| 王玮,张为强,叶维洁,等.血栓弹力图监测指导高危静脉血栓栓塞症肿瘤病人早期临床治疗的效果及预后观察[J].安徽医药,2020,24(6):1151-1154. |
| 血栓弹力图监测指导高危静脉血栓栓塞症肿瘤病人早期临床治疗的效果及预后观察 |
| Observation on the therapeutic effects and prognosis of thromboelastography monitoring in guiding early clinical treatment of cancer patients with high?risk venous thromboembolism |
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| DOI：10.3969/j.issn.1009?6469.2020.06.022 |
| 中文关键词: 静脉血栓栓塞 间歇性气体压缩装置 肝素，低分子量 阿司匹林 血栓弹力图 肿瘤病人 预后 受试者工作特征曲线 |
| 英文关键词: Venous thromboembolism Intermittent pneumatic compression devices Heparin,low?molecular?weight Aspirin Thromboelastography Tumor patients Prognosis Receiver operating characteristic(ROC) |
| 基金项目:2018年上海市静安区市北医院医学科研课题( 2018SBMS07) |
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| 中文摘要: |
| 目的探讨血栓弹力图( thrombelastography，TEG)监测指导高危静脉血栓栓塞症( Venous thromboembolism，VTE)肿瘤病人早期临床治疗的效果及预后观察。方法选取 2016年 1月至 2019年 1月期间上海市静安区市北医院收治的 168例高危 VTE住院肿瘤病人临床资料进行回顾性分析，根据治疗方法不同分为观察组和对照组。观察组 82例采用间歇性气囊加压装置治疗，并在 TEG监测下进行抗凝 +抗血小板治疗。对照组 86例仅采用间歇性气囊加压装置治疗。随访终点为有症状 VTE发生及出血出现，比较达到研究终点后两组 VTE发生率及出血发生率，分析 TEG监测指标对高危 VTE肿瘤病人治疗预后的预测价值。结果观察组 VTE发生率( 4.88%)低于对照组( 24.42%)(χ2＝12.654，P＝0.000)；观察组出血发生率( 1.16%)与对照组( 3.66%)差异无统计学意义( χ2＝0.307，P＝0.579)； VTE组、出血组及无 VTE/出血组凝血时间( R)、最大振幅( MA)及综合凝血指数( CI)值比较，差异有统计学意义( P＜0.05)；低 R值( OR＝0.884，95%CI:0.811~0.964)、高 CI值( OR＝1.119，95%CI:1.012~1.236)是影响接受治疗高危 VTE肿瘤病人 VTE发生的独立危险因素；经 ROC曲线分析， R值和 CI值预测高危 VTE肿瘤病人 VTE发生的曲线下面积分别为 0.788和 0.813，均具有较高预测价值。结论 TEG监测指标 R值和 CI值能有效预测高危 VTE肿瘤病人 VTE发生风险，根据 TEG监测指导高危 VTE肿瘤病人早期临床治疗，能有效降低 VTE发生风险，且不会明显增加出血风险。 |
| 英文摘要: |
| Objective To explore the therapeutic effects and prognosis of thrombelastography(TEG)monitoring in guiding early clinical treatment of patients with high?risk venous thromboembolism(VTE).Methods The clinical data of 168 cancer patients with high?risk VTE hospitalized in Shibei Hospital，Jing’an District，Shanghai from January 2016 to January 2019 were retrospec?tively analyzed.They were assigned into observation group and control group according to different treatment methods.82 patients inobservation group were treated with intermittent balloon compression device and given anticoagulation + antiplatelet therapy underTEG monitoring，while 86 patients in control group were treated with intermittent balloon compression device only.The follow?upendpoint was taken as occurrence of symptomatic VTE and hemorrhage，and the incidence rate of VTE and incidence rate of hemor? rhage were compared between the two groups after reaching the endpoint.The predictive value of TEG monitoring indexes on treat?ment prognosis of patients with high?risk VTE tumors was analyzed. Results The incidence rate of VTE in observation group(4.88%)was lower than that in control group(24.42%)( χ2＝12.654，P＝0.000).The incidence rate of hemorrhage in observation group(1.16%)was higher than that in control group(3.66%)( χ2＝0.307，P＝0.579).There were significant differences in the clotting time(R)，maximum amplitude(MA)and coagulation(CI)among VTE group，hemorrhage group and non?VTE/hemorrhage group(P＜0.05).The low R value(OR＝0.884，95%CI:0.811-0.964)and high CI value(OR＝1.119，95%CI:1.012?1.236)were independent risk factors affecting the VTE in patients with high?risk VTE tumors.ROC curve analysis showed that the values of ar?ea under the curve of R and CI values in predicting VTE in patients with high?risk VTE tumors were 0.788 and 0.813，respectively， and both had higher predictive value.Conclusions The TEG monitoring indexes of R value and CI value can effectively predictthe risk of VTE in patients with high?risk VTE tumors.According to TEG monitoring guidance，early clinical treatment of patients with high?risk VTE tumors can effectively reduce the risk of VTE and it will not increase the risk of hemorrhage. |
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