作者：郭健1 ，龚益 1，2 ，夏敬文 1 ，李芸 3 ，谭晋韵 4 ，陈小东 1

单位：

1.200040上海市，复旦大学附属华山医院呼吸与危重症医学科　2.201907上海市，复旦大学附属华山医院北院呼吸科　3.200040 上海市，复旦大学附属华山医院病案图书室　4.200040 上海市，复旦大学附属华山医院血管外科

单位（英文）：

1.Department of Respiratory and Critical Care Medicine，Huashan Hospital of Fudan University，Shanghai 200040，China2.Department of Respiratory，Huashan North Hospital of Fudan University，Shanghai 201907，China3.Medical Records Library，Huashan Hospital of Fudan University，Shanghai 200040，China4.Department of Vascular Surgery，Huashan Hospital of Fudan University，Shanghai 200040，China

关键词：

静脉血栓栓塞；肺栓塞；深部静脉血栓形成；静脉血栓栓塞风险评估和防控系统

关键词（英文）：

Venous thromboembolism；Pulmonary embolism；Deep-venous thrombosis；Venous thromboembolism risk assessment and prevention and control system

中图分类号：

DOI：

10.12114/j.issn.1008-5971.2021.00.011

基金项目：

摘要：

背景　静脉血栓栓塞症（VTE）是住院患者重要的非预期死亡原因之一，其症状隐匿、死亡率高。据调查，国内对 VTE 的认识仍处于中低水平，医院亟须建立 VTE 防控体系。但如何建设 VTE 防控体系及建立的 VTE 防控体系是否能快速有效地服务于临床是医务人员共同关注的问题。目的　分析某院 2007—2016 年 VTE 状况及其风险评估和防控系统应用效果。方法　在复旦大学附属华山医院电子病案系统检索 2007—2016 年 VTE 患者资料及 VTE 风险评估和防控系统建立前后 3 年，即 2013-10-01 至 2016-09-30 与 2016-10-01 至 2019-09-30 VTE 患者资料。分析2007—2016 年肺栓塞（PE）、下肢深静脉栓塞（DVT）患者例数占出院总例数的百分比，2007—2016 年 PE 患者死亡例数占总死亡例数的百分比，2007—2016 年不同年龄段男性、女性患者 PE、DVT 发生率，2007—2016 年 PE 患者主要诱因。比较 VTE 风险评估和防控系统建立前后 PE 发生率、致死性 PE 发生率、PE 患者住院天数、DVT 发生率、DVT 患者住院天数。结果　2007—2016 年 PE 患者例数占出院总例数的百分比呈线性上升趋势（R 2 =0.877）；2016 年PE 患者例数占出院总例数的百分比较 2007 年增加 6.56 倍。2007—2016 年 DVT 患者例数占出院总例数的百分比呈线性上升趋势（R 2 =0.788）；2016 年 DVT 患者例数占出院总例数的百分比较 2007 年增加 2.27 倍。2007—2016 年 PE 患者死亡例数占死亡总例数的百分比波动较大，2010 年最低，2015 年最高，2016 年明显下降。2007—2016 年≤ 60 岁男性患者 PE、DVT 发生率分别低于＞ 60 岁男性患者（P ＜ 0.05）。2007—2016 年≤ 60 岁女性患者 PE、DVT 发生率分别低于＞ 60 岁女性患者（P ＜ 0.05）。2007—2016 年 PE 患者主要诱因中排名前 3 的分别是肿瘤（23.707%）、感染（20.259%）、手术（15.086%）。VTE 风险评估和防控系统建立前后 PE 发生率、致死性 PE 发生率、PE 患者住院天数比较，差异无统计学意义（P ＞ 0.05）；VTE 风险评估和防控系统建立后 DVT 发生率低于 VTE 风险评估和防控系统建立前，DVT 患者住院天数少于 VTE 风险评估和防控系统建立前（P ＜ 0.05）。结论　复旦大学附属华山医院2007—2016 年 PE、DVT 患者例数占出院总例数的百分比均呈线性上升趋势，VTE 防控体系的建立刻不容缓。目前已建立的 VTE 风险评估和防控系统有助于降低 DVT 发生率，缩短 DVT 患者住院时间。

英文摘要：

Background　Venous thromboembolism（VTE）is one of the important unexpected causes of death in hospitalized patients.The symptoms of VTE are hidden and the mortality rate is high.According to the survey，the understandingof VTE in China is still at a low level，so it is necessarily for hospital to establish VTE prevention and control system.However，how to build the VTE prevention and control system and whether the VTE prevention and control system can serve the clinic quickly and effectively are the common concerns of medical staff.Objective　To analyze the status of VTE from 2007 to 2016 and application effect of its risk assessment and prevention and control system in a hospital.Methods　The electronic medical record system of Huashan Hospital of Fudan University was used to retrieve the data of VTE patients from 2007 to 2016，and the data of VTE patients three years before（from October 1，2013 to September 30，2016）and after（from October 1，2016 to September 30，2019）the establishment of VTE risk assessment and prevention and control system.The percentages of patients with pulmonary embolism（PE）and lower extremity deep-venous thrombosis（DVT）in the total number of discharged patients from 2007 to 2016，the percentage of PE deaths in the total number of deaths from 2007 to 2016，the incidence of PE and DVT in male and female patients of different ages from 2007 to 2016，and the complications of PE patients from 2007 to 2016 were analyzed.The incidence of PE，the incidence of fatal PE，the length of stay of PE patients，the incidence of DVT and the length of stay of DVT patients were compared before and after the establishment of VTE risk assessment and prevention and control system.Results　The percentage of patients with PE in the total number of discharged patients from 2007 to 2016 increased with a linear model（R 2 =0.877）.Compared with 2007，the percentage of PE patients in the total number of discharged patients in 2016 increased 6.56 times.The percentage of patients with DVT in the total number of discharged patients from 2007 to 2016 increased with a linear model（R 2 =0.788）.Compared with 2007，the percentage of DVT patients in the total number of dischargedpatients in 2016 increased 2.27 times.From 2007 to 2016，the percentage of PE deaths in the total number of deaths fluctuated greatly，the lowest in 2010，the highest in 2015，and decreased significantly in 2016.From 2007 to 2016，the incidence of PE and DVT in patients with ≤ 60 years old was lower than that in patients with ＜ 60 years old in male and femalerespectively（P ＜ 0.05）.The top three proegumenal case of PE were tumor（23.707%），infection（20.259%）and surgery（15.086%）.There was no significant difference in the incidence of PE and fatal PE and length of stay of PE patients between before and after the establishment of VTE risk assessment and prevention and control system（P ＞ 0.05）.After the establishment of VTE risk assessment and prevention and control system，the incidence of DVT was lower than that before the establishment of VTE risk assessment and prevention and control system，and the length of stay of DVT patients was less than that before the establishment of VTE risk assessment and prevention and control system（P ＜ 0.05）.Conclusion　From 2007 to 2016，the percentage of PE and DVT patients in the total number of discharged patients in Huashan Hospital of Fudan University increased with a linear model.Therefore，the establishment of VTE prevention and control system is urgent.At present，the established VTE risk assessment and prevention and control system is helpful to reduce the incidence of DVT and shorten the length of stay of DVT patients.

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