急性创伤性脊髓损伤患者深静脉血栓形成的危险因素分析

Risk factors of deep vein thrombosis in patients with acute traumatic spinal cord injury

目的研究手术前未接受任何抗凝治疗的脊柱骨折合并脊髓损伤患者早期的DVT发病率，并进行危险因素分析，探讨可能从早期抗凝治疗中获益的人群。方法回顾性收集本院2013年1月至2013年12月所有手术前未接受任何抗凝治疗的脊柱骨折合并脊髓损伤患者的临床数据。所有患者均于术前接受彩色多普勒超声检查评估是否有下肢静脉血栓形成。用Logistic回归分析方法针对可能影响深静脉血栓形成的因素进行相关性分析。结果在纳入分析的143例患者中，46例（32．2％）患者下肢深静脉超声检查阳性（近端n=15，远端n=31）。平均诊断时间为伤后（3．35±1．65）d，其中43例（98％）患者于伤后一周内确诊。Logistic回归分析显示完全性运动障碍、下肢长骨骨折（P=0．010）、腰髓损伤（P=0．001）是深静脉血栓形成的独立危险因素。结论创伤性脊髓损伤患者在受伤早期已有深静脉血栓形成，且发病率较高。完全性运动障碍、合并下肢长骨骨折、腰髓损伤是深静脉血栓形成危险因素，此类患者可能从早期抗凝治疗中获益。

Objective To investigate the incidence and risk factors of deep vein thrombosis （DVT） in a cohort of Chinese patients with traumatic spinal cord injury （ TSCI）, and in addition, to evaluate the effect of injury types and concomitant injuries of other parts of body. Method Records of 143 casualties admitted to our institute for TSCI were analyzed retrospectively. Both lower extremities of all casualties were examined routinely with color Doppler uhrasonography （ CDUS ） before major surgical treatment. None of these casualties received any thromboprophylaxis before CDUS. Logistic regression was used to analyze risk factors of DVT. Results Of the 143 patients, 32. 2% （ n = 46 ） suffered from DVT （ proximal n = 15, distal n = 31 ）. All casualties were diagnosed within one week after injury （mean 3.35 ± 1.65 days）. Risk factors associated with DVT induced complete motor paralysis （odds ratio [ OR] 5.05, 95% C1 1.70- 14. 90）, concomitant fracture of lower extremities （ OR 4. 30, 95% CI 1.34-17.64）, and lumbar vertebra injury （OR 4. 29. 95% CI 1.50-10. 83 ）. Conclusions Clinically detectable DVT in TSCI are not uncommon in the Chinese population. Casualties with multiple risk factors may be benefited from early administration of thromboprophylaxis.