| Objective: Whether new morbidity or mortality,lung cancer is still in the first place in Chinese cancer crowd.For patients with NSCLC(non-small cell lung cancer)who can accept complete resection of the tumor,surgery is still the best treatment.VTE(venous thromboembolism)is a common complication of lung cancer perioperative,serious impact on the prognosis of patients with lung tumor after operation and the quality of life.This study aims to analyze the central lung cancer patients perioperative merge VTE risk factors,and explore the effective scheme suitable for the center of VTE prevention.Content: 675 patients confirmed lung tumor by lung surgery in January 2018 to August2019 in our center were retrospectively analyzed.Patients clinical data were collected,including gender,age,smoking history,complication,operation mode,operation time,intraoperative blood loss,hospital stay,histological type,tumor size,pathologic stage,postoperative prophylactic anticoagulation(including drug prevention and physical prevention),postoperative bleeding,early systemic thromboembolism prophylaxis,and preoperative and D-dimer level postoperative 1,3,5 days,etc.Analysis of patients with perioperative risk factors and independent risk factors of VTE;The best diagnostic value of D-dimer level in the diagnosis of VTE was analyzed through D-dimer level change with different time points and D-dimer level differences between different groups;Further explore the ordinary heparin and low molecular heparin on lung cancer perioperative VTE prophylaxis,and analysis of different anticoagulant drugs and the risk of perioperative bleeding in the correlation;To explore the lung cancer perioperative VTE prevention strategies.Methods: Screening the center lung cancer patients with postoperative systemic review and collect relevant clinical data into the group of patients,the patients into groups according to whether VTE grouping,the single factor and multiple factors logistic regression analysis of VTE and non VTE group carries on the statistical analysis,found out the clinical features of the difference between the two groups,further analyzing the risk factors of lung cancer postoperative VTE.Make plasma D-dimer to predict lung cancer incidence of postoperative VTE the ROC(receiver-operating characteristic)curve,Youden index’s biggest tangent point was chosen as the best threshold,and calculated the corresponding degree of sensitivity,specific,positive predictive value,negative predictive value and accuracy.Calculated the best prediction of D-dimer to predict VTE incidence of lung cancer postoperative.Will accept the thoracoscope lung surgery in perioperative patients with anticoagulant drugs divided into ordinary heparin and low molecular heparin group,compared two groups of preoperative and postoperative blood coagulation function parameters,routine blood related parameters and intraoperative bleeding and postoperative drainage,etc.,discussion of lung cancer patients perioperative VTE prophylaxis occurrence of anticoagulant drugs selection,type of drug,dose and drug application time.Statistical analysis was by using SPSS version 22.0 and P < 0.05 was statistically significant for the difference.Results: the incidence of VTE after surgery was 12.8% in the mass.The benign tumor and malignant tumor incidence of VTE were 7.4% and 14.4% respectively.Age,operation method,tumor size,pathological type and postoperative anticoagulation,physical therapy,postoperative bleeding,operation time,preoperative and postoperative day 1,3 and 5 days of D-dimer level,intraoperative blood loss,early systemic thromboembolism prophylaxis,100% of the D-dimer increment,the length of time between the factors in the group of thrombosis and non-thrombosis have significant difference(P < 0.05).Age and 5 days after surgery D-dimer levels are independent risk factors of postoperative lower limb venous thrombosis(P <0.05).Postoperative D-dimer level is significantly higher than before the operation,whether it is benign or malignant tumor group(P < 0.001),and two groups of patients with postoperative D-dimer levels showed significant difference(P < 0.05).No matter in the group of thrombosis or a thrombosis,D-dimer level of preoperative and postoperative significant difference between different time points(P < 0.001).Early systemic thromboembolism prophylaxis,1 day after the operation,routine anticoagulation(nadroparin calcium injection of 0.4 ml)on a regular basis at least every day,and the application of body compression therapy between thrombosis and nonthrombosis group have significant difference(P = 0.037).Compared with other time points,the area under the ROC curve of 3 days after surgery D-dimer in the diagnosis of VTE was maximum,0.841 [95% CI(0.797,0.884)],the optimal threshold was1143.0 ng/ml,the corresponding sensitivity and speciality rate were 70.1% and 81.1%respectively,the positive predictive value was 35.3%,negative predictive value was94.9%,the accuracy was 79.7%,Youden index was 0.512,P < 0.001.APTT of postoperative common heparin group was 30.25 ±4.67 s,APTT long than low molecular heparin group(28.07 ± 5.94 s),P = 0.026,statistically significant;Common heparin group patients intraoperative blood loss was 112.29 ± 92.18 ml,significantly more than the low molecular heparin group(50.16 ± 60.62 ml),P < 0.001.Conclusion: the incidence of VTE in lung cancer perioperative was high,and mainly composed of plexus venosus leg muscle thrombosis.It is very important that take normalize anticoagulation and mechanical auxiliary treatment through thrombus assessment scale screening.Perioperative D-dimer level dynamic monitoring is helpful to prevention of VTE.VTE risk is extremely high and need to be much accounted when3 days after surgery of D-dimer level is higher than 1143.0 ng/ml.For perioperative anticoagulants to prevent VTE,low molecular heparin can reduce the risk of blood clots,at the same time also reduce the risk of perioperative bleeding,shall be as the first choice of anticoagulant drugs. |
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