髋部周围骨折术后深静脉血栓形成因素的Logistic回归分析

A binary logistic regression analysis of deep venous thrombosis after hip fracture surgery

目的 研究髋部周围骨折术后深静脉血栓形成（DVT）的发生率,探讨其致病因素、保护因素及预防对策.方法 回顾性分析2005年1月至2010年5月收治的441例髋部周围骨折行大型手术的患者,男223例,女218例;年龄22～87岁,平均65.7岁.以性别、年龄、手术时间、手术方式、麻醉方式、输血、物理预防、药物预防及合并症为自变量,DVT的发生率为因变量,进行Logstic回归分析. 结果 441例患者术后获平均17.2个月（3个月～4年7个月）随访.其中69例发生DVT,发生率为15.6%.经分析进入Logstic回归方程的因素是：手术时间、麻醉方式、输血、物理预防、药物预防及合并症（P＜0.05）.其中手术时间、全身麻醉、输血、合并症（原发性高血压及糖尿病）是DVT的危险因素,物理预防和药物预防是保护因素.年龄、性别和手术方式对发生DVT的影响差异无统计学意义（P＞0.05）. 结论髋部周围骨折术后易并发DVT.围手术期仔细评估血栓形成的相关因素,避免全身麻醉或输血,缩短手术时间,控制合并症,术后积极采用物理及药物预防措施,高危患者相应延长抗凝治疗时间,对降低DVT的发生率有重要意义.

Objective To explore the incidence, etiological and protective factors, and preventive countermeasures of deep venous thrombosis （DVT） in patients undergoing hip surgery. Methods Four hundred and forty-one patients who had hip fracture surgery in our department from January, 2005 to May, 2010were analyzed retrospectively. They were 223 males and 218 females, aged 65.7 years. （range, 22 to 87）. A binary logistic regression was performed, using gender, age, duration of surgery, surgery type, anesthesia type, blood transfusion, physical therapy, thrombo-prophylaxis and complication as covariates, taking DVT incidence as the dependant variable. Results The patients obtained a median follow-up of 17.2 months （range, 3 months to 4 years and 7 months）. Sixty-nine patients developed DVT （incidence, 15.6%）.Analysis of multiple variables showed that duration of surgery, anesthesia type, blood transfusion, hypertension and diabetes were risk factors to DVT. Physical therapy and thrombo-prophylaxis were protective factors.Age, gender and surgery type had no statistically significant influence on DVT （P 〉 0.05）. Conclusions The DVT incidence after hip fracture surgery is high. In order to decrease the DVT incidence, surgeons should try their best to estimate risk factors for every patient perioperatively, avoid general anesthesia or blood transfusion, shorten operating duration, effectively control complications, actively perform physical therapy or thrombo-prophylaxis, and prolong the anticoagulant therapy for patients with higher risk factors.