下肢动脉硬化闭塞症腔内治疗术后发生静脉血栓栓塞症的危险因素

Risk factors of venous thromboembolism after endovascular surgery of atherosclerosis obliterrans

目的:探讨下肢动脉硬化闭塞症腔内治疗术后发生静脉血栓栓塞症的危险因素。方法:回顾性分析2014年6月—2019年6月于山东第一医科大学附属省立医院血管外科接受腔内治疗的75例下肢动脉硬化闭塞症患者的临床资料,根据发生静脉血栓栓塞症与否分为血栓组与非血栓组,对比分析两组患者的性别、年龄、体重指数、病程等临床资料,对单因素分析显示组间差异有统计学意义的因素,代入二元Logistic回归分析进行独立危险因素检验。结果:两组性别、年龄、体重指数、病程、合并糖尿病人数、合并冠心病人数、合并高血压人数、溃疡面积、手术时长、出血量、支架长度、术中缝合穿刺点人数、术后卧床时间、白细胞计数、血小板计数、凝血酶原时间、活化部分促凝血酶原激酶时间、纤维蛋白原和纤维蛋白原降解产物水平等方面差异无统计学意义(P>0.05)。而在腹围、Fontaine分期、术中逆穿人数、D-二聚体水平方面差异有统计学意义(P<0.05)。Logistic回归分析显示,Fontaine分期、术中逆穿为下肢动脉硬化闭塞症腔内治疗术后发生静脉血栓栓塞症的独立危险因素(P<0.05)。结论:临床工作者应考虑患者Fontaine分期、术中逆穿等因素,以期降低下肢动脉硬化闭塞症腔内治疗术后发生静脉血栓栓塞症的概率。

Objective:To investigate the risk factors of venous thromboembolism after endovascular surgery of atherosclerosis obliterrans.Methods:The clinical data of 75 patients hospitalized in Department of Vascular Surgery,Shandong Provincial Hospital Affiliated to Shandong First Medical University from June 2014 to June 2019 were retrospectively analyzed.The patients were divided into thrombotic group and un-thrombotic group according to the occurrence of venous thromboembolism,and the clinical data of the two groups,such as age,body mass index,disease duration were compared and analyzed in a single-factor analysis.The single factors with significant differences between two groups were substituted into binary logistic regression analysis for independent risk factor test,and the difference was statistically significance(P<0.05).Results:There were no statistically significant differences in gender,age,body mass index,disease duration,number of combined diabetes mellitus,number of combined coronary heart disease,number of combined hypertension,ulcer size,operative time,bleeding volume,stent length,number of intraoperative suture puncture points,white blood cell count,platelet count,prothrombin time,activated partial thromboplastin time,fibrinogen and fibrinogen degradation products levels(P>0.05).In contrast,abdominal circumference,Fontaine staging,number of intraoperative retropubic punctures,and D-dimer level between two groups were statistically significant different(P<0.05).Logistic regression showed that Fontaine stage and intraoperative retrograde puncture were independent risk factors for venous thromboembolism after endovascular surgery of atherosclerosis obliterrans.Conclusion:Medical workers should consider the factors such as Fontaine stage and intraoperative retrograde puncture in order to reduce the venous thromboembolism rate of endovascular surgery of atherosclerosis obliterrans.