解放軍總醫(yī)院住院患者靜脈血栓栓塞癥的流行病學(xué)調(diào)查
發(fā)布時間：2018-10-10 12:37
【摘要】：[目的]靜脈血栓栓塞癥(venous thromboembolism, VTE)包括深靜脈血栓形成(deep venous thrombosis, DVT)和肺血栓栓塞癥(pulmonary thromboembolism,PTE),該疾病的特點(diǎn)是高發(fā)病率、高病死率,且漏診率較高。目前國內(nèi)缺乏關(guān)于VTE的大樣本流行病學(xué)調(diào)查資料,尤其缺乏尸檢流行病學(xué)資料。本研究擬采用回顧性病歷分析的方法調(diào)查解放軍總醫(yī)院近年來經(jīng)病理診斷及臨床診斷確診的VTE患者的患病率、病死率、疾病特點(diǎn)及醫(yī)院對VTE的預(yù)防、診斷及治療情況,以期為國內(nèi)廣大醫(yī)務(wù)工作者更好的認(rèn)識VTE這一疾病提供有價值的參考依據(jù)。[方法]①病理流行病學(xué)調(diào)查部分:逐份查閱解放軍總醫(yī)院南樓住院部2006年1月1日至2015年12月31日期間的所有死亡病歷,篩選出其中接受尸檢的患者。逐份查閱尸檢報(bào)告,統(tǒng)計(jì)經(jīng)尸檢確認(rèn)的PTE患者人數(shù)。對于確診的PTE患者,詳細(xì)查閱死亡病歷,記錄所有PTE患者的尸檢詳情及臨床特征;用Caprini模型評估患者住院期間的血栓形成風(fēng)險(xiǎn);并就醫(yī)院對PTE的預(yù)防、診斷、治療情況進(jìn)行評估。②臨床流行病學(xué)調(diào)查部分:通過解放軍總醫(yī)院電子病歷檢索系統(tǒng),檢索該醫(yī)院2006年1月1日至2015年12月31日的所有住院病歷,篩選出其中經(jīng)臨床診斷確診的VTE患者,統(tǒng)計(jì)VTE的患病率及其分布情況。對于院內(nèi)新發(fā)的PTE病例,詳細(xì)分析其疾病特點(diǎn)、發(fā)病相關(guān)的危險(xiǎn)因素分布情況及醫(yī)院的防診治情況。[結(jié)果]研究期間解放軍總醫(yī)院南樓住院部共入選278例尸檢患者,尸檢率26.3%。尸檢共檢出9例PTE患者,其中7例為死亡相關(guān)性PTE。尸檢病例中的PTE患病率為3.2%,死亡相關(guān)性PTE占比為2.5%。全部7例死亡相關(guān)性PTE患者的栓塞部位均為騎跨肺動脈主干及左右肺動脈的“Y”字形血栓。醫(yī)院對PTE患者的藥物預(yù)防率為33.3%,無一例患者生前被確診PTE。研究期間解放軍總醫(yī)院通過臨床診斷確診的VTE病例共計(jì)4360人次(VTE總患病率4.86‰),其中單純性PTE665人次,單純性DVT3322人次,同時合并PTE和DVT的病例373人次,PTE總患病率為1.16‰,DVT總患病率為4.12‰。非手術(shù)科室的VTE平均患病率高于手術(shù)科室(5.78‰ vs3.67‰,P0.05)。臨床死亡患者中PTE的患病率為2.6%,死亡相關(guān)性PTE占比為2.4%。研究期間共發(fā)生院內(nèi)新發(fā)PTE136例,手術(shù)科室的新發(fā)PTE病例多于非手術(shù)科室(70例vs 66例)。院內(nèi)新發(fā)PTE病例住院期間的病死率為62.5% (85例),栓塞部位以累積一葉或一葉以上肺動脈的大面積栓塞為主(73.2%),醫(yī)院對院內(nèi)新發(fā)PTE患者的藥物預(yù)防率為33.3%。[結(jié)論]本研究中尸檢患者的PTE患病率低于西方國家報(bào)道的水平,這一結(jié)果提示種族因素可能對PTE的患病率產(chǎn)生較大影響。院內(nèi)新發(fā)PTE病死率高,預(yù)防率低,應(yīng)引起臨床醫(yī)生的高度關(guān)注。
[Abstract]:[objective] Venous thromboembolism (venous thromboembolism, VTE) includes deep venous thrombosis (deep venous thrombosis, DVT) and pulmonary thromboembolism (pulmonary thromboembolism,PTE), which is characterized by high incidence, high mortality and high missed diagnosis rate. At present, there is a lack of large sample epidemiological data on VTE in China, especially autopsy epidemiological data. This study aims to investigate the prevalence, mortality, disease characteristics and prevention, diagnosis and treatment of VTE patients diagnosed by pathology and clinical diagnosis in PLA General Hospital in recent years by retrospective analysis of medical records. In order to provide valuable reference for medical workers in China to better understand the disease of VTE. [methods] 1Pathology epidemiology investigation part: the medical records of all death cases from January 1, 2006 to December 31, 2015 in the inpatient department of Nanlou Hospital of PLA General Hospital were reviewed, and the autopsy patients were screened out. The autopsy reports were reviewed and the number of PTE patients confirmed by autopsy was counted. For the confirmed PTE patients, the death records were reviewed in detail, the autopsy details and clinical features of all PTE patients were recorded, the risk of thrombus formation during hospitalization was assessed by Caprini model, and the prevention and diagnosis of PTE in hospital, Evaluation of treatment. 