胸外科术后重症患者下肢深静脉血栓形成及其凝血状态分析

Incidence of Lower Limb Deep Venous Thrombosis and Coagulation Status in Severe Patients after Thoracic Surgery

背景与目的分析胸外科术后重症患者住重症加强护理病房(intensive care unit, ICU)期间的下肢深静脉血栓(deep venous thrombosis, DVT)发生率与凝血指标。方法回顾性分析2016年7月-2018年6月接受物理预防血栓的胸外科术后重症患者,将床旁下肢静脉超声、血常规、凝血四项、血栓弹力图等结果完善的病例纳入研究,对发生血栓人群的一般信息、病种、手术方式、凝血指标等进行分析。结果共纳入患者50例,年龄22岁-80岁,男34例,女16例。共有11例患者出现小腿深静脉血栓(22.0%),男性发生术后血栓的比例为29.4%(10/34),女性为6.3%(1/16)。恶性肿瘤的DVT发生率为23.5%(8/34),非恶性肿瘤的发生率为18.6%(3/16)。比较发生血栓和未发生血栓组的血小板计数、凝血四项、血栓弹力图等,除活化部分凝血活酶时间血栓组较无血栓组显著延长外,余无统计学差异。结论即便在充分物理预防的基础上,胸科术后重症患者下肢深静脉血栓仍为高发,且男性、恶性肿瘤患者多见;术后超声筛查有助于早期发现DVT。

Background and objective The aim of this study was to analyze the incidence of lower limb deep ve- nous thrombosis (DVT)and the corresponding coagulation status in severe patients after thoracic surgery.Methods Severe patients after thoracic surgery who received mechanical prophylaxis of lower limb DVT between July 2016and June 2018were analysed retrospectively.Their general information,disease species,surgical treatment,and coagulation index were reviewed. Results Fifty patients were finally included.There were 34male and 16female,aging from 22to 80years.The incidence of DVT was 22.0%,all of them were isolated calf DVT.The incidence was 29.4%in male patients,while 6.3%in female; 23.5%in malignant diseases and 18.6%in benign.MI coagulation index presented no statistical difference between patients with and without DVT,except activated partial thromboplastin time (APTT).Conclusion Even on the basis of adequate mechanical prophylaxis,lower limb DVT is common in severe patients after thoracic surgery.Meanwhile,male patients and malignant diseases are more suscepted.