Objective To assess the venous thromboembolism（VTE）three-level management and fourlevel network comprehensive prevention and control system in effectively preventing perioperative venous thrombosis in kidney transplant patients. Methods The case control study was used for cluster sampling. A total number of222 kidney transplant patients operated in 2019 were selected as the experimental group, and 190 kidney transplant patients operated in 2018 were used as the control group. Patients in both groups received kidney transplantation. The VTE routine preventive care measures were used in the control group. The VTE three-level management and fourlevel network comprehensive prevention and control system for VTE risk prevention and management were used in the experimental group. Plasma D-Dimer（DD）levels were monitored at 1 day before surgery as well as 1 d and 7 d after surgery in both groups, and color Doppler ultrasound examination of blood flow in both lower limbs was performed at 1 d and 7 d after surgery. The experimental group was scored by the Caprini 2005 risk assessment model at 1 d before surgery as well as 1 d, 7 d and 14 d after surgery, the corresponding early warning program was adopted. The incidence of VTE, mortality and length of hospital stay were compared between the two groups, and the Caprini2005 risk assessment model score and stratification of the experimental group were analyzed. Results There was no significant difference in D-D index between the two groups before surgery and 1 d after surgery（P ＞ 0.05），there was a statistically significant difference between the two groups in D-D index at 7 days after surgery（P ＜ 0.05）. The positive venous blood flow in the lower limbs of the control group was significantly higher than the experimental group（P ＜ 0.05）. The control group had significant longer hospital stays than the experimental group（P ＜ 0.05）. No postoperative PTE and death occurred in the two groups of patients. The incidence of VTE in the control group was higher than that in the experimental group, and the difference was statistically significant（P ＜ 0.05）. Two patients in the experimental group developed calf muscular vein thrombosis（CMVT）at 7 d and 14 d after surgery, and were stratified into high-risk and very high-risk. Conclusion The venous thromboembolism three-level management and four-level network comprehensive prevention and control system can be used to screen the occurrence of VTE in kidney transplant patients during perioperative period, it provides effective intervention measures, which can detect and prevent the occurrence of VTE at an early stage and ensure the safety of patients.

目的 应用静脉血栓栓塞症（venous thromboembolism，VTE）三级管理四级网络综合防控体系， 有效预防肾移植患者围术期静脉血栓的发生。 方法 采用病例前后对照研究方法，整群抽样，选取 2019 年 222 例肾移植患者作为实验组，2018 年 190 例肾移植患者作为对照组。两组患者均实施肾移植手术治疗， 对照组患者采用 VTE 常规预防护理措施，实验组采用 VTE 三级管理四级网络综合防控体系进行 VTE 风险 防治管理。两组患者均于术前 1 d 及术后 1、7 d 监测血浆 D- 二聚体（D-Dimer，D-D）水平，于术前 1 d、 术后 7 d 行彩色超声多普勒检查双下肢静脉血流情况。实验组于术前 1 d 及术后 1、7、14 d 应用 Caprini 2005 风险评估模型进行评分并采取相应预警方案。比较两组术后 VTE 发生率、病死率、住院天 数，分析实验组 Caprini 2005 风险评估模型评分及分层情况以及发生 VTE 情况。 结果 两组术前 1 d 和术 后 1 d D-D 指标差异无统计学意义（P ＞ 0.05），术后 7 d 两组 D-D 指标差异有统计学意义（P ＜ 0.05）。 对照组双下肢静脉血流超声阳性率发生率高，与实验组相比差异有统计学意义（P ＜ 0.05）。对照组住 院天数多于实验组，差异有统计学意义（P ＜ 0.05）。两组患者术后均未发生肺血栓栓塞症（pulmonary thromboembolism，PTE），均无死亡病例，对照组 VTE 发生率高于实验组，差异有统计学意义（P ＜ 0.05）。 实验组 2 例患者分别于术后 7 d 和 14 d 发生小腿肌间静脉血栓（calf muscular vein thrombosis，CMVT），且 预警分层为高危和极高危。 结论 采用静脉血栓栓塞症三级管理四级网络综合防控体系，对肾移植患者围 术期 VTE 的发生进行筛查并给予有效的干预措施，能够及早发现并积极预防 VTE 的发生，保证患者的安全。