颈椎手术围术期静脉血栓栓塞症相关因素及 预测效能分析

Analysis of Associated Factors and Predictive Performance of Perioperative Venous Thromboembolism in Cervical Spine Surgery

摘要: 目的：探讨颈椎手术患者围术期静脉血栓栓塞症(VTE)的独立危险因素，并建立联合预测模型，评价其预测效能。方法：回顾性分析重庆医科大学附属永川医院1000例颈椎手术患者的临床资料。根据围术期是否发生VTE分为VTE组30例和非VTE组970例。比较两组一般资料、合并症、围术期实验室指标及手术相关指标。将单因素分析中差异有统计学意义的变量纳入多因素Logistic回归分析，以筛选围术期VTE的独立危险因素；采用受试者工作特征(ROC)曲线评价各指标及联合模型的预测效能。结果：1000例患者中，围术期发生VTE 30例，发生率为3.0%。单因素分析显示，两组在血红蛋白(Hb)、凝血酶原时间(PT)、D-二聚体(D2)、手术时间、活化部分凝血活酶时间(APTT)、谷草转氨酶(AST)及白细胞计数(WBC)方面差异均有统计学意义(均P < 0.05)。多因素Logistic回归分析显示，Hb升高(OR = 1.071, 95% CI: 1.040~1.103)、PT延长(OR = 1.788, 95% CI: 1.182~2.705)、D2升高(OR = 1.160, 95% CI: 1.085~1.240)及手术时间延长(OR = 1.017, 95% CI: 1.010~1.025)均为围术期VTE的独立危险因素(均P < 0.05)。由上述4项指标构建的联合模型AUC为0.857 (95% CI: 0.750~0.964)，优于各单项指标。Hb最佳截断值为134.84时，阴性预测值为99.0%。结论：Hb升高、PT延长、D2升高及手术时间延长是颈椎手术患者围术期发生VTE的独立危险因素。基于上述指标建立的联合预测模型对围术期VTE具有较好的预测效能。

Abstract: Objective: To identify independent risk factors for perioperative venous thromboembolism (VTE) after cervical spine surgery and to develop a combined prediction model. Methods: We retrospectively reviewed 1000 patients who underwent cervical spine surgery at Yongchuan Hospital, Chongqing Medical University. Patients were divided into a VTE group (n = 30) and a non-VTE group (n = 970) according to the occurrence of perioperative VTE. Demographic characteristics, comorbidities, perioperative laboratory parameters, and surgery-related variables were compared between the two groups. Variables significant in univariate analyses were entered into multivariable logistic regression to identify independent risk factors for perioperative VTE. Receiver operating characteristic (ROC) curve analysis was performed to assess the predictive performance of individual variables and the combined model. Results: Perioperative VTE occurred in 30 of 1000 patients, yielding an incidence of 3.0%. On univariate analysis, hemoglobin (Hb), prothrombin time (PT), D-dimer (D2), operative time, activated partial thromboplastin time (APTT), aspartate aminotransferase (AST), and white blood cell count (WBC) differed significantly between the two groups (all P < 0.05). Multivariable Logistic regression identified higher Hb (OR = 1.071, 95% CI: 1.040~1.103), prolonged PT (OR = 1.788, 95% CI: 1.182~2.705), elevated D2 (OR = 1.160, 95% CI: 1.085~1.240), and longer operative time (OR = 1.017, 95% CI: 1.010~1.025) as independent risk factors for perioperative VTE (all P < 0.05). The model incorporating these four variables showed good discriminatory ability, with an AUC of 0.857 (95% CI: 0.750~0.964), outperforming each variable alone. At the optimal cutoff of 134.84, Hb had a negative predictive value of 99.0%. Conclusion: Higher Hb, prolonged PT, elevated D2, and longer operative time were independently associated with perioperative VTE after cervical spine surgery. A model combining these variables demonstrated good performance for identifying patients at increased perioperative VTE risk.