Analysis of risk factors for severity of pulmonary thromboembolism after craniocerebral tumor operation under cluster intervention measure
YANG Yakun1 HAN Song1 LIU Ning1 ZHANG Xufei2 ZHANG Linpeng1 HAN Mingyang1 ZHANG Yunxin3 YAN Changxiang1▲
1.Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, China;
2.Department of Neurological Imaging, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, China;
3.Department of Neurological Intensive Care Unit, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, China
Abstract：Objective To analyze the risk factors of pulmonary thromboembolism with different severity after craniocerebral tumor operation under cluster intervention measures, and to provide reference for early clinical intervention of pulmonary thromboembolism. Methods The clinical information of 56 patients with pulmonary thromboembolism diagnosed by CT pulmonary angiography after craniocerebral tumor operation in the Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University from June 2016 to June 2019 was retrospectively analyzed. The patients were divided into low risk group (36 cases) and high risk group (20 cases) according to the diagnosis and treatment guidelines of pulmonary thromboembolism. Clinical phenotypes, coagulation function and perioperative related factors were compared between the two groups, and multivariate logistic regression was used to analyze the risk factors of pulmonary thromboembolism with different severity. Results Among the 56 patients, 35 were male and 21 were female. The mean age was (46.23±18.12) years old. Postoperative pathology showed malignant tumor in 20 cases, accounting for 35.71%; benign tumors in 36 cases, accounting for 64.29%. Tumor site classification showed sellar region tumors in 26 cases, accounting for 46.43%; supratentorial tumor in 21 cases, accounting for 37.50%; skull base tumor in 7 cases, accounting for 12.5%; infratentorial tumor in 2 cases, accounting for 3.57%. There were no significant differences in clinical phenotype and coagulation function between the two groups (P ＞ 0.05). There was no significant difference in perioperative related factors between the two groups except the time of water fasting before operation (P ＞ 0.05). Multivariate logistic regression analysis showed that the presence of postoperative limb mobility disorder was a risk factor for pulmonary thromboembolism after craniocerebral tumor operation (OR = 9.574, P = 0.02). Conclusion Pulmonary thromboembolism after craniocerebral tumor operation has complex underlying causes and no specific clinical manifestations. The identification of the risk factors of pulmonary thromboembolism combined with the results of laboratory examination is helpful for the early diagnosis and treatment of pulmonary thromboembolism.
杨亚坤1 韩松1 刘宁1 张旭妃2 张林朋1 韩明阳1 张云馨3 闫长祥1▲. 集束化干预措施下颅脑肿瘤术后肺血栓栓塞症严重程度危险因素分析[J]. 中国医药导报, 2021, 18(14): 76-80.
YANG Yakun1 HAN Song1 LIU Ning1 ZHANG Xufei2 ZHANG Linpeng1 HAN Mingyang1 ZHANG Yunxin3 YAN Changxiang1▲. Analysis of risk factors for severity of pulmonary thromboembolism after craniocerebral tumor operation under cluster intervention measure. 中国医药导报, 2021, 18(14): 76-80.
[1] Yan C，Wang X，Su H，et al. Recent Progress in Research on the Pathogenesis of Pulmonary Thromboembolism：An Old Story with New Perspectives [J]. Biomed Res Int，2017，2017：6516791.
[2] 中华医学会呼吸病学分会肺栓塞与肺血管病学组，中国医师协会呼吸医师分会肺栓塞与肺血管病工作委员会，全国肺栓塞与肺血管病防治协作组.肺血栓栓塞症诊治与预防指南[J].中华医学杂志，2018，98（14）：1060-1087.
[3] Comerota AJ，Katz ML，White JV. Why does prophylaxis with external pneumatic compression for deep vein thrombosis fail? [J]. Am J Surg，1992，164（3）：265-268.
[4] Tian R，Gao J，Chen A，et al. Silent pulmonary thromboembolism in neurosurgery patients：Report of 2 cases and literature review [J]. Medicine（Baltimore），2016，95（33）：e4589.
[5] 中华医学会神经外科学分会，中国神经外科重症管理协作组.中国神经外科重症管理专家共识（2020版）[J].中华医学杂志，2020，100（19）：1443-1458.
[6] Resar R，Pronovost P，Haraden C，et al. Using a bundle approach to improve ventilator care processes and reduce ventilator-associated pneumonia [J]. Jt Comm J Qual Patient Saf，2005，31（5）：243-248.
