侧颅底手术后下肢静脉血栓形成的危险因素分析

Risk Factors for Deep Vein Thrombosis of Lower Extremities after Lateral Skull Base Surgery

目的分析耳科侧颅底手术后患者下肢深静脉血栓形成的临床危险因素。方法回顾性分析2020年1月~2020年12月在中国人民解放军总医院耳鼻咽喉头颈外科行侧颅底手术的患者81例的临床资料、治疗及预后,研究临床因素与术后下肢静脉血栓的相关性。结果经下肢血管彩超检查,81例侧颅底手术后有13例(16.0%)发生下肢静脉血栓。经治疗,无一例发生肺栓塞。二元logistics分析表明:术前D-二聚体(hazard ratio[HR],20.842;95%CI,1.386-313.516;P=0.028)和载脂蛋白B(hazard ratio[HR],99.223;95%CI,1.965-5010.066;P=0.022)偏高是术后静脉血栓发生的危险因素。ROC曲线表明对于耳侧颅底术后的血栓发生的预测价值显著高于0.5,但两者的预测准确性一般,两项指标的联合应用科提高预测准确性。结论本研究报导侧颅底手术后下肢静脉血栓的危险因素:术前D-二聚体和载脂蛋白B。尽管其预测准确性较低,仍建议对两者偏高的患者加强术前宣教、加强围手术期凝血功能、D-二聚体和下肢静脉超声的复查。

Objective To analyze the clinical risk factors for deep vein thrombosis(DVT)of lower extremities after lateral skull base surgery.Methods This was a retrospective study.81 patients underwent lateral skull base surgery in the department of Otorhinolaryngology Head and Neck Surgery in the PLA general hospital from Jan.2020 to Dec.2020 were enrolled.The clinical data,treatment and results were recorded.The correlation between clinical factors and postoperative venous thrombosis was studied.Results 13 patients with DVT after operation were diagnosed by ultrasonography and the incidence rate was 16.0%.No pulmonary embolism was found.Logistic regression analysis indicated that preoperative D-dimer(hazard ratio[HR],20.842;95%CI,1.386-313.516;P=0.028)and apolipoprotein B(hazard ratio[HR],99.223;95%CI,1.965-5010.066;P=0.022)were risk factors for the occurrence of DVT after operation.The predictive performances were normal as verified by Receiver operating characteristic(ROC)curve.Co-application of the two factors can improve the predictive performance.Conclusion Preoperative D-dimer and apolipoprotein B are risk factors of deep venous thrombosis after lateral skull base surgery.Although the prediction accuracy is normal,we still recommend detailed preoperative education for patients with high levels of both.Reexamination of coagulation function,D-dimer and venous ultrasound are also recommended.