胃肠外科手术患者术后下肢深静脉血栓形成危险因素分析

Analysis of risk factors of deep venous thrombosis of lower limb after gastrointestinal surgery

目的分析胃肠外科手术患者术后下肢深静脉血栓形成(deep venous thrombosis,DVT)的危险因素,并探讨临床应对策略。方法回顾性分析海南省人民医院2017年3月至2019年3月收治的1495例胃肠外科手术患者的临床资料,统计患者术后下肢DVT发生情况,并将其分别纳入发生组和未发生组,采用单因素和多因素Logistic回归分析探讨影响胃肠外科手术患者术后下肢DVT的危险因素。结果1495例胃肠外科手术患者中有278例发生下肢DVT,发生率为18.60%,其中以无症状肌间静脉血栓为主(97.84%),好发于左下肢(48.92%),发生时间集中于术后1 d内(73.74%)。多因素Logistic回归分析显示,年龄≥65岁、体质指数(body mass index,BMI)≥24 kg/m^2、消化系统恶性疾病、术后长期卧床均是胃肠外科手术患者术后下肢DVT的独立危险因素(均P<0.05)。结论胃肠外科手术患者术后下肢DVT发生率较高,其危险因素包括年龄≥65岁、BMI≥24 kg/m^2、消化系统恶性疾病、术后长期卧床,临床医生应重视高危患者的识别及早期干预,以避免下肢DVT对患者生活质量造成不良影响。

Objective To analyze the risk factors of deep venous thrombosis(DVT)of lower limb after gastrointestinal surgery,and to explore the clinical coping strategies.Method The clinical data of 1495 patients underwent gastrointestinal surgery in Hainan General Hospital from March 2017 to March 2019 were analyzed retrospectively.The incidence of postoperative DVT of lower limb was counted and included into occurrence group and non-occurrence group respectively.Univariate and multivariate Logistic regression analysis was used to explore the risk factors of DVT of lower limb in patients underwent gastrointestinal surgery.Result Among the 1495 patients,278 cases had DVT of lower limb,the incidence was 18.60%.The most common type of thrombus was asymptomatic intramuscular venous thrombosis(97.84%),which occurred in the left lower limb(48.92%)and concentrated in the postoperative 1 d(73.74%).Multivariate Logistic regression analysis showed that age≥65 years old,body mass index(BMI)≥24 kg/m^2,malignant diseases of digestive system and long-term bed rest after surgery were independent risk factors for DVT of lower limb after gastrointestinal surgery(all P<0.05).Conclusion The incidence of DVT of lower limb after gastrointestinal surgery is high,the risk factors include age≥65 years old,BMI≥24 kg/m^2,malignant diseases of digestive system and long-term bed rest after surgery,clinicians should pay attention to the identification of high-risk patients and early intervention to avoid the adverse effects of DVT of lower limb on patients'quality of life.