文章摘要
冯泉,李杰,薛汉中,孙亮,杨娜,田丁,何晓,张堃.下肢骨折病人术后35天内深静脉血栓的发生情况及危险因素分析.骨科,2020,11(6):541-546
下肢骨折病人术后35天内深静脉血栓的发生情况及危险因素分析
Occurrence and risk factors of deep vein thrombosis in patients with lower extremity fractures within 35 days after surgery
投稿时间:2020-03-05  
DOI:10.3969/j.issn.1674-8573.2020.06.014
中文关键词: 下肢骨折  出院后  深静脉血栓  术后35 d
英文关键词: Lower extremity fracture  After discharge  Deep vein thrombosis  Thirty-five days after surgery
基金项目:陕西省重点研发计划(2017ZDXM-SF-009)
作者单位E-mail
冯泉 西安交通大学医学院附属红会医院创伤骨科西安 710054延安大学医学院陕西延安 716000  
李杰 西安交通大学医学院附属红会医院创伤骨科西安 710054  
薛汉中 西安交通大学医学院附属红会医院创伤骨科西安 710054  
孙亮 西安交通大学医学院附属红会医院创伤骨科西安 710054  
杨娜 西安交通大学医学院附属红会医院创伤骨科西安 710054  
田丁 西安交通大学医学院附属红会医院创伤骨科西安 710054  
何晓 延安大学医学院陕西延安 716000  
张堃 西安交通大学医学院附属红会医院创伤骨科西安 710054 hhyyzk@126.com 
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中文摘要:
      目的 探讨下肢骨折病人出院后35 d内深静脉血栓形成(deep vein thrombosis, DVT)的发生率及危险因素。方法 回顾性分析2014年7月至2017年7月西安交通大学医学院附属红会医院创伤骨科收治的402例住院期间未发生DVT的下肢骨折病人的临床资料。所有病人术前、术后都常规用物理方法和药物抗凝预防DVT,嘱咐病人出院后口服利伐沙班抗凝至术后35 d,记录术后35 d复查时双下肢DVT的发生情况。根据术后35 d门诊复查双下肢超声结果将病人分为DVT组和非DVT组,分析比较两组病人的性别、年龄、骨折部位、身体质量指数、合并其他骨折、合并内科疾病、术后的实验室检查(D-二聚体)、术后住院时间的差异,对上诉结果中差异有统计学意义的变量进一步采用多因素Logistic回归分析,分析病人出院后DVT的危险因素。结果 402例下肢骨折病人出院后发生DVT的有56例(13.9%),其中2例(0.50%)发生肺栓塞,2例均合并有小腿肌间静脉血栓,1例发生在术后3周,1例在术后4周发生致死性肺栓塞。周围型52例,单纯中央型0例,混合型4例。膝关节以近的骨折病人DVT发生率为15.5%(36/232),膝关节周围骨折病人DVT发生率为13.8%(8/58),膝关节以远骨折病人DVT发生率10.7%(12/112)。两组间年龄、合并其他骨折、术后住院时间、冠心病、术后1 d D-二聚体、出院时D-二聚体的差异有统计学意义(P<0.05),多因素Logistic回归分析显示年龄>60岁[OR=3.207,95% CI(2.007,8.553),P=0.009]、合并其他骨折[OR=7.111,95% CI(2.297,22.011),P<0.001]、术后住院时间<7 d[OR=1.448,95% CI(1.225,1.718),P=0.020]、出院时D-二聚体偏高[OR=1.355,95% CI(0.892,12.626),P=0.027]是出院后DVT的独立危险因素。结论 虽然出院前常规使用物理方法和药物抗凝预防DVT,出院后嘱咐病人口服利伐沙班35 d,但是出院时没有DVT的下肢骨折病人术后35 d仍有发生DVT的可能(13.9%),严重者还会发生肺栓塞,年龄、合并其他骨折、术后住院时间较短、出院时D-二聚体是出院后DVT发生的独立危险因素。
英文摘要:
      Objective To evaluate the incidence and risk factors of deep vein thrombosis (DVT) in patients with lower limb fractures within 35 d after surgery. Methods A retrospective study was performed on 402 cases of lower extremity fractures who did not have DVT during hospitalization in Hong Hui Hospital of Xi'an Jiaotong University School of Medicine from July 2014 to July 2017. All patients were routinely given physical methods and drugs to prevent blood clots before and after surgery, and the patients who were discharged from the hospital were given oral anticoagulant drugs for 35 d. The incidence of DVT of the lower extremities 35 days after surgery was recorded. The patients were divided into DVT group and non-DVT group according to the results of double lower extremity ultrasound 35 d after surgery, The gender, age, fracture site, body mass index, concomitant fractures, concomitant medical diseases, postoperative laboratory examination (D-dimer) and hospital stay between two groups were compared. The multivariate Logistic regression analysis was used to analyze the variables with statistical significance in the appeal results and the risk factors of DVT after discharge. Results Of the 402 patients, 56 (13.9%) patients developed DVT after discharge, including 2 cases (0.50%) of pulmonary embolism concomitant to calf muscle venous thrombosis: one case at 3rd week after surgery, and one case of lethal pulmonary embolism at 4th week after surgery. There were 52 cases of peripheral thrombus, no central thrombosis, and 4 cases of mixed thrombus. The incidence of DVT in patients with proximal fractures of the knee was 15.5% (36/232). The incidence of DVT in patients with fractures around the knee was 13.8% (8/58). The incidence of DVT in patients with distal knee fractures was 10.7% (12/112). The difference in age, concomitant other fractures, postoperative hospital stay, coronary heart disease, D-dimer at 1st d postoperatively and D-dimer at discharge between two groups was statistically significant (P<0.05). Multivariate Logistic regression analysis showed age >60 years old [OR=3.207, 95% CI (2.007, 8.553), P=0.009], concomitant other fractures [OR=7.111, 95% CI (2.297, 22.011), P<0.001], and postoperative hospital stay <7 d [OR=1.448, 95% CI (1.225, 1.718), P=0.020] and D-dimer at discharge [OR=1.355, 95% CI (0.892, 12.626), P=0.027] were independent risk factors for DVT after discharge. Conclusion Although physical methods and drugs are used routinely to prevent DVT before discharge, and after discharge, the patients took rivaroxaban orally for 35 d, patients with lower limb fracture without DVT at discharge were still likely to have DVT 35 days after operation (13.9%), and pulmonary embolism was also found in severe cases. Age, concomitant fractures, and postoperative hospital stay and D-dimer at discharge were independent risk factors for DVT after discharge.
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