[7] Shapiro S，Dunnigan A，Keen S，et al. Interventional bundle for venous thromboembolism prevention： ensuring quality and effectiveness [J]. BMJ Open Qual，2019，8（2）：e000459.
[8] Adhikari CM，Bishal KC，Khadka S. Clinical profile，management and outcome of pulmonary embolism in Shahid Gangalal National Heart Centre，Kathmandu，Nepal [J]. Egypt Heart J，2018，70（1）：41-43.
[9] 熊长明，郑亚国，何建国，等.2014版欧洲心脏病学会急性肺血栓栓塞症诊断治疗指南解读[J].中国循环杂志，2014（11）：864-866.
[10] Konstantinides SV，Torbicki A，Agnelli G，et al. 2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism [J]. Eur Heart J，2014，35（45）：3145-3146.
[11] 中华医学会心血管病学分会肺血管病学组.急性肺栓塞诊断与治疗中国专家共识（2015）[J].中华心血管病杂志，2016，44（3）：197-211.
[12] Mismetti P，Laporte S，Pellerin O，et al. Effect of a retrievable inferior vena cava filter plus anticoagulation vs anticoagulation alone on risk of recurrent pulmonary embolism： a randomized clinical trial [J]. JAMA，2015，313（16）：1627-1635.
[13] 黄兰，王宋平.142例肺栓塞的临床特点及危险因素分析[J].临床肺科杂志，2019，24（2）：304-307.
[14] Office of the Surgeon General（US），National Heart, Lung, and Blood Institute（US）. The Surgeon General’s Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism [M]. Rockville（MD）：Office of the Surgeon General（US），2008.
[15] Cohen AT，Agnelli G，Anderson FA，et al. Venous thromboembolism （VTE） in Europe. The number of VTE events and associated morbidity and mortality [J]. Thromb Haemost，2007，98（4）：756-764.
[16] Benvenuti L，Gagliardi R. Risk of postoperative hemorrhage after intracranial surgery after early nadroparin administration：results of a prospective study [J]. Neurosurgery，2004，55（5）：1229-1230.
[17] 周奕，杨京华，刘双.622例急性肺栓塞患者的临床特点分析[J].心肺血管病杂志，2014，33（6）：820-824.
[18] Cha SI，Shin KM，Lim JK，et al. Pulmonary embolism concurrent with lung cancer and central emboli predict mortality in patients with lung cancer and pulmonary embolism [J]. J Thorac Dis，2018，10（1）：262-272.
[19] Abdol Razak NB，Jones G，Bhandari M，et al. Cancer-Associated Thrombosis：An Overview of Mechanisms，Risk Factors，and Treatment [J]. Cancers （Basel），2018， 10（10）：380.
[20] 钱海，周忠清，刘宇翔，等.颅咽管瘤术后肺动脉栓塞的研究[J].中国微侵袭神经外科杂志，2011，16（6）：262-263.
[21] 钟建利，王学文，张勇，等.高危与非高危肺栓塞患者的临床特征及治疗、预后分析[J].实用心脑肺血管病杂志，2020，28（7）：103-108.
[22] 汪璟，鲁晓杰，苗增利，等.神经外科术后静脉栓塞症发病率及早期诊断[J].临床神经外科杂志，2013，10（4）：229-231.
[23] 赵月，程兆忠.不同部位急性肺栓塞的相关因素差异性分析及预后研究[J].临床医学进展，2020，10（4）： 530-536.
[24] 矫翠婷，王新桐，王斐，等.血清正五聚蛋白3、肿瘤坏死因子-α表达与急性肺栓塞治疗后短期复发的相关性[J].疑难病杂志，2021，20（3）：222-226.
[25] 孙雪峰，施举红.肺栓塞溶栓治疗新理念[J].协和医学杂志，2020，11（2）：135-139.
[26] Collen JF，Jackson JL，Shorr AF，et al. Prevention of venous thromboembolism in neurosurgery：a metaanalysis [J]. Chest，2008，134（2）：237-249.
[27] Kearon C，de Wit K，Parpia S，et al. Diagnosis of Pulmonary Embolism with d-Dimer Adjusted to Clinical Probability [J]. N Engl J Med，2019，381（22）：2125-2134.
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