骨科住院患者发生下肢深静脉血栓的相关危险因素分析

Analysis of risk factors associated with deep venous thrombosis in orthopedic inpatients

目的探讨骨科住院患者下肢深静脉血栓(DVT)形成的相关危险因素,为临床护理及预防血栓形成提供参考。方法采用回顾性病例对照方法,选取苏州大学附属第一医院2014年2月至2018年10月148例确诊患有DVT的骨科住院患者作为病例组,同时随机抽取同时期、同科室的148例没有确诊DVT发生的骨科住院患者作为对照组,回顾性分析2组患者在骨科住院期间的电子病史资料以及相关实验室检查指标。对2组患者的性别、年龄、血凝7项等指标以及高血压、糖尿病、DVT史等多个DVT常见危险因素进行统计学分析。结果病例组中患者发生右DVT63例占42.5%,病例组患者出现发热、肺部感染、咳嗽、咳痰、胸闷气短、胸腔积液、便秘临床症状特征与对照组患者比较差异有统计学意义(χ2值为5.688~12.312,P<0.05或0.01)。病例组与对照组DVT发生相关危险因素的单因素分析结果显示,病例组患者年龄、损伤类型、下肢关节置换、石膏固定、高血压、DVT病史、中心静脉置管、D-二聚体以及术前白蛋白水平、纤维蛋白原降解产物、红细胞计数与对照组患者比较差异有统计学意义(t值为-7.275~3.998,χ2值为4.889~13.305,Z值为-3.454、-3.500,P<0.01);多因素Logistic回归分析结果显示,下肢关节置换(OR=0.383,95%CI0.190~0.773)、咳嗽(OR=0.085,95%CI0.010~0.731)、胸闷气短(OR=0.240,95%CI0.077~0.745)、便秘(OR=0.312,95%CI0.135~0.718)、红细胞计数(OR=3.314,95%CI2.105~5.216)和高血压(OR=0.534,95%CI0.292~0.976)是骨科住院患者DVT形成的独立危险因素(P<0.01或0.05)。结论骨科住院患者发生DVT是多因素作用的共同结果,其中,下肢关节置换、咳嗽、胸闷气喘、便秘、红细胞计数和高血压是其独立危险因素,应当予以监测和预防护理。

Objective To explore the risk factors of deep venous thrombosis(DVT)in lower limbs of orthopedic inpatients,and provide reference for clinical nursing and prevention of thrombosis.Methods A retrospective case-control approach was used in this study.A total of 148 orthopedic inpatients diagnosed with DVT in the First Affiliated Hospital of Soochow University from February 2014 to October 2018 were selected as the case group.At the same time,148 orthopaedic inpatients with undiagnosed DVT in the same Department were randomly selected as the control group.The electronic medical history data and related laboratory examination indexes of the two groups of patients during hospitalization in Orthopedics Department were analyzed retrospectively.Gender,age,seven indicators of blood coagulation,as well as history of hypertension,diabetes,history of DVT and other common risk factors of DVT in the two groups were statistically analyzed.Results In the case group,63 patients(42.5%)DVT developed in the right lower extremity.The differences in the clinical symptoms and characteristics of fever,pulmonary infection,cough,expectoration,chest distress and shortness of breath,pleural effusion and constipation between the two groups were statistically significant(χ2 value was 5.688-12.312,P<0.01 or 0.05).Single factor analysis of related risk factors showed the differences of age,type of injury,lower limb joint replacement,a plaster cast,hypertension,history of DVT,central venous catheter,D-dimer and preoperative albumin levels,fibrinogen degradation products,and red blood cell count between the two groups were statistically significant(t value was-7.275-3.998,χ2 value was 4.889-13.305,Z value was-3.500--3.454,P<0.01).Multivariate Logistic regression analysis showed that lower limb joint replacement(OR=0.383,95%CI0.190-0.773),cough(OR=0.085,95%CI0.010-0.731),chest distress and shortness of breath(OR=0.240,95%CI0.077-0.745),constipation(OR=0.312,95%CI0.135-0.718),red blood cell count(OR=3.314,95%CI 2.105-5.216),hypertension(OR=0.534,95%CI0.292-0.976)were independent risk factors for DVT formation in orthopedic inpatients(P<0.01 or 0.05).Conclusions DVT in orthopedic inpatients is a common result of multiple factors,among which,lower limb joint replacement,cough,chest distress and shortness of breath,constipation,red blood cell count and hypertension are independent risk factor,which should be monitored and given preventive care.