髋关节置换术后患者下肢深静脉血栓形成的危险因素

RISK FACTORS FOR DEEP VEIN THROMBOSIS IN LOWER EXTREMITY AFTER HIP JOINT REPLACEMENT

目的分析髋关节置换术后患者下肢深静脉血栓(deep vein thrombosis,DVT)形成的危险因素。方法 2005—2008年接受髋关节置换术的患者200例,年龄45～88岁。术后2周行双侧下肢静脉Duplex彩色超声检查,观察DVT形成的情况,根据是否形成DVT,分为非DVT组和DVT组。记录围术期有关患者、手术和麻醉方面的临床资料。结果术后下肢DVT发生率38%,而近端DVT发生率3%。与非DVT组比较,DVT组年龄大,麻黄碱使用率及其用量增加,麻醉时间延长,术后1 d白细胞计数及术后最高白细胞计数明显升高(P<0.05);Logistic回归分析结果显示,上述因素与下肢DVT有关(r=0.91 3,P<0.05)。结论髋关节置换术后患者下肢DVT的危险因素为年龄>75岁,使用麻黄碱>25 mg、麻醉时间>3.5 h及术后白细胞计数明显升高。

Objective To determine the factors which contribute to the development of deep vein thrombosis（DVT） in lower extremity in patients after hip joint replacement. Methods Two hundred patients receiving hip joint replacement from 2005 to 2008 were included in this study. Their age ranged from 45 to 88 years. Bilateral lower extremity vein Duplex color ultrasound was performed before and 2 weeks after operation for detection of DVT. The patients were divided into DVT and DVT-free groups based on the development of DVT after operation. Detailed perioperative clinical information about the patients, surgery and anesthesia was collected. Results Low extremity DVT was found in 38% of the patients after operation. The incidence of proximal DVT was 3%. The age was older, the rate of ephedrine administration was significantly higher and the amount of ephedrine given was larger in DVT group than in DVT-free group. Duration of anesthesia was significantly longer and WBC count on the 1st postoperative day was significantly higher in DVT group than in DVT-free group （ P 〈 0.05）. Logistic analysis indicated that the above factors were closely related to DVT. Conclusion Age 〉75 year, ephedrine administration 〉25 mg,duration of anesthesia 〉3.5 h and marked increase in WBC count after operation are the risk factors for DVT in lower extremity after hip joint replacement.