急性下肢深静脉血栓形成部位与发生肺栓塞的关系分析

Analysis of the relationship between the location of acute lower extremity deep venous thrombosis and pulmonary embolism

目的探讨急性下肢深静脉血栓形成(LDVT)患者血栓形成部位与发生肺栓塞的关系。方法收集2012年3月至2020年12月青岛大学附属青岛市市立医院记录在电子病历系统的714例LDVT患者的临床资料。根据血栓形成部位的不同将患者分为左下肢组(n=492,左LDVT)、右下肢组(n=138,右LDVT)、双侧下肢组(n=84,双侧LDVT),其中,左下肢组+右下肢组为单侧下肢组(n=630)。分析不同组别LDVT患者的临床特征。分析LDVT患者发生肺栓塞的危险因素。比较近端与孤立性远端LDVT患者的治疗情况及肺栓塞的发生率。结果左下肢组患者肺栓塞的发生率高于右下肢组患者,且双侧下肢组患者肺栓塞的发生率高于单侧下肢组患者(P<0.05)。左下肢组与右下肢组患者的饮酒史、糖尿病、肺部感染、存在多个合并症、血栓形成部位、治疗情况比较,差异均有统计学意义(P<0.05)。单侧下肢组与双侧下肢组患者的性别、吸烟史、饮酒史、肾功能不全、肺部感染、脑血栓、存在多个合并症、远期手术、静脉血栓病史、血栓形成部位、治疗情况比较,差异均有统计学意义(P<0.05)。有脑血栓病史和采取治疗是LDVT患者发生肺栓塞的保护因素(P<0.05);有吸烟史、有饮酒史、存在多个合并症、近期手术、有静脉血栓病史、孤立性远端LDVT是LDVT患者发生肺栓塞的危险因素(P<0.05)。在所有LDVT患者中,孤立性远端LDVT患者中接受抗血栓治疗的患者比例明显低于近端LDVT患者,且肺栓塞的发生率明显高于近端LDVT患者(P<0.01)。在左LDVT、右LDVT患者中,孤立性远端LDVT患者肺栓塞的发生率均高于近端LDVT患者(P<0.05)。结论孤立性远端LDVT患者肺栓塞的发生率高于近端LDVT患者,这可能与对孤立性远端LDVT患者的治疗不足有关,因此,对于孤立性远端LDVT患者,可能需要进行常规抗凝治疗。右LDVT患者肺栓塞的发生率低于左LDVT患者,其主要原因可能是左LDVT患者的合并症较多。

Objective To investigate the relationship between the location of thrombosis in patients with acute lower extremity deep venous thrombosis(LDVT)and the occurrence of pulmonary embolism(PE).Method The clinical data of 714 patients diagnosed with LDVT recorded in the electronic medical record system in Qingdao Municipal Hospital Affiliated to Qingdao University between March 2012 and December 2020 were collected.According to the different location of thrombus,714 patients with LDVT were divided into left lower extremity group(left LDVT),right lower extremity group(right LDVT)and bilateral lower extremity group(bilateral LDVT).The left lower extremity group+the right lower extremity group is the unilateral lower extremity group.The clinical characteristics of patients with LDVT in different groups were analyzed.The risk factors of PE in patients with LDVT analyzed.The treatment and the incidence of PE between patients with proximal and isolated distal LDVT were compared.Result The incidence of PE in the left lower extremity group was higher than that in the right lower extremity group,and the incidence of PE in the bilateral lower extremity group was higher than that in the unilateral lower extremity group(P<0.05).There were significant differences in drinking history,diabetes,pulmonary infection,multiple complications,thrombosis sites and treatment between the left lower extremity group and the right lower extremity group(P<0.05).There were significant differences in gender,smoking history,drinking history,renal insufficiency,pulmonary infection,cerebral thrombosis,multiple complications,long-term operation,history of venous thrombosis,location of thrombosis and treatment between unilateral lower extremity group and bilateral lower extremity group(P<0.05).The history of cerebral thrombosis and treatment were the protective factor of PE in patients with LDVT(P<0.05).Smoking history,drinking history,multiple complications,recent surgery and history of venous thrombosis were the risk factors of PE in patients with LDVT(P<0.05).Among patients with LDVT,the proportion of patients receiving antithrombotic therapy in patients with isolated distal LDVT was significantly lower than that in patients with proximal LDVT,and the incidence of PE was significantly higher than that in patients with proximal LDVT(P<0.01).In patients with deep venous thrombosis of the left and right lower extremities,the incidence of PE in patients with isolated distal LDVT was higher than that in patients with proximal LDVT(P<0.05).Conclusion The probability of PE was higher in patients with isolated distal LDVT than that in patients with proximal LDVT,which may be related to the inadequate treatment of isolated distal LDVT,so that isolated distal venous DVT may require routine anticoagulation.The probability of PE on the right side is lower than that on the left side,which may be mainly due to more complications in patients with left-sided LDVT.