|
Venous Thromboembolism in Neurocritical Care PatientsViarasilpa T, Panyavachiraporn N, Jordan J, et al.Journal of intensive care medicine, 2019, 68(4): 885066619841547.DOI: 10.1177/0885066619841547Venous thromboembolism (VTE) is a potentially life-threatening complication among critically ill patients. Neurocritical care patients are presumed to be at high risk for VTE; however, data regarding risk factors in this population are limited. We designed this study to evaluate the frequency, risk factors, and clinical impact of VTE in neurocritical care patients.静脉血栓栓塞（VTE）是重症患者中可能危及生命的并发症。神经重症患者被认为是VTE的高危人群；但是，有关该人群中风险因素的数据是有限的。我们设计这项研究是为了评估VTE在神经重症患者中的发病率，危险因素和临床影响。We obtained data from the electronic medical record of all adult patients admitted to neurological intensive care unit (NICU) at Henry Ford Hospital between January 2015 and March 2018. Venous thromboembolism was defined as deep vein thrombosis, pulmonary embolism, or both diagnosed by Doppler, chest computed tomography (CT) angiography or ventilation–perfusion scan >24 hours after admission. Patients with ICU length of stay <24 hours or who received therapeutic anticoagulants or were diagnosed with VTE within 24 hours of admission were excluded. 我们从2015年1月至2018年3月在亨利福特医院收治的神经重症监护室（NICU）的所有成年患者的电子病历中获得了数据。静脉血栓栓塞被定义为入院24小时后通过多普勒，胸部计算机断层扫描（CT）血管造影或通气-灌注扫描诊断为深静脉血栓形成，肺栓塞，或两者均有。ICU住院时间<24小时或接受治疗性抗凝血剂或入院后24小时内被诊断为VTE的患者被排除在外。Among 2188 consecutive NICU patients, 63 (2.9%) developed VTE. Prophylactic anticoagulant use was similar in patients with and without VTE (95% vs 92%; P= .482).Venous thromboembolism was associated with higher mortality (24% vs 13%, P=.019), and longer ICU (12 [interquartile range, IQR 5-23] vs 3 [IQR 2-8] days, P < .001) and hospital (22 [IQR 15-36] vs 8 [IQR 5-15] days, P < .001) length of stay. In a multivariable analysis, potentially modifiable predictors of VTE included central venous catheterization (odds ratio [OR] 3.01; 95% confidence interval [CI], 1.69-5.38; P < .001) and longer duration of immobilization (Braden activity score <3, OR 1.07 per day; 95% CI, 1.05-1.09; P < .001). Nonmodifiable predictors included higher International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) scores (which accounts for age >60, prior VTE, cancer and thrombophilia; OR 1.66; 95% CI, 1.40-1.97; P < .001) and body mass index (OR 1.05; 95% CI, 1.01-1.08; P=.007). 在2188名连续入住NICU患者中，63名（2.9％）患有VTE。VTE和非VTE患者的预防性抗凝血剂使用相似（95％vs 92％；P = .482）。血栓栓塞与较高的死亡率（24％vs 13％，P = .019）和较长的住ICU时间（12 [四分位数间距，IQR 5-23] vs 3 [IQR 2-8]天，P <.001）和住院时间（22 [IQR 15-36] vs 8 [IQR 5-15]天，P <.001）有关。在多变量分析中，潜在可修改的VTE预测因子包括中心静脉导管置入（优势比[OR] 3.01; 95％置信区间[CI]，1.69-5.38；P <.001）和更长的留置时间（Braden活动评分<3，OR 1.07/天; 95％CI，1.05-1.09；P <.001）。不可修改的预测因子包括更高的国际医疗预防登记静脉血栓栓塞（IMPROVE）评分（其中年龄> 60岁，既往VTE，癌症和血栓形成倾向；OR 1.66；95％CI，1.40-1.97；P <.001）和体重指数（OR1.05；95％CI，1.01-1.08；P = .007）。Despite chemoprophylaxis, VTE still occurred in 2.9% of neurocritical care patients. Longer duration of immobilization and central venous catheterization are potentially modifiable risk factors for VTE in critically ill neurological patients.尽管进行了药物预防，但仍有2.9％的神经重症患者发生VTE。中心静脉导管置入及较长的留置时间是危重神经病患者VTE潜在可改变的危险因素。
|
