神经外科患者围手术期深静脉血栓形成的危险因素分析

Analysis of risk factors of deep venous thrombosis in neurosurgical patients during the perioperative period

目的:探讨影响神经外科患者围手术期肢体深静脉血栓(DVT)形成的临床因素。方法:回顾性分析2019年1—12月首都医科大学三博脑科医院神经外科收治的298例患者的临床资料。收集包括一般临床资料、重要实验室检查结果以及手术资料等可能影响DVT形成的危险因素。根据术前、术后静脉超声检查结果是否显示存在DVT,分为术前DVT组(n=24)和术前无DVT组(n=274),术后DVT组(n=125)和术后无DVT组(n=173)。采用单因素及多因素logistic回归分析法判断影响术前、术后DVT形成的危险因素。结果:围手术期无患者因DVT发生致残或死亡。单因素logistic回归分析结果显示,术前D-二聚体升高和年龄因素是影响术前DVT发生的临床因素(均P<0.05);年龄、卧床、术后脱水≥3 d及术后D-二聚体升高是影响术后DVT发生的临床因素(均P<0.05)。多因素logistic回归分析结果显示,术前D-二聚体升高(OR=1.725,95%CI:1.149~2.590,P=0.009)和年龄(OR=1.055,95%CI:1.005~1.107,P=0.029)是术前DVT发生的独立危险因素;年龄(OR=1.065,95%CI:1.040~1.092,P<0.001)和术后D-二聚体升高(OR=1.091,95%CI:1.019~1.168,P=0.013)是术后DVT发生的独立危险因素。结论:年龄大、D-二聚体升高的神经外科患者围手术期发生DVT风险高。

Objective To investigate the clinical factors affecting the deep venous thrombosis(DVT)in neurosurgical patients during the perioperative period.Methods A retrospective analysis was conducted on the clinical data of 298 patients admitted to the Department of Neurosurgery,Sanbo Brain Hospital,Capital Medical University from January to December 2019.We documented suspicious DVT risk factors including general clinical data,important laboratory test results,and surgical data.Based on whether there was DVT revealed by preoperative and postoperative intravenous ultrasound examination,the patients were divided into preoperative DVT group(n=24)and preoperative non-DVT group(n=274),postoperative DVT group(n=125)and postoperative non-DVT group(n=173).Univariate and multivariate logistic regression analysis were used to determine the risk factors that affected the formation of DVT before and after surgery.Results No patient developed disability or died due to DVT during the perioperative period.Univariate logistic regression analysis showed that preoperative D-dimer and age were the clinical factors that affected the occurrence of preoperative DVT(all P<0.05);age,bed rest,postoperative dehydration≥3 d and increase of postoperative D-dimer were the clinical factors that affected the occurrence of DVT post operation(all P<0.05).Multivariate logistic regression analysis showed that increase of preoperative D-dimer(OR=1.725,95%CI:1.149-2.590,P=0.009)and age(OR=1.055,95%CI:1.005-1.107,P=0.029)were independent risk factors for preoperative DVT;age(OR=1.065,95%CI:1.040-1.092,P<0.001)and increase of postoperative D-dimer(OR=1.091,95%CI:1.019-1.168,P=0.013)were independent risk factors for postoperative DVT.Conclusion The risk of perioperative DVT seems higher in neurosurgical patients with older age or elevated D-dimer.