老年髋部骨折术前下肢深静脉血栓形成高危因素及抗凝治疗分析

High risk factors and anticoagulant therapy of deep vein thrombosis in lower limbs before operation in elderly patients with hip fractures

目的探讨老年髋部骨折术前下肢深静脉血栓形成(DVT)的独立危险因素并评价抗凝治疗方案,为临床制定合理的抗凝方案提供参考。方法笔者回顾性分析自2014-01—2015-12诊治的536例老年(≥60岁)髋部骨折。对纳入的患者术前发生DVT的可疑危险因素(年龄、性别、是否多处骨折、是否合并恶性肿瘤病史、高脂血症、静脉血栓栓塞症病史、吸烟史、发生骨折至入院时间、糖尿病史等)进行统计分析,得到独立危险因素。对患者抗凝药物的使用情况进行整理分析,参照最新指南评价抗凝治疗方案是否合理。结果共纳入203例,其中术前并发DVT 53例。Logistic回归分析得出高脂血症、抗血小板药物服用史、静脉血栓栓塞症病史、发生骨折至入院时间、骨折前是否长期卧床是独立危险因素(P<0.05)。入组患者在住院期间均使用低分子肝素进行DVT的防治,但是剂量疗程有所不同。结论合并高脂血症、既往静脉血栓栓塞症病史、骨折前长期卧床是老年髋部骨折术前并发DVT的独立危险因素,而骨折前有抗血小板药物服用史、发生骨折至入院时间<24 h则是有利因素。老年髋部骨折患者抗凝方案基本符合指南推荐,但合理性仍有待改进。

Objective To investigate the independent risk factors of lower limb deep venous thrombosis （DVT） before operation in elderly patients with hip fractures and evaluate the treatment plans. Methods Five hundred and thirty six elderly patients （≥60 years old） with hip fractures from January 2014 to December 2015 were retrospectively analyzed. The statistical method was used to analyze the suspicious risk factors of preoperative patients with DVT （age, sex, with multiple fractures, history of malignant tumor, hyperlipidemia, history of vein thromboembolism, smoking, fracture time, history of diabetes） to find independent risk factors. The use of anticoagulant drugs in the patients was also analyzed and the rationality of their anticoagulation therapy was evaluated according to the latest guidelines. Results Two hundred and three cases were included in the study, and 53 cases had preoperative DVT. The results of logistic regression analysis showed： hyperlipidemia, history of taking antiplatelet drugs, history of venous thromboembolism, fracture time and history of long-term lying in bed before fracture were the independent risk factors （P 〈0.05）. Low molecular weight heparin was used as anticoagulation therapy during hospitalization of all the patients, hut in different dose and course. Conclusion Hyperlipidemia, history of venous thromboembolism and long-term lying in bed before fractures are the independent risk factors of preoperative DVT in elderly patients with hip fracture. History of taking antiplatelet drugs and fracture time less than 24 h are favorable factors. The anticoagulation therapy of the elderly patients with hip fracture in our＇ hospital was routine in accordance with the guidelines, but the rationality is still to be improved.