老年患者全麻下全髋置换术后下肢深静脉血栓发生情况及危险因素

Incidence and risk factors of deep venous thrombosis for the elderly patients with total hip arthroplasty under general anesthesia

目的探讨全麻下全髋置换的老年患者术后下肢深静脉血栓的发生情况及其危险因素。方法选取南京鼓楼医院和南京市浦口医院2015年1月至2018年6月在全麻下择期行全髋置换的老年患者共计398例为研究对象,在术后5～10 d行下肢彩超检查,观察其深静脉血栓的发生情况,对影响术后下肢深静脉血栓发生的危险因素分别进行单因素和多因素Logistic回归分析。结果 398例老年全髋置换患者中有136例出现术后下肢深静脉血栓,发生率为34. 17%; Logistic回归分析结果显示:年龄大于70岁、体质指数大于25 kg/m^2、合并糖尿病、甘油三酯大于等于1. 7 mmol/L、D-二聚体大于等于500μg/L以及手术时间大于2 h等是导致老年患者全髋置换术后深静脉血栓发生的危险因素(OR>1,P <0. 05),而不使用骨水泥、仅置换单侧及术后3 d内下床活动是避免老年患者全髋置换术后深静脉血栓发生的保护性因素(OR <1,P <0. 05)。结论老年、肥胖、合并糖尿病、甘油三酯大于等于1. 7 mmol/L、D-二聚体大于等于500μg/L及较长的手术时间与老年患者全麻下全髋关节置换术后深静脉血栓的发生关系密切,应尽量避免双侧同时置换,鼓励患者术后早期下床活动,以降低老年患者全麻下全髋置换术后深静脉血栓的发生率。

Objective To investigate the incidence and the risk factors of deep venous thrombosis for the elderly patients with total hip arthroplasty under general anesthesia.Methods A total of 398 elderly patients undergoing elective total hip replacement under general anesthesia in Nanjing drum tower medical college and Nanjing Pukou hospital from January 2015 to June 2018 were selected as the study subjects.The incidence of deep venous thrombosis was observed,and color doppler ultrasound was performed in 5~10 days after operation.Single factor analysis and multivariable logistic regression analysis were performed to analyze the risk factors that may affect deep venous thrombosis in patients of hip arthroplasty.Results In 398 elderly patients with hip replacement,136 patients with deep venous thrombosis of the lower extremities were found,and the incidence was 34.17%.The results of logistic regression analysis showed:age >70 years old,body mass index >25 kg/m^2,suffering from diabetes,triglyceride≥1.7 mmol/L,the numerical value of D-Dimer≥500μg/L and the operation time >2 hours were the risk factors of deep venous thrombosis for the elderly patients with hip arthroplasty(OR >1,P<0.05).While without the use of bone cement,only unilateral replacement and out of bed activity within 3 days after operation were the protective factors of deep venous thrombosis for the elderly patients of hip arthroplasty(OR<1,P<0.05).Conclusion Older age,obesity,diabetes mellitus,triglyceride(≥1.7 mmol/L),D-dimer(≥500μg/L)and longer operation time are closely related to the occurrence of deep venous thrombosis after total hip arthroplasty under general anesthesia.Therefore,we should try to avoid bilateral simultaneous replacement,encourage patients to get out of bed early after surgery,and ultimately reduce the incidence of deep vein thrombosis in elderly patients undergoing total hip replacement under general anesthesia.