目的分析静脉血栓栓塞症(VTE)住院患者的患病情况、临床特征和危险因素。方法回顾性分析北京协和医院1994年至2004年住院 VTE 病例的患病趋势、人口学特点、获得性及遗传性危险因素。结果共收集 VTE 患者672例,男:女=1.2:1,中位年龄53(1...目的分析静脉血栓栓塞症(VTE)住院患者的患病情况、临床特征和危险因素。方法回顾性分析北京协和医院1994年至2004年住院 VTE 病例的患病趋势、人口学特点、获得性及遗传性危险因素。结果共收集 VTE 患者672例,男:女=1.2:1,中位年龄53(14～92)岁。初发患者580例(86.3%),发病高峰年龄男性患者为40～50岁,女性为50～60岁。主要获得性危险因素有抗磷脂抗体阳性(32.0%)、外伤和(或)手术(31.1%)、肿瘤(17.1%)。其中具有多种获得性危险因素者占35.7%。94例患者在抗凝治疗前取外周血检测了蛋白 C(PC)、蛋白 S(PS)和抗凝血酶(AT)活性。抗凝蛋白总缺陷率为44.7%,以 PC 缺乏以及 PC 与 AT 联合缺乏为主,分别占13.8%和10.6%。同时具有遗传和获得性危险因素者占31.6%。结论研究结果显示综合医院的住院 VTE 病例数呈逐年上升趋势,男性 VTE 患者的初发年龄较女性提早约10年。主要获得性危险因素为抗磷脂抗体阳性、外伤或手术和肿瘤,而遗传性危险因素则以 PC 缺乏和 PC 与 AT 联合缺乏为主。多种危险因素并存是促发 VTE 的重要原因。展开更多
Background Venous thromboembolism is known to be an important social and health care problem because of its high incidence among patients who undergo surgery. Studies on the mechanical prophylaxis of thromboembolism a...Background Venous thromboembolism is known to be an important social and health care problem because of its high incidence among patients who undergo surgery. Studies on the mechanical prophylaxis of thromboembolism after gynaecological pelvic surgery are few. The aim of our study was to evaluate the effect of mechanical thromboembolism prophylaxis after gynaecological pelvic surgery using a combination of graduated compression stockings （GCS） and intermittent pneumatic compression （IPC） or GCS alone. Methods The study was performed on 108 patients who were randomly assigned to two groups. The first group received GCS before the operation and IPC during the operation （IPC＋GCS group）, The second group received GCS before the operation （GCS group）. To analyze the effect of the preventive measures and the laboratory examination on the incidence of thrombosis and to compare the safety of these measures, the incidence of adverse reactions was assessed. Results The morbidity associated with DVT was 4.8% （5/104） in the IPC＋GCS group and 12.5% （14/112） in the GCS group. There were significant statistical differences between the two groups. There were no adverse effects in either group. Conclusions The therapeutic combination of GCS and prevention in high-risk patients undergoing gynaecological group.（No. ChiCTR-PRC-10000935）. IPC was more effective than GCS alone for thrombosis pelvic surgery, and there were no adverse effects in either展开更多
Background Acute pulmonary thromboembolism （APE） causes right ventricular dysfunction （RVD） and cardiac troponin I （cTnl） elevation. Patients with RVD and cTnl elevation have a worse prognosis. Thus, early detec...Background Acute pulmonary thromboembolism （APE） causes right ventricular dysfunction （RVD） and cardiac troponin I （cTnl） elevation. Patients with RVD and cTnl elevation have a worse prognosis. Thus, early detection of RVD and cTnl elevation is beneficial for risk stratification. In this study, we assessed 14-day adverse clinical events and combined RVD on transthoracic echocardiography （TTE） with cTnl in risk stratification among a broad spectrum of APE patients. Methods The prospective multi-centre trial included 90 patients with confirmed APE from 12 collaborating hospitals. Acute RVD on TTE was diagnosed in the presence of at least 2 of the following： right ventricular dilatation （without hypertrophy）, loss of inspiratory collapse of inferior vena cava （IVC）, right ventricular （RV） hypokinesis, tricuspid regurgitant jet velocity 〉2.8 m/s. The study patients were divided into two groups according to clinical and echocardiographic findings at presentation： Group Ⅰ： 50 patients with RVD; Group Ⅱ：40 patients without RVD. Results More than half of the patients （50/90, 55.6%） had RVD. Nearly one third （26/90, 28.9%） of patients had elevated cTnl at presentation and only 4.2% on the fourth day after initial therapy. A multiple Logistic regression model implied RVD, right and left ventricular end-diastolic diameter ratio （RVED/LVED）, and cTnl independently predict an adverse 14-day clinical outcome （P〈0.01）. Receiver operating characteristics （ROC） curves revealed that the cut-off values of RVED/LVED and cTnl yielding the highest discriminating power were 0.65 and 0.11 ng/ml, respectively. Furthermore, the incidence of an adverse 14-day clinical event in patients with RVD and elevated cTnl was greater （40.7%） than in patients with elevated cTnl or positive RVD alone （0% and 8.3%, respectively） （P〈0.001）. Conclusions RVD, RVED/LVED, and cTnl are independent predictors of 14-day clinical outcomes. The patients with RVED/LVED greater than 0.65展开更多
