高龄内科住院患者下肢深静脉血栓临床资料分析

Analysis of clinical data of lower limbs deep vein thrombosis in inpatients with advanced age in internal medicine

目的分析高龄内科住院患者合并下肢深静脉血栓形成(DVT)的治疗及预后情况。方法回顾性分析, 收集2016年3月至2019年3月北京大学第三医院老年内科收治高龄老年人, 其中确诊下肢DVT患者106例, 男性58例(54.7%), 女性48例(45.3%), 年龄80~99岁。单纯DVT患者91例(85.9%), 合并肺栓塞15例(15.2%), 随访半年内的治疗情况及预后。结果 106例患者中有症状45例(42.5%), 无症状61例(57.6%)。累及下肢近端深静脉(腘静脉及以上静脉)28例(26.4%), 仅累及远端深静脉78例(73.6%)。除高龄外, 其他DVT危险因素为肺部感染60例(56.6%)、卧床(>3 d)58例(54.7%)、2型糖尿病50例(47.2%)、脑梗死46例(43.4%)、心力衰竭37例(34.9%)、活动性恶性肿瘤28例(26.4%)。静脉血栓评分高风险80例(75.5%), 出血高风险68例(64.2%)。74例接受抗凝治疗(69.8%), 与抗凝组(32例, 30.2%)患者比较, 未抗凝组卧床、肾功能不全、心力衰竭、脑梗死的患病率及全因死亡率高(P<0.05或P<0.01)。未抗凝患者出血高风险高于抗凝患者(P<0.01)。抗凝患者合并肺栓塞、近端深静脉受累比率及复查好转率高于未抗凝患者(P<0.05或P<0.01)。抗凝患者中, 26例接受住院期间短期的低分子肝素抗凝, 48例(45.3%)出院后继续口服抗凝药物。3个月时抗凝治疗率为31.1%(33例), 6个月为24.5%(26例)。抗凝患者4例发生非致死性出血, 但与未抗凝患者比较, 差异无统计学意义(P>0.05)。结论高龄内科住院患者应警惕肺部感染、卧床、脑梗死、恶性肿瘤等DVT危险因素;高龄内科住院患者出血高风险比例较高, 接受规律抗凝治疗比例偏低, 需全面评估患者抗凝治疗的风险及获益, 给予个体化治疗。

Objective To analyze the treatment and prognosis of advanced age inpatients in Medical Department with lower limbs deep venous thrombosis(DVT),Methods This was a retrospective study of elderly medical inpatients with DVT,including 58 males(54.7%)and 48 females(45.3%),aged from 80 to 99 years old,in Geriatric Medicine of Peking University Third Hospital from March 2016 to March 2019.There were 91 patients(85.9%)with DVT alone and 15 patients(15.2%)with pulmonary embolism.The clinical data of patients were analyzed,and treatment and prognosis within half a year after discharge were followed-up.Results A total of 106 elderly medical patients were included,the ratio of male to female was 1.2;1.0,the age range was 80-99 years old,the median age was 86 years old.Of a total of 106 DVT patients,forty five cases(42.5%)developed symptoms,sixty-one cases(57.6%)were asymptomatic.Twenty-eight cases(26.4%)involved the proximal lower limb deep veins(popliteal veins and above),seventy-eight cases(73.6%)only involved distal deep veins.Except for advanced age,other DVT risk factors included sixty cases(56.6%)of lung infection,58 cases(54.7%)being bedridden(>3 d),50 cases(47.2%)of type 2 diabetes,46 cases(43.4%)of cerebral infarction,37 cases(34.9%)of heart failure.and 28 cascs(26.4%)of active malignancies.etc.Of a total of 106 DVT patients,80 cases(75.5%)had high risk of venous thrombosis score.and 68 cases(64.2%)had high risk of bleeding.74 cases received anticoagulant treatment,the rate of anticoagulant treatment was 69.8%.Compared with anticoagulant patients»non-anticoagulant group showed that renal insufficiency»being bedridden»heart failure,cerebral infarction prevalence,and all-cause mortality were increased(P VO.05 or PVO.01).The rate of high risk of bleeding was significantly higher in the non-anticoagulation group than in the anticoagulation group(P<0.01).The pulmonary embolism rate*proximal deep vein involvement rate and their improvement rate when timely rechecking were significantly higher in anticoagulation group than in non-anticoagulation group(P V0.05 or P V0.01,respectively).In the anticoagulati on group,26 patients received short term low-molecular heparin(LMH)treatment during hospitalization,48 patients(45.3%)were prescribed oral anticoagulants at the time of discharge.Anticoagulation treatment rate is 31.1%(33 cases)at 3 months and 24.5%(26 cases)at 6 months.Non-fatal bleeding occurred in 4 patients in anticoagulation group,but there was no significant difference between the two groups(P〉0.05).Conclusions Great attention should be paid to the risk factors such as lung infection*being bedridden,cerebral infarction,and malignant tumor in the elderly medical inpatients.The rate of high risk of bleeding was high in elderly inpatients,and the rate of regular anticoagulant treatment is low.The risk versus benefit of anticoagulant therapy should be comprehensively evaluated*and individualized therapy should be given.