| 杨哲奇,高彦哲,陈景涛.3种风险评估工具预测骨科手术患者深静脉血栓形成价值对比[J].中国烧伤创疡杂志,2025,(1):43~48. |
| DOI： |
| 中文关键词: 深静脉血栓形成 骨科手术 风险评估模型 Ａｕｔａｒ 量表 改良 Ｐａｄｕａ 量表 Ｃａｐｒｉｎｉ 量表 |
| 英文关键词:Deep vein thrombosis Orthopedic surgery Risk assessment model Autar scale Modified Padua scale Caprini scale |
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| 中文摘要: |
| 【摘要】 目的 对比分析 Autar 量表、Caprini 量表、改良 Padua 量表预测骨科手术患者深静脉血栓形成的价值。方法 选取2021年1月至2023年1月兴安盟人民医院收治的 280 例拟行手术治疗的骨科患者作为研究对象, 收集患者年龄、既往史、体重指数等深静脉血栓形成评估工具中所涉及的所有项目资料, 于术前及术后 24 h分别采用 Autar 量表、Caprini 量表、改良 Padua 量表评估患者深静脉血栓形成风险, 收集术后 6 周内患者深静脉血栓形成发生情况, 分析量表内部一致性信度 (Cronbach’s α 系数)、条目敏感性、结构效度、预测效度, 并采用受试者操作特征 (ROC) 曲线分析量表预测骨科手术患者深静脉血栓形成的价值。结果 术后 24 h 评估骨科手术患者深静脉血栓形成风险时, Autar 量表、Caprini 量表、改良 Padua 量表Cronbach’s α 系数分别为 0.755?0.791、0.716, 高于术前评估时的Cronbach’s α 系数 0.732、0.779、0.674; 选取术后 24 h 骨科手术患者深静脉血栓形成风险评估结果进行条目敏感性分析, 结果显示, 分别去掉其中 1 个维度后, Autar 量表、Caprini 量表?改良 Padua 量表Cronbach’s α 系数为 0.611 ~ 0.779、0.620 ~ 0.805、0.603 ~ 0.794; 方差最大旋转后结果显示,Autar 量表、Caprini 量表、改良 Padua 量表特征值大于 1 的因子分别有 3、2、3 个, 累计方差贡献率分别为63.23%、74.48%、64.28%; 术后 24 h 采用 Autar 量表、Caprini 量表、改良 Padua 量表评估骨科手术患者深静脉血栓形成风险的灵敏度分别为 73.8%、81.5%、69.2%, 特异度分别为 73.4%、74.9%、66.7%, 高于术前评估的灵敏度 69.2%、75.4%、63.1%以及特异度 70.0%、71.5%、63.3%; ROC 曲线分析结果显示, Caprini 量表评估骨科手术患者深静脉血栓形成风险的价值明显高于 Autar 量表与改良 Padua 量表 (术前: Z = 2.341、2.837,P= 0.015、0.006; 术后 24 h: Z = 2.541、3.168, P = 0.011、0.002), 而 Autar 量表又明显高于改良 Padua 量表(Z= 1.984、2.533, P = 0.047、0.013), 当诊断界值分别取 15、7、6 分时, 灵敏度分别为 72.3%、75.4%?67.7%, 特异度分别为 75.4%、81.2%、69.6%。结论 与 Autar 量表和改良 Padua 量表相比, Caprini 量表对骨科手术患者深静脉血栓形成的评估有较强的针对性, 内部一致性信度更好, 预测价值更高。 |
| 英文摘要: |
| 【Abstract】 Objective To compare the values of Autar scale, Caprini scale and modified Padua scale in predictingdeep vein thrombosis in patients undergoing orthopedic surgery. Methods 280 orthopedic patients admitted into Xing’an League People’s Hospital from January 2021 to January 2023 for surgical treatment were enrolled as research subjects to collect the data of patients including sex, disease history, body mass index and other items involved in the deep vein thrombosis assessment tool. Autar scale, Caprini scale and modified Padua scale were respectively used to assess the risk of deep vein thrombosis in patients before and 24 hours after operation. The occurrence of deep vein thrombosis of patients was collected within 6 weeks after operation to analyze the internal consistency reliability (Cronbach’s α coefficient), item sensitivity, construct validity and predictive validity of the scales, and the receiver operating characteristic (ROC) curve analysis scale was used to predict the value of deep vein thrombosis in patients undergoing orthopedic surgery. Results At 24 h after operation when evaluating the risk of deep vein thrombosis in patients undergoing orthopedic surgery, the Cronbach’s α coefficients of Autar scale, Caprini scale and modified Padua scale were 0.755, 0.791 and 0.716 respectively, which were all higher than the preoperative values of 0.732, 0.779, and 0.674. The item sensitivity analysis was conducted on the risk assessment results of deep vein thrombosis in patients undergoing orthopedic surgery at 24 h after operation, and the results showed that, after removing one of the dimensions, the Cronbach’s α coefficients of Autar scale, Caprini scale and modified Padua scale were 0.611-0.779, 0.620-0.805 and 0.603-0.794, respectively. After maximum rotation of variance, there were 3, 2 and 3 factors with eigenvalues greater than 1 in Autar scale, Caprini scale and modified Padua scale, respectively, and the cumulative variance contribution rates were 63.23%, 74.48% and 64.28%, respectively. At 24 h after operation, the sensitivity and specificity of Autar scale, Caprini scale and modified Padua scale were 73.8% / 73.4%, 81.5% / 74.9%, and 69.2% / 66.7% respectively, which were higher than the corresponding 69.2% / 70.0%, 75.4% / 71.5%, and 63.1% / 63.3% evaluated before operation. The results of ROC curve analysis showed that the risk value of deep vein thrombosis in patients undergoing orthopedic surgery predicted by Caprini scale was significantly higher than that by Autar scale and modified Padua scale ( before operation: Z = 2.341 and 2.837, P = 0.015 and 0.006; 24 h after operation: Z= 2.541 and 3.168, P= 0.011 and 0.002), and the risk value by the Autar scale was significantly higher than that by the modified Padua scale (Z= 1.984 and 2.533, P= 0.047 and 0.013). The sensitivity of the three scales was respectively 72.3%, 75.4% and 67.7% and the specificity was respectively 75.4%, 81.2% and 69.6% when 15, 7 and 6 points were taken as diagnostic cut?offs. Conclusion Compared with Autar scale and modified Padua scale, the Caprini scale is more targeted in the assessment of deep vein thrombosis in patients undergoing orthopedic surgery, and presented better internal consistency reliability and higher predictive value. |
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