不同患肢和年龄的继发性下肢深静脉血栓患者诱发因素分析

Predisposing Factors for Secondary Lower Extremity Deep Venous Thrombosis among Patients with Different Affected Limbs and Age

目的探讨不同患肢、年龄的继发性下肢深静脉血栓(DVT)患者诱发因素的差异,为下肢DVT的预防、诊断和治疗提供参考。方法选取2011年1月—2014年6月南昌大学第二附属医院血管外科收治的783例下肢DVT患者为研究对象,记录患者临床资料,包括性别、年龄、下肢DVT分型、患肢,以及可能的诱发因素,包括近期手术史、创伤骨折、制动/瘫痪、恶性肿瘤、血管内操作,女性患者子宫切除、口服避孕药、妊娠/产褥期等。结果右下肢DVT患者158例(20.2%),左下肢582例(74.3%),双下肢43例(5.5%)。不同患肢的下肢DVT患者性别、下肢DVT分型比较,差异有统计学意义(P<0.05)。男性、女性右下肢继发性DVT患者创伤骨折比例低于左下肢,恶性肿瘤比例高于左下肢(P<0.05)。下肢DVT患者中青年(≤39岁)151例(19.3%),中年(40~64岁)424例(54.1%),老年(≥65岁)208例(26.6%)。不同年龄患者性别、下肢DVT分型比较,差异均有统计学意义(P<0.05)。青年男性继发性肢DVT患者诱发因素主要为创伤骨折(39.1%)、近期手术(26.1%)、血管内操作(26.1%),中年、老年男性继发性下肢DVT患者诱发因素主要为近期手术(50.9%、45.2%)、创伤骨折(38.6%、35.7%)。青年女性继发性下肢DVT患者诱发因素主要为妊娠/产褥期(85.7%),中年女性继发性下肢DVT患者诱发因素主要为近期手术(57.7%),老年女性继发性下肢DVT患者诱发因素主要为创伤骨折(47.9%)和近期手术(43.8%)。结论右下肢继发性DVT患者创伤骨折比例低于左下肢,恶性肿瘤比例高于左下肢。青年男性继发性下肢DVT患者诱发因素主要为创伤骨折、近期手术、血管内操作,中年、老年男性继发性下肢DVT患者诱发因素主要为近期手术、创伤骨折。青年女性继发性下肢DVT患者诱发因素主要为妊娠/产褥期,中年女性继发性下肢DVT患者诱发因素主要为近期手术,老年女性继发性下肢DVT患者诱发因素主要为创伤骨折和近期手术。

Objective To study the differences in the predisposing factors for secondary lower extremity deep venous thrombosis（ 下肢 DVT） among patients with different affected limbs and age,and to provide references for the prevention,diagnosis and treatment of DVT.Methods A total of 783 DVT patients who were treated in Department of Vascular Surgery,the Second Affiliated Hospital of Nanchang University from January 2011 to June 2014,were selected as study subjects.The clinical data including gender,age,the classification of DVT,and affected limbs,and the possible predisposing factors for DVT including history of recent surgery,traumatic fracture,immobilization / paralysis,malignancy,intravascular procedure,and hysterectomy,oral contraceptives,conception / puerperium of female patients,were recorded.Results Of the 783 patients,158（ 20.2%） had DVT in the right leg,582（ 74.3%） in the left leg and 43（ 5.5%） in both legs.There were significant differences in gender and classification of DVT among DVT patients with different affected limbs（ P〈0.05）.In male and female secondary DVT patients,the percentage of traumatic fracture in right DVT patients was significantly lower than that in left DVT patients（ P〈0.05）,and the percentage of the malignant tumor in right DVT patients was higher than that in left DVT patients（ P〈0.05）.In DVT patients,151 cases（ 19.3%） were young（ ≤39 years）,424 cases（ 54.1%） were middle-aged（ 40-64 years）,208 cases（ 26.6%） were elderly（ ≥65 years）.There were significant differences in gender and classification of DVT among different age groups of DVT patients（ P〈0.05）.The major predisposing factors for young male secondary DVT patients were traumatic fracture（ 39.1%）,recent surgery（ 26.1%）,intravascular procedure（ 26.1%）; the major predisposing factors for middle-aged and elderly male secondary DVT patients were recent surgery（ 50.9%,45.2%）,traumatic fracture（ 38.6%,35.7%）.The major predisposing factors were conception / puerperium（ 85.7%） among young female secondary DVT patients,recent surgery（ 57.7%） among middle-aged female secondary DVT patients,traumatic fracture（ 47.9%） and recent surgery（ 43.8%） among elderly female secondary DVT patients.Conclusion The percentage of traumatic fracture is lower,and malignancy is higher in right secondary DVT patients than those in left secondary DVT patients.The major predisposing factors for young male secondary DVT patients are traumatic fracture,recent surgery,and intravascular procedure,and middle-aged and elderly male secondary DVT patients are recent surgery and traumatic fracture.The major predisposing factors are conception / puerperium for young female secondary DVT patients,recent surgery for middle-aged female secondary DVT patients,traumatic fracture and recent surgery for elderly female secondary DVT patients.