结直肠癌患者围手术期VTE 风险评分动态变化的回顾性研究：基于 Caprini 量表的时序分析及护理启示
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叶丽好,阳霞,周姗姗
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中山大学肿瘤防治中心，广东广州，510060
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摘要：目的 探讨结直肠癌患者围手术期静脉血栓栓塞症（venous thromboembolism, VTE）风险的动态演变规律，基于 Caprini 风险评估量表分析术前、术后 24 h、术后 72 h 三个时间点的风险变化特征，为临床实施动态化 VTE 防控提供循证依据。方法 采用回顾性队列研究设计，选取 2024 年 6 月—2025 年 6 月于本院接受择期手术治疗的 180 例结直肠癌患者为研究对象，收集患者一般人口学资料、疾病与手术相关资料，分别提取术前 24 h 内（T0）、术后 24 h（T1）、术后 72 h（T2）三个时间点的 Caprini 评分及风险等级，采用重复测量方差分析、Cochran's Q 检验、多元线性回归等方法进行统计分析。结果 180 例患者 Caprini 评分在 T0、T1、T2 三个时间点对比，差异具有统计学意义（F=287.34，P<0.001）；两两比较显示，T1 评分显著高于 T0 与 T2，T2 评分亦显著高于 T0（P 均< 0.001）。风险等级分布随时间发生显著变化（χ2=213.56，P<0.001），T0 时点高危占比 38.33%，T1时点高危占比升至 94.44%，T2 时点高危占比为 91.67%。多元线性回归分析显示，年龄（β=0.032，P=0.012）、手术时长（β=0.008，P<0.001）、术中出血量（β=0.005，P=0.003）、肿瘤 TNM 分期（β=0.412，P=0.007）是 Caprini 评分术后增幅的独立影响因素。本组患者围手术期症状性 VTE 发生率为 0，机械预防实施率为 62.22%，药物预防实施率为 18.33%。结论 结直肠癌患者围手术期 VTE 风险呈动态升高趋势，术后 24 h 为风险峰值时段，高龄、手术时间长、出血量大、晚期肿瘤患者风险增幅更为显著。临床应建立围手术期动态评估机制，重点关注术后 24 h 关键窗口期，针对高风险人群实施分层精准干预，以提升 VTE 防控效果。
关健词：结直肠癌；围手术期；静脉血栓栓塞症；Caprini风险评估量表；动态变化 |
Retrospective Study on the Dynamic Changes in Perioperative VTE Risk Scores in Colorectal Cancer Patients: Temporal Analysis Based on the Caprini Scale and Nursing Implications
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Lihao Ye, Xia Yang, Shanshan Zhou
Cancer Center, Sun Yat-sen University, Guangzhou Guangdong 510060, China
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Abstract：Objective To explore the dynamic evolution patterns of venous thromboembolism (VTE) risk in colorectal cancer patients during the perioperative period, analyze the risk changes at three time points (preoperative, 24 hours postoperative, and 72hours postoperative) based on the Caprini risk assessment scale, and provide evidence-based support for clinical implementation of dynamic VTE prevention. Methods A retrospective cohort study design was employed, selecting 180 colorectal cancer patients undergoing elective surgery at our hospital from June 2024 to June 2025 as the study subjects. General demographic data, disease-related information, and surgical details were collected. Caprini scores and risk levels were extracted at three time points: preoperative (T0),24 hours postoperative (T1), and 72 hours postoperative (T2). Statistical analyses were performed using repeated-measures ANOVA,Cochran’s Q test, and multiple linear regression. Results The Caprini scores among the 180 patients showed statistically significant differences across T0, T1, and T2 (F=287.34, P<0.001). Pairwise comparisons revealed that T1 scores were significantly higher than T0 and T2, while T2 scores were also significantly higher than T0 (all P<0.001). The distribution of risk levels changed significantly over time (χ2=213.56, P<0.001), with high-risk proportions at T0, T1, and T2 being 38.33%, 94.44%, and 91.67%, respectively.Multiple linear regression analysis identified age (β=0.032, P=0.012), operative duration (β=0.008, P<0.001), intraoperative blood loss (β=0.005, P=0.003), and tumor TNM stage (β=0.412, P=0.007) as independent factors influencing postoperative increases in Caprini scores. The symptomatic VTE incidence rate in this cohort was 0%, with mechanical prophylaxis implementation at 62.22%and pharmacological prophylaxis at 18.33%. Conclusion The perioperative VTE risk in colorectal cancer patients exhibits a dynamic upward trend, peaking at 24 hours postoperative. Older age, prolonged surgery, significant blood loss, and advanced tumor stage are associated with more pronounced risk increases. Clinically, a dynamic perioperative assessment mechanism should be established,with a focus on the critical 24-hour postoperative window period, and stratified precision interventions should be implemented for high-risk populations to enhance the effectiveness of VTE prevention and control.
Keywords : colorectal cancer; perioperative; venous thromboembolism; Caprini risk assessment scale; dynamic changes
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