肝切除术后血栓高危人群深静脉血栓形成危险因素分析

Analysis of risk factors of deep vein thrombosis in high-risk groups after hepatectomy

目的 分析影响肝切除术后深静脉血栓形成(deep venous thrombosis, DVT)的危险因素。方法 回顾性分析2018年6月至2021年9月于华中科技大学同济医学院附属同济医院行肝切除术的190例术前Caprini评分≥5分的深静脉血栓高危病人的临床资料,将术后发生DVT的93例病人纳入DVT组,术后未发生DVT的97例病人纳入非DVT组。比较两组病人以下指标的差异:性别,年龄,体质量指数,有无肝硬化及门静脉高压,术前血常规、凝血功能、肝肾功能情况,疾病类型,肿瘤分期,手术范围,手术时长,第一肝门阻断次数,第一肝门阻断总时长,术中出血量和输血量,术后第1、3、5天D-二聚体水平及并发症发生率,术后死亡率。将单因素分析证实差异有统计学意义(P<0.1)的自变量建立回归方程,最后带入二分类Logistic回归模型进行多因素分析确定独立危险因素。结果 两组病人性别、年龄、第一肝门阻断情况、第一肝门阻断总时长、术前白蛋白含量比较差异均有统计学意义(均P<0.05);Logistic回归分析显示:性别为女性[OR=2.594,95%置信区间(CI)为(1.233,5.454),P=0.012]和术前白蛋白含量<35 g/L[OR=3.962,95%CI(1.309,11.993),P=0.015]为影响肝切除术后出现DVT的独立危险因素(P<0.05)。结论 术前低蛋白血症、女性病人接受肝切除术后出现DVT的风险相对较高,应对高危病人及时干预,纠正低蛋白血症,预防DVT的发生。

Objective To explore the risk factors of deep venous thrombosis(DVT) after hepatectomy.Methods From June 2018 to September 2021, clinical data were retrospectively reviewed for 190 high-risk patients of DVT(Caprini score ≥5) undergoing hepatectomy. Two groups of DVT(n=93) and non-DVT(n=97) were assigned. Gender, age, body mass index(BMI), liver cirrhosis, portal hypertension, preoperative routine blood test, blood coagulation, liver function, renal function, disease type, tumor stage, operative scope, operative duration, occlusion frequency of the first porta hepatis, total time of occlusion, intraoperative volume of blood loss and unit of blood transfusion were compared between two groups. According to the difference of postoperative mortality, independent variables confirmed by univariate analysis were significantly different(P<0.1). Finally independent risk factors were determined by multivariate analysis with a binary Logistic regression model.Results Significant inter-group differences existed in gender, age, occlusion of the first porta hepatis, total time of occlusion and preoperative albumin level(P<0.05). Logistic regression analysis revealed that gender and preoperative albumin content <35 g/L were independent risk factors for DVT after hepatectomy.Conclusion Females with preoperative hypoproteinemia have a relatively high risk of DVT after hepatectomy. Timely intervention should be provided for correcting hypoproteinemia and preventing the occurrence of DVT.