發(fā)布時(shí)間：2018-07-07 16:47

  本文選題：骨科大手術(shù) + 深靜脈血栓形成　； 參考：《重慶醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的通過病例回顧研究,比較三種血栓風(fēng)險(xiǎn)評(píng)估表對(duì)骨科大手術(shù)患者術(shù)后深靜脈血栓形成(DVT)的預(yù)測(cè)價(jià)值,篩選出一種適宜骨科大手術(shù)患者使用的血栓風(fēng)險(xiǎn)評(píng)估表,為骨科醫(yī)護(hù)人員選擇血栓評(píng)估表提供依據(jù)。方法采用回顧性病例對(duì)照研究,選取2014年6月至12月在重慶某三甲醫(yī)院行骨科大手術(shù)的185例患者為研究對(duì)象,收集患者一般資料,對(duì)所有患者分別使用Wells、Caprini、Autar三種血栓風(fēng)險(xiǎn)評(píng)估表進(jìn)行評(píng)估并記錄結(jié)果,以多普勒超聲檢查結(jié)果為診斷標(biāo)準(zhǔn),將確診為DVT的患者作為DVT組,其余患者作為非DVT組,通過ROC曲線分析,以評(píng)估表的靈敏度、特異度和曲線下面積為指標(biāo)來評(píng)價(jià)三種血栓風(fēng)險(xiǎn)評(píng)估表對(duì)骨科大手術(shù)人群DVT的預(yù)測(cè)價(jià)值。結(jié)果根據(jù)納入排除標(biāo)準(zhǔn)共收集185例臨床病例資料,48例發(fā)生DVT,發(fā)生率是25.9%,2例患者同時(shí)并發(fā)了肺栓塞。Wells、Caprini、Autar三種血栓風(fēng)險(xiǎn)評(píng)估表的ROC曲線下面積(AUC)分別為0.958、0.680、0.723,均有統(tǒng)計(jì)學(xué)意義(P0.05),表明三種血栓風(fēng)險(xiǎn)評(píng)估表對(duì)骨科大手術(shù)患者DVT的發(fā)生均有一定的預(yù)測(cè)能力,而Wells評(píng)估表的AUC與Caprini、Autar兩種評(píng)估表AUC比較的差異有統(tǒng)計(jì)學(xué)意義(P0.05),Autar評(píng)估表與Caprini評(píng)估表AUC比較的差異無統(tǒng)計(jì)學(xué)意義(P0.05),表明Wells評(píng)估表的預(yù)測(cè)價(jià)值更高。Wells評(píng)估表在最佳診斷界值1.5分時(shí),其對(duì)應(yīng)的靈敏度為0.958,特異度為0.898;Caprini評(píng)估表在最佳診斷界值9.5分時(shí),靈敏度、特異度分別為0.625、0.693;Autar評(píng)估表在最佳診斷界值14.5時(shí),靈敏度為0.875,特異度0.518。結(jié)論骨科大手術(shù)后DVT發(fā)生率較高。Wells、Caprini和Autar三種評(píng)估表對(duì)骨科大手術(shù)患者DVT的發(fā)生均有一定的預(yù)測(cè)能力,其中預(yù)測(cè)價(jià)值最高的是wells評(píng)估表。但因其涉及條目以DVT癥狀、體征為主,更適合輔助骨科臨床醫(yī)生對(duì)DVT患者進(jìn)行診斷和鑒別診斷;Caprini評(píng)估表和Autar評(píng)估表則更關(guān)注DVT的危險(xiǎn)因素,有利于及時(shí)發(fā)現(xiàn)患者高危因素,更適用于DVT風(fēng)險(xiǎn)評(píng)估。Caprini評(píng)估表中涉及多項(xiàng)實(shí)驗(yàn)室檢查項(xiàng)目,如有缺項(xiàng),可能導(dǎo)致危險(xiǎn)因素評(píng)估不全,而Autar評(píng)估表中項(xiàng)目均容易快速獲取,且包含了風(fēng)險(xiǎn)分級(jí)和預(yù)防措施指引,因此更適宜骨科護(hù)理工作者使用。
[Abstract]:Objective to compare the predictive value of three thrombotic risk assessment tables for deep venous thrombosis (DVT) in patients undergoing major orthopedic surgery, and to select a suitable thrombotic risk assessment table for major orthopedic surgery patients. To provide basis for orthopaedic medical staff to select thrombus assessment form. Methods A retrospective case-control study was conducted. 185 patients undergoing major orthopedic surgery in a third Class A Hospital in Chongqing from June to December 2014 were selected as the subjects, and the general data of the patients were collected. All patients were assessed and recorded with Wellsberg Caprinitar three thrombotic risk assessment tables. The patients diagnosed with DVT were selected as DVT group and the rest as non-DVT group by ROC curve analysis, using Doppler ultrasound as diagnostic criteria. The predictive value of three kinds of thrombotic risk assessment tables for large orthopedic surgery population DVT was evaluated by the sensitivity, specificity and area under curve of the evaluation table. Results according to the exclusion criteria, a total of 185 cases of DVT were collected. The incidence of DVT was 25.9%. The area under the ROC curve (AUC) of the three risk assessment tables of pulmonary embolism, Wellsberg Caprinius Autar was 0.958 鹵0.680 / 0.723, respectively, with statistical significance. (P0.05), which indicated that the three thrombus risk assessment tables had certain predictive ability for DVT in patients undergoing major orthopedic surgery. However, there was significant difference between AUC of Wells evaluation table and AUC of Caprinius Autar evaluation table (P0.05). There was no significant difference between AUC evaluation table and Caprini evaluation table (P0.05), which indicated that the predicted value of Wells evaluation table was higher than that of Caprini-Autar evaluation table. Wells evaluation table had a higher predictive value at 1.5 minutes of the best diagnostic threshold, and there was no significant difference between AUC and Caprini evaluation table (P0.05). The corresponding sensitivity was 0.958, and the specificity was 0.875 and the specificity was 0.518 when the best diagnostic threshold was 9.5 minutes. Conclusion the incidence rate of DVT after major orthopedic surgery is higher. Wellsberg Caprini and Autar have certain predictive ability for the occurrence of DVT in orthopaedic major surgery patients. The highest predictive value is the wells evaluation table. However, because the items involved are mainly symptoms and signs of DVT, it is more suitable to assist orthopedic clinicians in diagnosis and differential diagnosis of DVT patients. However, the evaluation form of Caprini and Autar are more concerned about the risk factors of DVT, which is helpful to discover the high risk factors of patients in time. It is more suitable for the risk assessment of DVT.Caprini assessment form, which involves many laboratory inspection items. If there is a missing item, it may lead to incomplete assessment of risk factors, while the items in the Autar assessment form are easy to obtain quickly and contain guidelines on risk classification and preventive measures. Therefore, it is more suitable for orthopedic nursing workers to use.
【學(xué)位授予單位】：重慶醫(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)】：R473.6

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