腹部手术患者迟发性静脉血栓栓塞症的危险因素分析

Analysis of risk factors for delayed VTE in patients undergoing abdominal surgery

目的 分析腹部手术患者术后迟发性静脉血栓栓塞症(VTE)的危险因素,并提出改进措施。方法 纳入2019年1月至2021年10月四川省友谊医院普外科出院的腹部手术患者415例,术后1、3、6月随访患者并安排血管超声筛查。采用Logistic回归分析术后迟发性VTE的危险因素。结果 415例患者中术后1、3、6月确诊下肢深静脉血栓形成(DVT)的患者分别为13例(3.1%)、16例(3.9%)及10例(2.4%),未发现肺栓塞患者。Logistic回归分析显示,术后1月VTE发生的主要危险因素是手术持续时间(OR=1.01,P=0.006)和总住院时间(OR=1.09,P=0.026),其次是合并糖尿病(OR=4.87,P=0.035);而术后3月和6月,体重指数则是VTE的主要危险因素(P<0.001),其次是合并心脏病(OR=4.28,P=0.044)及高血压病(OR=4.06,P=0.04)。结论 术后半年内仍存在迟发性VTE的可能,应在术后不同阶段采取相应的预防措施进行干预。

Objective To analyze the risk factors for delayed venous thrombosis(VTE) in patients with abdominal surgery and propose improvement measures.Methods Between January 2019 and October 2021, 415 patients undergoing abdominal surgery at the Department of General Surgery of Sichuan Friendship Hospital were included. The patients were followed up, and screened by using ultrasound for deep venous thrombosis at one month, 3 and 6 months after operation. Logistic regression analysis was used to analyze the risk factors for postoperative delayed VTE.Results Of the 415 patients, there were 13(3.1%), 16(3.9%) and 10(2.4%) patients with DVT after one month, 3 and 6 months of operation, respectively. No patients with pulmonary embolism were found. Logistic regression analysis showed that the duration of surgery(OR=1.01, P=0.006) and length of hospital stay(OR=1.09, P=0.026) were the most important risk factors followed by combined diabetes(OR=4.87,P=0.035) for DVT after one month of operation. After 3 and 6 months of operation, body mass index was the most significant risk factor for VTE(P<0.001) followed by combined heart disease(OR=4.28,P=0.044) and hypertension(OR=4.06,P=0.04).Conclusion There is still the possibility of delayed VTE within six months after the operation. Corresponding preventive measures should be taken to intervene at different stages after surgery.