文摘目的分析静脉血栓栓塞症(VTE)住院患者的患病情况、临床特征和危险因素。方法回顾性分析北京协和医院1994年至2004年住院 VTE 病例的患病趋势、人口学特点、获得性及遗传性危险因素。结果共收集 VTE 患者672例,男:女=1.2:1,中位年龄53(14～92)岁。初发患者580例(86.3%),发病高峰年龄男性患者为40～50岁,女性为50～60岁。主要获得性危险因素有抗磷脂抗体阳性(32.0%)、外伤和(或)手术(31.1%)、肿瘤(17.1%)。其中具有多种获得性危险因素者占35.7%。94例患者在抗凝治疗前取外周血检测了蛋白 C(PC)、蛋白 S(PS)和抗凝血酶(AT)活性。抗凝蛋白总缺陷率为44.7%,以 PC 缺乏以及 PC 与 AT 联合缺乏为主,分别占13.8%和10.6%。同时具有遗传和获得性危险因素者占31.6%。结论研究结果显示综合医院的住院 VTE 病例数呈逐年上升趋势,男性 VTE 患者的初发年龄较女性提早约10年。主要获得性危险因素为抗磷脂抗体阳性、外伤或手术和肿瘤,而遗传性危险因素则以 PC 缺乏和 PC 与 AT 联合缺乏为主。多种危险因素并存是促发 VTE 的重要原因。
文摘Background Venous thromboembolism is known to be an important social and health care problem because of its high incidence among patients who undergo surgery. Studies on the mechanical prophylaxis of thromboembolism after gynaecological pelvic surgery are few. The aim of our study was to evaluate the effect of mechanical thromboembolism prophylaxis after gynaecological pelvic surgery using a combination of graduated compression stockings （GCS） and intermittent pneumatic compression （IPC） or GCS alone. Methods The study was performed on 108 patients who were randomly assigned to two groups. The first group received GCS before the operation and IPC during the operation （IPC＋GCS group）, The second group received GCS before the operation （GCS group）. To analyze the effect of the preventive measures and the laboratory examination on the incidence of thrombosis and to compare the safety of these measures, the incidence of adverse reactions was assessed. Results The morbidity associated with DVT was 4.8% （5/104） in the IPC＋GCS group and 12.5% （14/112） in the GCS group. There were significant statistical differences between the two groups. There were no adverse effects in either group. Conclusions The therapeutic combination of GCS and prevention in high-risk patients undergoing gynaecological group.（No. ChiCTR-PRC-10000935）. IPC was more effective than GCS alone for thrombosis pelvic surgery, and there were no adverse effects in either
基金This study was supported by a grant from National Project of the DiagnosisTreatment Strategies for Pulmonary Thromboembolism in China(NATSPUTE)(No.2004BA703B07)
文摘Background Acute pulmonary thromboembolism （APE） causes right ventricular dysfunction （RVD） and cardiac troponin I （cTnl） elevation. Patients with RVD and cTnl elevation have a worse prognosis. Thus, early detection of RVD and cTnl elevation is beneficial for risk stratification. In this study, we assessed 14-day adverse clinical events and combined RVD on transthoracic echocardiography （TTE） with cTnl in risk stratification among a broad spectrum of APE patients. Methods The prospective multi-centre trial included 90 patients with confirmed APE from 12 collaborating hospitals. Acute RVD on TTE was diagnosed in the presence of at least 2 of the following： right ventricular dilatation （without hypertrophy）, loss of inspiratory collapse of inferior vena cava （IVC）, right ventricular （RV） hypokinesis, tricuspid regurgitant jet velocity 〉2.8 m/s. The study patients were divided into two groups according to clinical and echocardiographic findings at presentation： Group Ⅰ： 50 patients with RVD; Group Ⅱ：40 patients without RVD. Results More than half of the patients （50/90, 55.6%） had RVD. Nearly one third （26/90, 28.9%） of patients had elevated cTnl at presentation and only 4.2% on the fourth day after initial therapy. A multiple Logistic regression model implied RVD, right and left ventricular end-diastolic diameter ratio （RVED/LVED）, and cTnl independently predict an adverse 14-day clinical outcome （P〈0.01）. Receiver operating characteristics （ROC） curves revealed that the cut-off values of RVED/LVED and cTnl yielding the highest discriminating power were 0.65 and 0.11 ng/ml, respectively. Furthermore, the incidence of an adverse 14-day clinical event in patients with RVD and elevated cTnl was greater （40.7%） than in patients with elevated cTnl or positive RVD alone （0% and 8.3%, respectively） （P〈0.001）. Conclusions RVD, RVED/LVED, and cTnl are independent predictors of 14-day clinical outcomes. The patients with RVED/LVED greater than 0.65
