胃肠外科围手术期下肢深静脉血栓形成的临床分析

Clinical characteristics and risk factors of deep venous thrombosis of lower extremities in patients of gastrointestinal surgery

目的探讨胃肠外科围手术期下肢深静脉血栓（deep verlous thrombosis，DVT）形成的临床特点和危险因素。方法应用彩色多普勒超声动态监测2014年11月至2015年8月郑州大学第一附属医院胃肠外科收治的所有符合入组标准的120例胃肠道疾病手术患者围手术期下肢深静脉血栓形成情况，统计所有患者手术前后DVT相关临床指标，并分析其对下肢DVT形成的影响。结果在120例患者中，术后出现下肢DVT的有49例（40．8％），其中左下肢24例（49．0％），右下肢10例（20．4％），双下肢15例（30．6％），以无症状型肌问静脉血栓为临床表现的有48例（98％），发生在术后2h内的有36例（73．5％）。多因素logistics回归分析结果显示：年龄〉60岁、恶性肿瘤、超重（BMI≥24kg／m。）、术后D-二聚体水平升高〉1mg／L、术后感染与下肢DVT发生密切相关。结论术后2h内无症状性肌间静脉血栓是胃肠外科围手术期下肢DVT的主要类型，左下肢DVT发生率较高，高龄（年龄〉60岁）、恶性肿瘤、术后感染、D．二聚体水平升高〉1mg／L、超重是胃肠外科下肢DVT形成的独立危险因素。

Objective -To study the clinical characteristics and risk factors of lower extremity deep venous thrombosis （DVT） during perioperative period of gastrointestinal surgery. Methods Color Doppler ultrasound was used for detecting lower extremity deep venous thrombosis in 120 patients undergoing gastrointestinal surgery from November 2014 to August 2015 in the First Affiliated Hospital of Zhengzhou University. Results There were 49 cases （40. 8% ） of lower extremity DVT after operation, including 24 cases （49%） of left lower extremity, 10 cases （20.4%） of right lower extremity,and 15 cases （30.6%） of both lower extremities. 48 cases （98%） were asymptomatic muscular venous thrombosis. 73.5% （36 cases） DVT occurred within 2 hours postoperatively. Multiple logistic regression analysis showed that age over 60 years, malignant tumor, overweight （BMI ≥ 24 kg/m2）, D-dimer increment 〉 1 mg/L, postoperative infection were closely related to the occurence of deep venous thrombosis of the lower extremities. Conclusion Asymptomatic muscular venous thrombosis within 2 hours after surgery is the main type of lower limb thrombosis in the perioperative gastrointestinal surgery. Age over 60 years, malignant tumor, postoperative infection, D-dimer increment 〉 1 mg/L, overweight are independent risk factors for lower extremity DVT after gastrointestinal surgery.