| 王志猛,王彪,路遥,等.脊柱损伤病人术前深静脉血栓发生情况及其危险因素分析.骨科,2019,10(3): 193-197. |
| 脊柱损伤病人术前深静脉血栓发生情况及其危险因素分析 |
| Preoperative incidence and risk factors of deep venous thrombosis in patients with spine injury |
| 投稿时间：2018-12-26 |
| DOI：10.3969/j.issn.1674-8573.2019.03.005 |
| 中文关键词: 脊柱骨折 深静脉血栓形成 发生率 危险因素 Logistic回归分析 |
| 英文关键词: Spinal fractures Deep vein thrombosis Incidence Risk factors Logistic regression analysis |
| 基金项目:陕西省自然科学基金（2017ZDXM-SF-009） |
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| 中文摘要: |
| 目的 观察脊柱损伤病人术前下肢深静脉血栓形成（deep vein thrombosis, DVT）的发生情况，并分析其危险因素。方法 回顾性分析2017年3月至2017年12月西安市红会医院收治的422例脊柱损伤病人的临床资料，根据入院时下肢静脉超声诊断结果将其分为DVT组和非DVT组。先通过单因素分析比较两组间的年龄、性别、骨折部位、受伤至首次行超声检查时间、吸烟、入院时实验室检查（纤维蛋白原、D-二聚体、血红蛋白、血细胞比容）、合并内科疾病（原发性高血压、糖尿病、冠心病）、美国脊髓损伤协会（American Spinal Injury Association, ASIA）分级、颈部及下肢超声检查结果等因素，再采用Logistic回归分析确定其独立危险因素。结果 422例脊柱损伤病人中，术前并发DVT者83例（19.7%），未发生DVT者339例（80.3%）。分析DVT组与非DVT组的组间数据，ASIA分级、合并有原发性高血压、吸烟、血红蛋白及血细胞比容水平、受伤至首次超声检查时间、伴发大血管斑块形成、伴发大血管硬化比较，差异均有统计学意义（P均＜0.05）。Logistic回归分析发现，ASIA分级为A级或B级（P=0.005，OR=6.153，95%CI：0.065~0.607）、合并原发性高血压（P=0.019，OR=2.270，95%CI：0.255~0.882）、吸烟（P=0.006，OR=2.116，95%CI：0.230~0.780）、受伤至首次超声检查时间＞7 d（P=0.033，OR=1.956，95%CI：1.054~3.628）、伴发大血管硬化（P=0.006，OR=1.299，95%CI：1.078~1.565）为脊柱损伤病人术前DVT的独立危险因素。结论 脊柱损伤病人术前DVT的发生率较高，其中ASIA分级为A级或B级、合并原发性高血压、吸烟、受伤至首次超声检查时间＞7 d、伴发大血管硬化是脊柱损伤病人术前DVT发生的独立危险因素。 |
| 英文摘要: |
| Objective To investigate the incidence and risk factors of deep vein thrombosis (DVT) in lower extremities before surgery for traumatic spinal injury. Methods Data of 422 patients with traumatic spinal fractures admitted to Xi'an Red Cross Hospital from March 2017 to December 2017 were retrospectively analyzed. Patients were divided into DVT group and non-DVT group according to the results of venous ultrasound diagnosis of lower limbs at admission. Firstly, the age, sex, fracture, time from injury to first ultrasonic examination, smoking, laboratory examination on admission (fibrinogen, D-dimer, hemoglobin, hematocrit), merge medical disease (primary hypertension, diabetes, coronary atherosclerosis, heart disease), American Spinal Injury Association (ASIA) grade and the results of lower limb ultrasound were compared by single factor analysis. Then the Logistic regression analysis was used to determine the independent risk factors. Results Out of 422 patients with spinal injury, 83 (19.7%) had DVT before operation, and 339 (80.3%) had no DVT. The data between DVT group and non-DVT group were analyzed, and there were significant differences in ASIA classification, concurrent essential hypertension, smoking, hemoglobin and hematocrit levels, time from injury to first ultrasonic examination, concurrent macrovascular plaque formation and macrovascular sclerosis (P＜0.05 for all). Logistic regression analysis revealed ASIA (a-b) (P=0.005, OR=6.153, 95%CI: 0.065-0.607), primary hypertension (P=0.019, OR=2.270, 95%CI: 0.255-0.882), smoking (P=0.006, OR=2.116, 95%CI: 0.230-0.780), time from injury to first ultrasonic examination >7 days (P=0.033, OR=1.956, 95%CI: 1.054-3.628), and macrovascular sclerosis (P=0.006, OR=1.299, 95%CI: 1.078-1.565) were independent risk factors for DVT in patients with spinal injury before surgery. Conclusion The incidence of DVT in patients with spinal injury before surgery is high, among which ASIA (a-b), primary hypertension, smoking, time from injury to first ultrasonic examination ＞7 days, and concurrent macrovascular sclerosis are independent risk factors for DVT before surgery. |
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