下肢关节置换术后下肢深静脉血栓形成的影响因素分析及防治对策

Influencing Factors for Occurrence of Deep Venous Thrombosis after Lower Extremity Joint Replacement and Countermeasures

目的探讨下肢关节置换术后下肢深静脉血栓形成(DVT)的影响因素,并有针对性地提出临床防治对策。方法采用病例对照研究方法,选取医院2011年1月至2014年1月行全膝关节置换术与全髋关节置换术术后下肢DVT的患者106例作为研究对象(DVT组),选取同期行上述关节置换术术后无下肢DVT的120例患者为对照组(非DVT组),通过单因素分析及Logistic回归模型探求下肢关节置换术后发生下肢DVT的独立影响因素。结果单因素分析表明,DVT组与非DVT组在年龄、体重指数、是否糖尿病患者、凝血指标是否异常、手术类型、置换关节数、假体类型、术中出血量及术后机械抗凝类型等指标构成差异显著(P<0.05)。Logistic逐步回归模型显示年龄60岁以上、手术类型(全膝关节置换术)、合并糖尿病(、凝血指标异常、使用骨水泥型假体、术后物理抗凝类型(未使用下肢血液循环泵)等指标是术后下肢DVT的独立危险因素(P<0.05)。结论高龄、凝血功能异常、手术类型、糖尿病、假体类型、术后物理抗凝类型是下肢关节置换术后下肢DVT的独立危险因素,针对这些因素强化术前辅助检查与评估、术后监测与积极预防性抗凝治疗是预防下肢DVT的必要和有效措施。

Objective To investigate the influencing factors of lower extremity deep venous thrombosis （ DVT ） after lower extremity re-placement and to pertinently put forward the clinical countermeasure of prevention and treatment. Methods The case control study method was adopted. 106 patients with lower extremity DVT after total knee replacement （ TKR ） and total hip replacement （ THR ） in our hospital from January 2011 to January 2014 were selected as the research subjects （ DVT group ） , and contemporaneous 120 cases of above arthroplasty without lower extremity DVT were selected as the control group. The independent influencing factors for the occur-rence of lower extremity DVT were investigated by the single factor analysis and the logistic regression model. Results The single fac-tor analysis showed that the DVT group and the contrd group were obviously different from each other in the age, body mass index, complicating diabetes, coagulation abnormalities, operation type, joint replacement numbers, prosthesis type, intraoperative bleeding volume, postoperative mechanical anticoagulation type （ P 〈 0. 05 ） . The stepwise logistic regression model showed that the age above 60 years, type of operation, complicating diabetes mellitus, abnormal coagulation indexes, use of bone cement prosthesis and postoperative physical anticoagulation type （ without use of lower limb blood circulation pump ） were the independent risk factors for lower extremity DVT oc-currence （ P 〈 0. 05 ） . Conclusion Advanced age, coagulation abnormalities, operation type, diabetes mellitus, type of prosthesis and post-operative physical anticoagulation type are the independent risk factors for the occurrence of lower extremity DVT after lower limb arthroplasty, aiming at above factors, strengthening the preoperative auxiliary examination and evaluation, postoperative monitoring and ac-tively preventive anticoagulation therapy are necessary and effective measures for preventing lower extremity DVT.