成人患者术中静脉血栓栓塞症风险预测模型的构建与验证

方敏; 高兴莲; 王曾妍; 马琼; 任东平; 柯稳

doi:10.16460/j.issn2097-6569.2025.11.072

PDF(1374 KB)

护理学报 ›› 2025, Vol. 32 ›› Issue (11) : 72-78. DOI: 10.16460/j.issn2097-6569.2025.11.072

临床护理※静疗护理

成人患者术中静脉血栓栓塞症风险预测模型的构建与验证

方敏^1a,2, 高兴莲^1a, 王曾妍^1b, 马琼^1b, 任东平^1b, 柯稳^1b

作者信息 +

文章历史 +

摘要

目的构建并验证成人患者术中静脉血栓栓塞症风险预测模型。方法采用便利抽样法选取2023年4—9月于武汉市某三级甲等综合医院的618例手术患者为研究对象,利用Lasso回归结合多因素logistics回归筛选危险因素,构建列线图预测模型。以C指数评价模型的区分度,采用Calibration校准曲线、Hosmer-Lemeshow检验及Brier分数评估模型的校准度,应用决策曲线评估其临床有效性。结果纳入9个预测因素进入模型,即下肢严重创伤史（<1个月）、恶性肿瘤、手术方式、手术时间、截石位或头高脚低手术体位、术中失血量>500 mL、术中输血、CO₂气腹及纤维蛋白原。经内部验证前后模型的C统计量分别为0.820和0.825,H-L检验均P>0.5,Brier评分分别为0.168和0.167,校准曲线与决策曲线显示模型具有较好的校准度和临床有效性。结论该预测模型具有良好的预测效能和临床有效性,可为手术室医护人员筛查术中静脉血栓高危人群提供有效的风险预测工具。

关键词

外科手术 / 术中 / 静脉血栓 / 危险因素 / 预测模型 / 列线图 / 手术室护理

引用本文

EndNote

Ris (Procite)

Bibtex

导出引用

方敏, 高兴莲, 王曾妍, 马琼, 任东平, 柯稳. 成人患者术中静脉血栓栓塞症风险预测模型的构建与验证[J]. 护理学报. 2025, 32(11): 72-78 https://doi.org/10.16460/j.issn2097-6569.2025.11.072

