【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(R2=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(R2=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。更多还原

【Abstract】 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 understanding of 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(R2=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(R2=0.788).Compared with 2007,the percentage of DVT patients in the total number of discharged patients 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.更多还原