摘要
目的探讨老年胃癌患者术后静脉血栓栓塞症(VTE)的危险因素。方法收集2021年1月至2023年1月空军军医大学第一附属医院(西京医院)收治的96例老年胃癌患者的临床资料,将术后发生VTE的32例患者作为VTE组,并根据VTE组患者的年龄、性别,采用倾向匹配法按1:2的比例将术后未发生VTE的64例患者作为NVTE组。分析老年胃癌患者术后发生VTE的危险因素,并采用Logistic概率法建立危险预警模型,通过受试者工作特征(ROC)曲线分析各项危险因素对老年胃癌患者术后发生VTE的预测价值。结果单因素分析结果显示,VTE组患者的术前血小板计数、术后D-二聚体水平、围手术期输注红细胞的比例均高于NVTE组患者,术后卧床时间长于NVTE组患者,差异均有统计学意义(P﹤0.05)。多因素分析结果显示,术前血小板计数偏高、术后卧床时间较长、术后D-二聚体水平较高、围手术期输注红细胞均为老年胃癌患者术后发生VTE的独立危险因素(P﹤0.05)。ROC曲线分析结果显示,术前血小板计数≥270.51×109/L、术后卧床时间≥23.56 h、术后第1天D-二聚体水平≥3.32 ng/L对于老年胃癌患者术后发生VTE均具有中等预测价值(P﹤0.05);围手术期输注红细胞对于老年胃癌患者术后发生VTE具有较低的预测价值(P﹤0.05);各项危险因素联合构建的危险预警模型对于老年胃癌患者术后发生VTE具有较高的预测价值(P﹤0.05)。结论各项危险因素联合构建的危险预警模型对于老年胃癌患者术后发生VTE具有较高的预警价值,临床上可有针对性地筛查患者具备的危险因素,据此给予针对性干预措施,有效降低VTE的发生风险,同时针对患者进行情绪管理和健康教育,进一步满足患者身心需求,促进患者术后更好地恢复。
Objective To study the risk factors of postoperative venous thrombosis in elderly patients with gastric cancer.Method Clinical data of 96 elderly patients with gastric cancer who underwent treatment in the First Affiliated Hospital of the Air Force Medical University(Xijing Hospital)from January 2021 to January 2023 were collected.A total of 32 patients with postoperative VTE were included in the VTE group.According to the age and gender of the VTE group,64 patients without VTE were selected in 1:2 ratio using propensity matching method and included in the NVTE group.The risk factors of postoperative VTE in elderly patients with gastric cancer were analyzed,and the risk warning model was established by Logistic probability method.The predictive value of various risk factors for postoperative VTE in elderly patients with gastric cancer was analyzed by receiver operator characteristic(ROC)curve.Result Univariate analysis showed that preoperative platelet count,D-dimer level on the first day after surgery and proportion of patients with perioperative infusion of red blood cells in VTE group were higher than those in the NVTE group,postoperative bed rest time in VTE group was longer than that in the NVTE group,the differences were statistically significant(P<0.05).Multivariate analysis showed that high preoperative platelet count,longer postoperative bed rest time,higher postoperative D-dimer levels,and perioperative infusion of red blood cells were all independent risk factors for postoperative VTE in elderly gastric cancer patients(P<0.05).The analysis of ROC curve showed that preoperative platelet count≥270.51×109/L,postoperative bed rest time≥23.56 h,D-dimer lavel≥3.32 ng/L on the first day after surgery had moderate predictive value for postoperative VTE in elderly gastric cancer patients(P<0.5);perioperative infusion of red blood cells had lower predictive value(P<0.05);the risk warning model constructed by combining various risk factors had higher predictive value for postoperative VTE in elderly gastric cancer patients(P<0.05).Conclusion The risk warning model constructed by combining various risk factors has higher warning value for postoperative VTE in elderly patients with gastric cancer.In clinical practice,targeted screening of risk factors can be carried out to provide specialized prevention and treatment to effectively reduce the risk of VTE occurrence.Meanwhile,emotional management and health education can be conducted for patients to further meet their physical and mental needs and to promote better recovery of patients after surgery.
作者
崔桂华
毛玉烜
祝秋妮
袁旭龙
Cui Guihua;Mao Yuxuan;Zhu Qiuni;Yuan Xulong(Department of Gastroenterology,the First Affiliated Hospital of the Air Force Medical University(Xijing Hospital),Xi'an 710000,Shaanxi,China;Department of Digestive Intervention,the First Affiliated Hospital of the Air Force Medical University(XijingHospital),Xi'an 710000,Shaanxi,China)
出处
《血管与腔内血管外科杂志》
2023年第12期1514-1518,共5页
Journal of Vascular and Endovascular Surgery
关键词
胃癌
老年
静脉血栓栓塞症
危险因素
护理
gastric cancer
elderly patient
venous thromboembolism
risk factor
nursing
