神经外科病人术后下肢深静脉血栓危险因素分析

An analysis on the risk factors leading to deep venous thrombosis in lower extremities in patients after neurosurgical intervention

目的分析神经外科术后病人下肢深静脉血栓(DVT)形成的危险因素。方法收集北京友谊医院神经外科15个月内(2013年3月至2014年5月)下肢深静脉血栓的病人42例。予以术前,术后3 d、7 d、10 d、14 d检查下肢静脉超声,而后每7天复查一次超声。记录病人性别、年龄、诊断、既往病史、饮酒史、术中失血量、病理、术后神志、脱水剂应用及下肢深静脉血栓形成时间。结果 42例神经外科术后DVT患者中男性18例(42.9%),女性24例(57.1%);年龄15~80岁,平均年龄58.54±13.55岁;糖尿病史3例(7.1%),饮酒史9例(21.4%)。术中失血5~1 200 ml,平均失血量229.71±280.14 ml。血管相关疾病12例(28.6%);肿瘤21例(50%);其他神经外科疾病9例(21.4%)。术后神志清29例(69%),嗜睡11例(26.2%),昏迷2例(4.8%)。应用甘露醇7例,用量200~800 g,平均457.14±198.81g/人;平均应用6.29±1.70天/人。应用甘油果糖9例,用量50~300 g,平均256.17±176.78 g/人;平均应用3.89±2.37天/人。DVT血栓发现时间为术后1~16天,平均6.71±3.22天。结论糖尿病史,饮酒史,术中出血量增加,肿瘤,术后神志障碍,脱水剂应用,皆可促进神经外科术后病人下肢DVT的形成。下肢DVT多见于术后第4~7天。

Objective To explore the risk factors for formation of deep vein thrombosis（ DVT） in lower extremity（ LE） in order to avoid the occurrence of this complication. Methods A total of 42 patients with LE DVT in this hospital during March 2013 to May,2014 were entered in this study. Their lower limbs were preoperatively examined by color Doppler ultrasonography（ CDU） on the 3 rd,7 th and 14 th postoperative days,and every 7 days thereafter. If clinical signs and symptoms of LE DVT appeared,CDU will be performed immediately. The gender,age,diagnosis,past medical history,alcohol drinking,intraoperative blood loss,pathological examination,postoperative consciousness,application of dehydrating agent,and occurrent time of LE DVTwere all recorded. Results Among 42 patients,there were 18 males（ 42. 9%） and 24 females（ 57. 1%）,and the age of patients ranged from 15 to 80 years old（ with mean of 58. 54 ± 13. 55 years）,3（ 7. 1%） patients with diabetes mellitus and 9（ 21. 4%） patients with alcohol drinking. The average amount of intraoperative blood loss was 232. 8 ml（ 5 ~ 1 200 ml）. There were 12 cases（ 28. 6%） with vascular diseases,21（ 50. 0%） with tumors,and 9（ 21. 4%） with other neurosurgical diseases. The levels of consciousness in postoperative patients ranged from clearness to coma [clearness in 29 cases（ 69%）,sleepiness in 11（ 26. 2%） and coma in 2（ 4. 8%） ]respectively. Mannitol had been administrated in 7 patients with an average dosage of 457. 1 g（ 200 ~ 800 g） and an average period of 5. 6 days（ 4 ~ 8 days） per person,glycerol fructose had been administrated in 9 patients with an average dosage of 161. 1 g（ 50 ~ 300 g） and an average period of 2. 9 days（ 1 ~ 7 days） per person. The DVT in LE was found between 1 st to 16 th postoperative days（ with average of 6. 9 days）. Conclusion Diabetes mellitus,alcohol drinking,more intraoperative blood loss,tumor entity,consciousness disturbance and administration of dehydrating agent can promote the occurrence of post operative LE DVT in neurosurgical patients. The DVT of LE occurred mostly in the 4 th to 7 th postoperative days in neurosurgical patients.