全髋关节置换术后血栓性疾病危险因素多元回归分析

Multiple regression analysis of risk factors for venous thromboembolism after total hip arthroplasty

目的研究全髋关节置换术（THA）后静脉血栓栓塞（VTE）发生的危险因素。方法回顾性分析2004年1月-2010年1月于昆明医科大学第二附属医院骨科行THA或人工股骨头关节置换术的874例患者，其中男365例（41．8％），女509例（58．2％）；年龄30～94岁，中位年龄为66岁。采用血栓预防（术后2周使用低分子肝素，住院期间均使用双下肢气压泵）298例，未采用血栓预防576例。排除骨科手术原因以外引起的静脉血栓形成者。以VTE的发生为因变量，性别、年龄、体质指数、既往史、手术时间、抗血栓药物等因素为自变量，进行单因素和多因素的非条件性Logistic回归分析。结果共发生VTE304例，采用血栓预防者的VTE发生率为6．0％（18／298），显著低于未采用血栓预防者的49．7％（286／576，P=0．000）。高血压、高脂血症、肺栓塞史、深静脉栓塞史、恶性肿瘤放疗或化疗和手术时间是THA后发生VTE的危险因素（P值均〈0．05）。术后服用抗凝药物是预防VTE的保护因素（P〈0．05）。结论THA后发生VTE的危险因素包括术前、术中和术后因素，理想的抗凝方案应该贯穿整个围术期。

Objective To investigate the risk factors of venous thromboembolism （VTE） after total hip arthroplasty （THA）. Methods A total of 874 patients who underwent THA or artificial thigh bone joint replacement from January 2004 to January 2010, were enrolled in this retrospective study. There were 365 males and 509 females, with a mean age of 66 years （range, 30-94 years）. Low molecular heparin was applied two weeks postoperatively and pressure pump was used in lower limbs during hospital stay in 298 patients. And the prevention of thrombus was not performed in the other 576 patients. The incidence of VTE was taken as dependent variable, and sex, age, body mass index, past history, operative time, and antithrombotics were independent variables. The risk factors of VTE after hip arthroplasty were analyzed by Logistic regression analysis and multivariate statistical analysis. Results Symptomatic VTE occurred in 304 patients totally. The incidence of VTE in the patients with thrombus prevention was significantly lower than those without prevention （6.0% vs. 49.7%, P=0. 000）. Hypertension, hyperlipoidemia, the history of deep venous thrombosis and pulmonarg embolism, chemotherapy, radiotherapy and operative time were closely related to VTE after THA （all P 〈 0. 05）. Antithrombotics could decrease VTE after THA （P=0.05）. Conclusion The risk factors of VTE after THA may originate from the perioperative period. So the prophylaxis for VTE after THA should go through the whole perioperatvie period.