中图分类号： R473.6

参考文献

[1] 中国健康促进基金会血栓与血管专项基金专家委员会. 静脉血栓栓塞症机械预防中国专家共识[J]. 中华医学杂志, 2020,100(7):484-492. DOI: 10.3760/cma.j.issn.0376-2491.2020.07.002
[2] Bui MH, Le QC, Duong DH, et al.Economic burden of venous thromboembolism in surgical patients: a propensity score analysis from the national claims database in Vietnam[J]. PLoS One, 2020,15(4):e231411. DOI: 10.1371/journal.0231411.
[3] Lutsey PL, Zakai NA.Epidemiology and prevention of venous thromboembolism[J]. Nat Rev Cardiol,2023, 20(4):248-262. DOI: 10.1038/s41569-022-00787-6.
[4] Virani SS, Alonso A, Aparicio HJ, et al.Heart disease and stroke statistics-2021 update: a report from the American Heart Association[J]. Circulation, 2021,143(8):e254-e743. DOI: 10.1161/CIR.0000000000000950.
[5] Huang W, Cohen AT, Martin AC, et al.Magnitude of venous thromboembolism risk in US hospitals: impact of evolving national guidelines for prevention of venous thromboembolism[J]. Am J Med, 2019,132(5):588-595. DOI: 10.1016/j.amjmed.2018.12.028.
[6] Singh V, Muthusamy N, Ikwuazom CP, et al.Postoperative venous thromboembolism event increases risk of readmissions and reoperation following total joint arthroplasty: a propensity-matched cohort study[J]. Eur J Orthop Surg Traumatol, 2022,32(6):1055-1061. DOI: 10.1007/s00590-021-03071-4.
[7] 孙江丽, 张岩, 李虎. 彩色多普勒超声诊断全膝关节置换围手术期下肢深静脉血栓形成的临床价值[J]. 中华医学超声杂志(电子版), 2019,16(9):691-696. DOI: 10.3877/cma.j.issn.1672-6448.2019.09.009.
[8] 莫航沣, 陈亚萍, 韩慧, 等. 临床预测模型研究方法与步骤[J]. 中国循证医学杂志, 2024,24(2):228-236.
[9] 方敏, 高兴莲, 王曾妍, 等. 成人手术患者术中下肢深静脉血栓形成风险评估的证据总结[J]. 中国临床护理, 2023,15(10):634-639.DOI:10.3969/j.issn.1674-3768.2023.10.011.
[10] American Society of Anesthesiologists. Statement on ASA Physical Status Classification System.[EB/OL] (2020-12-13)[2024-08-01]. https://www.asahq.org/standards-and-practice-parameters/statement-on-asa-physical-status-classification-system.
[11] 方敏, 高兴莲, 柯稳, 等. 腹部消化系统手术患者术中低体温风险预测模型的构建与验证[J]. 护理学报, 2023,30(20):58-63. DOI: 10.16460/j.issn1008-9969.2023.20.058.
[12] Venous thromboembolic diseases: diagnosis, management and thrombophilia testing[M]. London: National Institute for Health and Care Excellence (NICE), 2023.
[13] Chopard R, Albertsen IE, Piazza G.Diagnosis and treatment of lower extremity venous thromboembolism: a review[J]. JAMA, 2020,324(17):1765-1776. DOI: 10.1001/jama.2020.17272.
[14] Moore EE, Moore HB, Kornblith LZ, et al.Trauma-induced coagulopathy[J]. Nat Rev Dis Primers, 2021,7(1):30. DOI: 10.1038/s41572-021-00264-3.
[15] 陈宋林,曲军,黄聪,等.泌尿外科腹腔镜术后静脉血栓栓塞症发生的危险因素及预测模型建立[J/OL].解放军医学杂志.(2024-06-05)[2024-12-18].http://kns.cnki.net/kcms/detail/11.1056.R.20240603.1928.006.html.
[16] Falanga A, Marchetti M.Cancer-associated thrombosis: enhanced awareness and pathophysiologic complexity[J]. J Thromb Haemost, 2023,21(6):1397-1408. DOI: 10.1016/j.jtha.2023.02.029.
[17] 李明, 万法青, 张英华, 等. 高龄股骨骨折闭合髓内钉内固定对围手术期静脉血栓相关指标的影响[J]. 中国组织工程研究, 2018,22(23):3609-3614. DOI: 10.3969/j.issn.2095-4344.0255.
[18] Kondreddy V, Keshava S, Das K, et al.The Gab2-MALT1 axis regulates thromboinflammation and deep vein thrombosis[J]. Blood,2022,140(13):1549-1564. DOI:10.1182/blood.2022016424.
[19] Fei J, Wang H, Han J, et al.TXNIP activates NLRP3/IL-1beta and participate in inflammatory response and oxidative stress to promote deep venous thrombosis[J]. Exp Biol Med (Maywood), 2023,248(18):1588-1597. DOI: 10.1177/15353702231191124.
[20] 宁伟超, 李贤. 外科手术后下肢深静脉血栓风险预测模型[J]. 护理研究, 2022,36(12):2113-2118. DOI: 10.12102/j.issn.1009-6493.2022.12.008.
[21] Torres FI.Hemorrhagic shock and the microvasculature[J]. Compr Physiol,2017,8(1):61-101.DOI:10.1002/cphy.c170006.
[22] 石琳璘. 影响库存血液报废的因素分析及改进管理建议[J]. 现代科学仪器, 2022,39(2):177-181.
[23] Ciavarella A, Gnocchi D, Custodero C, et al.Translational insight into prothrombotic state and hypercoagulation in nonalcoholic fatty liver disease[J]. Thromb Res, 2021,198:139-150. DOI: 10.1016/j.thromres.2020.12.002.
[24] 王曾妍, 高兴莲, 崔宇杨, 等. 手术体位对病人下肢静脉血流的影响[J]. 护理研究, 2021,35(3):511-513. DOI: 10.12102/j.issn.1009-6493.2021.03.031.
[25] He H, Gruartmoner G, Ince Y, et al.Effect of pneumoperitoneum and steep reverse-trendelenburg position on mean systemic filling pressure, venous return, and microcirculation during esophagectomy[J]. J Thorac Dis, 2018,10(6):3399-3408. DOI: 10.21037/jtd.2018.05.169.
[26] 梁惠霞, 林淑媛, 范蔚芳, 等. 子宫肌瘤经腹腔镜剔除术后并发下肢深静脉血栓风险评分系统的建立[J]. 国际妇产科学杂志, 2022,49(4):398-402. DOI: 10.12280/gjfckx.20211183.
[27] Luyendyk JP, Schoenecker JG, Flick MJ.The multifaceted role of fibrinogen in tissue injury and inflammation[J]. Blood, 2019,133(6):511-520. DOI: 10.1182/blood-2018-07-818211.
[28] Chapin J C, Hajjar K A.Fibrinolysis and the control of blood coagulation[J]. Blood Rev, 2015,29(1):17-24. DOI: 10.1016/j.blre.2014.09.003.
[29] Wolberg A S, Sang Y.Fibrinogen and Factor XIII in venous thrombosis and thrombus stability[J].Arterioscler Thromb Vasc Biol,2022,42(8):931-941.DOI:10.1161/ATVBAHA.122.317164.