胸部肿瘤术后重症患者DVT发生率及其凝血状态分析

Incidence of DVT and Coagulation Status in Critically 111 Patients after Thoracic Tumor Surgery

目的:分析胸部肿瘤术后人住重症监护病房(intensive care imit,ICU)患者下肢深静脉血栓形成(deep venous thrombosis,DVT)的发生率及相关凝血指标特点,旨在进一步提高对胸外科手术后重症患者合并DVT的认识。方法:本研究设计为回顾性病例对照研究,收集2018年1月至2021年1月西南医科大学附属医院收治的62例胸部肿瘤术后人住外科ICU的重症患者作为研究对象,人住ICU 24 h内行床旁双下肢静脉超声和/或静脉造影检查,计算人住ICU期间下肢DVT的发生率,对患者血常规、凝血四项、血栓弹力图等指标进行回顾性分析。结果:DVT的总体发生率为22.58%(14/62),发生时间1〜16 d,中位时间5(3〜12)d。男性胸部肿瘤术后重症患者DVT的发生率明显高于女性[30.23%(13/43)M 5.26%(1/19)],差异有统计学意义(X^(2)=4.700,P=0.030);恶性肿瘤术后重症患者DVT的发生率明显高于非恶性肿瘤患者[28.89%(13/45)vs 5.88%(1/17)],差异有统计学意义(X^(2)=3.836,P=0.048)。DVT组患者的活化部分凝血活酶时间(activated partial thromboplastin time,APPT)、D-二聚体水平明显高于未发生DVT患者,差异有统计学意义(P<0.05),其余指标未显示有统计学差异(P>0.05)。结论:胸部肿瘤术后重症患者下肢DVT的发生率较高,提示在外科手术后进行血栓筛查的必要性,尤其是针对恶性肿瘤患者及术后重症患者.APPT和D-二聚体水平升高与下肢DVT的发生相关。

Objective:To analyze the incidence of deep venous thrombosis(DVT)and the characteristics of coagulation indexes in patients admitted to intensive care unit(ICU)after thoracic tumor surgery,so as to further improve the understanding of severe patients with DVT after surgery.Methods:In this retrospective case-control study,62 severe patients after thoracic tumor surgery in the Affiliated Hospital of Southwest Medical University from January 2018 to January 2021 were selected as the research objects.Ultrasound was performed to exam lower extremity veins within 24 hours after the admission to ICU.The incidence of lower extremity DVT in ICU duration was calculated by thromboelastography,and other indicators were retrospectively analyzed.Results:The overall incidence rate of DVT was 22.58%(14/62),ranging from 1 to 16 days,with the median duration of 5(3-12)days.The inci-dence of DVT in male patients was significantly higher than that in female patients[30.23%(13/43)vs 5.26%(1/19),X^(2)=4.700,P=0.030];the incidence of DVT in critically ill patients with malignant tumor was significantly higher than that in those with non-malignant tumor[28.89%(13/45)vs 5.88%(1/17)=3.836,P=0.048].The activated par tial thromboplastin time(APFr)and D-dimer levels of patients in patients with DVT were significantly higher than those of patients without DVT(P<0.05),and differences in other indicators were not statistically significant between the DVT group and the non-DVT group(P>0.05).Conclusion:The incidence of postoperative DVT in the lower extremities of patients with severe thoracic tumors is higher,which suggests the necessity of thrombus screening after surgery,especially for malignant tumor patients and critically ill patients.Increases in APPT and D-dimer levels are related to the occurrence of DVT in lower extremities.