2 Clinical Epidemiology Survey part: through the Electronic Medical record Retrieval system of the General Hospital of the people's Liberation Army, all the medical records of the hospital from January 1, 2006 to December 31, 2015, were retrieved, The prevalence and distribution of VTE were analyzed among the patients with VTE diagnosed by clinical diagnosis. The characteristics of the disease, the distribution of the related risk factors, the prevention and treatment of the hospital were analyzed in detail for the new cases of PTE in hospital. [results] 278 autopsy patients were selected in the Department of South Building of PLA General Hospital during the study, and the autopsy rate was 26.3%. A total of 9 cases of PTE were detected by autopsy, of which 7 cases were death related PTE.. The prevalence of PTE in autopsy cases was 3.2%, and the proportion of death related PTE was 2.5%. The embolism site of all 7 death related PTE patients was "Y"-shaped thrombus which straddled the main pulmonary artery and left and right pulmonary arteries. The drug prevention rate of PTE patients in hospital was 33. 3%. None of the patients was diagnosed with PTE. before death. During the study period, 4360 cases of VTE were diagnosed by clinical diagnosis in PLA General Hospital (the total prevalence rate of VTE was 4.86 鈥，
本文編號：2261795
[Abstract]:[objective] Venous thromboembolism (venous thromboembolism, VTE) includes deep venous thrombosis (deep venous thrombosis, DVT) and pulmonary thromboembolism (pulmonary thromboembolism,PTE), which is characterized by high incidence, high mortality and high missed diagnosis rate. At present, there is a lack of large sample epidemiological data on VTE in China, especially autopsy epidemiological data. This study aims to investigate the prevalence, mortality, disease characteristics and prevention, diagnosis and treatment of VTE patients diagnosed by pathology and clinical diagnosis in PLA General Hospital in recent years by retrospective analysis of medical records. In order to provide valuable reference for medical workers in China to better understand the disease of VTE. [methods] 1Pathology epidemiology investigation part: the medical records of all death cases from January 1, 2006 to December 31, 2015 in the inpatient department of Nanlou Hospital of PLA General Hospital were reviewed, and the autopsy patients were screened out. The autopsy reports were reviewed and the number of PTE patients confirmed by autopsy was counted. For the confirmed PTE patients, the death records were reviewed in detail, the autopsy details and clinical features of all PTE patients were recorded, the risk of thrombus formation during hospitalization was assessed by Caprini model, and the prevention and diagnosis of PTE in hospital, Evaluation of treatment. 2 Clinical Epidemiology Survey part: through the Electronic Medical record Retrieval system of the General Hospital of the people's Liberation Army, all the medical records of the hospital from January 1, 2006 to December 31, 2015, were retrieved, The prevalence and distribution of VTE were analyzed among the patients with VTE diagnosed by clinical diagnosis. The characteristics of the disease, the distribution of the related risk factors, the prevention and treatment of the hospital were analyzed in detail for the new cases of PTE in hospital. [results] 278 autopsy patients were selected in the Department of South Building of PLA General Hospital during the study, and the autopsy rate was 26.3%. A total of 9 cases of PTE were detected by autopsy, of which 7 cases were death related PTE.. The prevalence of PTE in autopsy cases was 3.2%, and the proportion of death related PTE was 2.5%. The embolism site of all 7 death related PTE patients was "Y"-shaped thrombus which straddled the main pulmonary artery and left and right pulmonary arteries. The drug prevention rate of PTE patients in hospital was 33. 3%. None of the patients was diagnosed with PTE. before death. During the study period, 4360 cases of VTE were diagnosed by clinical diagnosis in PLA General Hospital (the total prevalence rate of VTE was 4.86 鈥，
本文編號：2261795
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