急诊创伤性骨盆骨折合并多发伤患者发生下肢深静脉血栓的影响因素分析

Analysis of the influencing factors of deep vein thrombosis of lower extremity in pelvic fracture patients combined with multiple injuries

目的探讨急诊创伤性骨盆骨折合并多发伤患者发生下肢深静脉血栓(DVT)的影响因素。方法回顾性分析2016年6月-2019年9月重庆市大足区人民医院收治的268例急诊创伤性骨盆骨折合并多发伤患者的临床资料。分析围手术期(入院至术后3个月)DVT的发生率。采用Logistic回归模型对影响DVT的因素进行分析,根据结果构建预测模型。采用ROC曲线法分析模型预测DVT的价值,计算曲线下面积、灵敏度、特异度.和准确度。结果268例骨盆骨折合并多发伤患者中,发生DVT者88例,占32.84%。Logistic回归分析结果显示年龄≥60岁(OR=2.365,95%CI:1.653~5.394,P=0.005)、ISS评分≥25分(OR=4.236,95%CI:1.937~6.002,P=0.002)、GCS评分<9分(OR=1.968,95%CI:1.125~3.627,P=0.018)、术后未使用抗凝药(OR=4.369,95%Cl:1.699~6.374,P<0.001)、术后卧床时间≥7 d(OR=5.136,95%CI:1.937~7.815,P<0.001)是骨盆骨折合并多发伤患者发生DVT的独立影响因素。本研究构建了DVT预测模型,其ROC曲线下面积为0.701。该模型预测DVT的灵敏度为81.82%(72/88)、特异度为87.09%(108/124),准确率为67.16%(180/268)。结论急诊创伤性骨盆骨折合并多发伤患者围手术期DVT的发生率较高。年龄≥60岁、ISS评分≥25分、GCS评分<9分、术后未使用抗凝药、术后卧床时间≥7 d是骨盆骨折合并多发伤患者发生DVT的独立影响因素。

Objective To explore the influencing factors of deep vein thrombosis(DVT)of lower extremity in pelvic fracture patients combined with multiple injuries.Methods The clinical data of 268 cases of pelvic fracture patients combined with multiple injuries between June 2016 to September 2019 were analyzed retrospectively.The incidence of DVT during the perioperative period(admission to hospital to 3 months after operation)was analyzred.Logistic regression model was used to analyze the factors afcting DVT,and a prediction model was built according to the results.ROC curve analysis model was used to predict the value of DVT and calculate the area,sensitivity,specificity and accuracy under the curve.Results Among 268 pelvic fracture patients combined with multiple injuries,88(32.84%)had DVT.Logistic regression analysis showed that age≥60 years old(OR=2.365,95%CI:1.653~5.394,P=0.005),ISS≥25 points(OR=4.236,95%Cl:1.937~6.002,P=0.002),GCS<9 points(OR=1.968,95%CI:1.125~3.627.P=0.018),no anticoagulant after operation(OR=4.369,95%CI:1.699~6.374,P<0.001),and bed time≥7 days after operation(OR=5.136,95%CI:1.937~7.815,P<0.001)were independent influencing factors of DVT in patients with pelvic frac ture and multiple injuries.The area under ROC curve is 0.701.The sensitivity,specifieity and accuracy of the model were 81.82%(72/88),87.09%(108/124)and 67.16%(180/268)respectively.Conclusion The ineidence of DVT is higher in patients with pelvie fracture and multiple injuries.Age≥60 years old,ISS≥25,GCS<9,no anticoagulant af-ter operation,and time in bed≥7 days are independent influencing factors of DVT in patients with pelvic fracture and multiple injuries.