had contralateral leg circumference difference size difference and discharge. Follow up by telephone or clinic, records of patients after discharge compliance of patients with lower extremity symptoms and signs. According to the Villalta standard for evaluation evaluation of patients with post thrombotic syndrome (post-thrombotic syndrome, PTS) incidence and severity, and record the occurrence of major bleeding, recurrence and other complications. Results: 78 cases of VTE patients were hospitalized within 6 weeks before the onset of history, surgical 63 cases of history, including 7 cases of non tumor surgery for gynecological, 7 cases underwent brain surgery and 17 cases underwent Department of orthopedics surgery, 13 cases underwent tumor surgery, 9 cases of cesarean section, 6 cases undergoing general surgery, 4 cases of varicose vein surgery; 15 patients hospitalized in the Department of history. The activity of tumor in 3 cases, cerebral infarction in 4 cases, infection in 1 cases, with gynecological disease in 1 cases, 4 patients had medical history, 1 cases of pregnancy history, other medical history. 1 cases accepted preventive measures the proportion is 37.18%, only 21.79%. patients receive sufficient prevention during hospitalization 7 patients underwent catheter directed thrombolysis (catheter directed thrombolysis, CDT), 38 patients received peripheral system thrombolysis, 33 patients received anticoagulant therapy, 15 cases of inferior vena cava filter placement. All patients' symptoms were improved, the hospital had contralateral leg circumference difference was statistically significant (P0.05). The center type, mixed type of deep vein thrombosis (deep vein, thrombosis, DVT) patients, each treatment group limb symptoms had no significant difference (P0.05) of.78 patients were followed up for 4~22 months, the average follow-up time was 12.77 + 5.23 months.41 patients medication compliance is good; 37 patients without regular monitoring coagulation medication adjustment, of which 16 patients were discharged after treatment to stop anticoagulation in.15 patients developed PTS, mild lesions in 11 cases, moderate lesions in 4 cases, 3 cases of recurrence, 3 patients died, 2 patients with primary disease deterioration, 1 patients with brainstem hemorrhage. Conclusion: according to the statistical data center, risk factors for venous thromboembolism and the proportion of guide deviation. At present our country failed to assess risk factors in hospitalized patients with VTE proper and classified. To hospitalized patients carrying VTE risk factors effectively. Prevention. VTE patients with definite diagnosis recommend catheter contact thrombolysis under the condition of the disease. After discharge, medication compliance will affect the prognosis and related complications.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R543.6

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