胃肠外科手术患者术后下肢深静脉血栓形成危险因素分析Analysis of risk factors of deep venous thrombosis of lower limb after gastrointestinal surgery
刘倩;刘奎杰;王振奋;黄平;叶木林;姚宏亮;
摘要(Abstract):
目的分析胃肠外科手术患者术后下肢深静脉血栓形成(deep venous thrombosis,DVT)的危险因素,并探讨临床应对策略。方法回顾性分析海南省人民医院2017年3月至2019年3月收治的1495例胃肠外科手术患者的临床资料,统计患者术后下肢DVT发生情况,并将其分别纳入发生组和未发生组,采用单因素和多因素Logistic回归分析探讨影响胃肠外科手术患者术后下肢DVT的危险因素。结果 1495例胃肠外科手术患者中有278例发生下肢DVT,发生率为18.60%,其中以无症状肌间静脉血栓为主(97.84%),好发于左下肢(48.92%),发生时间集中于术后1 d内(73.74%)。多因素Logistic回归分析显示,年龄≥65岁、体质指数(body mass index,BMI)≥24 kg/m2、消化系统恶性疾病、术后长期卧床均是胃肠外科手术患者术后下肢DVT的独立危险因素(均P<0.05)。结论胃肠外科手术患者术后下肢DVT发生率较高,其危险因素包括年龄≥65岁、BMI≥24 kg/m2、消化系统恶性疾病、术后长期卧床均是胃肠外科手术患者术后下肢DVT的独立危险因素(均P<0.05)。结论胃肠外科手术患者术后下肢DVT发生率较高,其危险因素包括年龄≥65岁、BMI≥24 kg/m2、消化系统恶性疾病、术后长期卧床,临床医生应重视高危患者的识别及早期干预,以避免下肢DVT对患者生活质量造成不良影响。
关键词(KeyWords): 胃肠外科;下肢;深静脉血栓形成;危险因素
基金项目(Foundation): 2018年海南省科学技术厅重点研发计划项目(158hn266)
作者(Authors): 刘倩;刘奎杰;王振奋;黄平;叶木林;姚宏亮;
参考文献(References):
- [1]崔超毅,张荣,宋菊民,等.腹部外科病人术后症状性静脉血栓栓塞症多中心临床流行病学研究[J].中国实用外科杂志,2020,40(5):547-550,556.
- [2]刘晓婷.肺栓塞流行病学及危险因素与死亡相关因素的分析[D].长春:吉林大学,2011.
- [3]董嘉尧.临床评分量表及血清学标记物对深静脉血栓诊断和治疗的临床意义[D].广州:南方医科大学,2016.
- [4]中华医学会外科学分会血管外科学组.深静脉血栓形成的诊断和治疗指南(第2版)[J].中国医学前沿杂志(电子版),2013,5(3):53-57.
- [5]MANGIALARDI R J,MARTIN G S,BERNARD G R,et al.Hypoproteinemia predicts acute respiratory distress syndrome development,weight gain,and death in patients with sepsis[J].Crit Care Med,2000,28(9):3137-3145.
- [6]NORDSTR?M M,LINDBLAD B,BERGQVIST D,et al.A prospective study of the incidence of deep-vein thrombosis within a defined urban population[J].J Intern Med,1992,232(2):155-160.
- [7]吴贵阳,叶甫波,陈国平.胃肠道恶性肿瘤腹腔镜手术对下肢深静脉血栓形成的临床分析[J].世界华人消化杂志,2018,26(11):673-679.
- [8]KIBBE M R,UJIKI M,GOODWIN A L,et al.Iliac vein compression in an asymptomatic patient population[J].Chin Med J (Engl),2004,39(5):937-943.
- [9]PRIMIGNANI M,TOSETTI G.Etiology of non-cirrhotic portal vein thrombosis in children:Few or many causes?[J].Dig Liver Dis,2020,52(1):118-120.
- [10]王首骏,王帅兵,王彤,等.乳腺癌术后发生下肢深静脉血栓的危险因素及血栓风险评估[J].中国肿瘤临床,2017,44(23):1199-1203.
- [11]PIAZZA G,SEDDIGHZADEH A,GOLDHABER S Z.Deep-vein thrombosis in the elderly[J].Clin Appl Thromb Hemost,2008,14(4):393-398.
- [12]ZUO J,HU Y.Admission deep venous thrombosis of lower extremity after intertrochanteric fracture in the elderly:a retrospective cohort study[J].J Orthop Surg Res,2020,15(1):549
- [13]SILVERSTEIN R L,BAUER K A,CUSHMAN M,et al.Venous thrombosis in the elderly:more questions than answ-ers[J].Blood,2007,110(9):3097-3101.
- [14]STOKES S,BREHENY P,RADULESCU A,et al.Impact of obesity on the risk of venous thromboembolism in an inpatient pediatric population[J].Pediatr Hematol Oncol,2014,31(5):475-480.
- [15]DARVALL K A L,SAM R C,SILVERMAN S H,et al.Obesity and thrombosis[J].Eur J Vasc Endovasc Surg,2007,33(2):223-233.
- [16]GRIFFIN M R,STANSON A W,BROWN M L,et al.Deep venous thrombosis and pulmonary embolism:risk of subseq-uent malignant neoplasms[J].Arch Intern Med,1987,147(11):1907-1911.
- [17]MONREAL M,LAFOZ E,CASALS A,et al.Occult cancer in patients with deep venous thrombosis.A systematic appr-oach[J].Cancer,1991,67(2):541-545.
- [18]ZARROUK M,SALIM S,ELF J,et al.Testing for thromb-ophilia in mesenteric venous thrombosis-Retrospective original study and systematic review[J].Best Pract Res Clin Gastro-enterol,2017,31(1):39-48.
- [19]石波,刘家开,李景,等.彩色多普勒超声联合Padua预测量表对老年全膝关节置换术后下肢深静脉血栓形成的诊断价值分析[J].中国医学前沿杂志(电子版),2020,12(4):85-88.
- [20]ORKEN D N,KENANGIL G,OZKURT H,et al.Prevention of deep venous thrombosis and pulmonary embolism in patients with acute intracerebral hemorrhage[J].Neurologist,2009,15(6):329-331.