老年腹股沟疝术后发生深静脉血栓的影响因素分析

Analysis of influencing factors for postoperative deep vein thrombosis in elderly patients with inguinal hernia

目的探讨老年腹股沟疝患者术后发生深静脉血栓的影响因素。方法采用回顾性病例对照研究方法。收集2018年3月至2021年3月济宁医学院附属医院收治的352例老年腹股沟疝患者的临床资料;男325例,女27例;年龄为(72±3)岁。观察指标:(1)治疗和随访情况。(2)术后深静脉血栓发生的影响因素分析。采用门诊和电话方式进行随访,了解患者深静脉血栓发生情况。随访时间截至2021年9月。正态分布的计量资料以x±s表示,组间比较采用t检验。计数资料以绝对数表示,组间比较采用χ^(2)检验。单因素分析根据资料类型选择对应的统计学方法。多因素分析采用Logistic回归模型。结果(1)治疗和随访情况。352例腹股沟疝患者中,难复性疝18例,可复性疝334例;均成功施行腹腔镜疝修补术,其中行腹膜外腹腔镜疝修补术95例、行经腹腔腹膜前腹腔镜疝修补术257例,手术时间为(70±7)min,术中出血量为(8.0±1.5)mL,术中输血39例、未输血313例,普通补片167例、轻量补片185例,术区压迫时间为(19.7±2.9)h,下床活动时间为(5.6±1.8)h,术后住院时间为(3.0±1.9)d。352例患者术后均获得6个月随访,随访期间7例发生深静脉血栓。(2)术后深静脉血栓发生的影响因素分析。单因素分析结果显示:年龄、体质量指数、吸烟史、酗酒史、合并高血压、合并慢性阻塞性肺疾病、合并冠心病、合并脑血管疾病、合并静脉曲张、术中输血、术后下床活动时间、术后住院时间是影响腹股沟疝患者术后发生深静脉血栓的相关因素(t=2.19、2.06,χ^(2)=9.86、9.02、7.90、14.36、17.12、36.25、28.27、7.32,t=3.30、3.04,P<0.05)。多因素分析结果显示:年龄、合并高血压、合并慢性阻塞性肺疾病、合并冠心病、合并脑血管疾病、合并静脉曲张、术中输血、术后下床活动时间、术后住院时间是影响老年腹股沟疝患者术后发生深静脉血栓的独立影响因素(优势比=4.32,5.95,6.44,15.85,9.63,7.61,9.88,7.27,7.96,95%可信区间为0.92~8.72,4.45~12.74,1.74~19.46,3.97~36.84,4.95~16.26,2.65~18.03,3.50~21.47,1.48~16.37,2.08~14.73,P<0.05)。结论年龄、合并高血压、合并慢性阻塞性肺疾病、合并冠心病、合并脑血管疾病、合并静脉曲张、术中输血、术后下床活动时间、术后住院时间是影响老年腹股沟疝患者术后发生深静脉血栓的独立影响因素。

Objective To investigate the influencing factors for postoperative deep vein thrombosis in elderly patients with inguinal hernia.Methods The retrospective case‑control study was conducted.The clinical data of 352 elderly patients with inguinal hernia who were admitted to the Affiliated Hospital of Jining Medical College from March 2018 to March 2021 were collected.There were 325 males and 27 females,aged(72±3)years.Observation indicators:(1)treatment and follow‑up;(2)analysis of influencing factors for postoperative deep vein thrombosis.Follow‑up was conducted using outpatient examination and telephone interview to detect occurrence of deep vein thrombosis in patients up to September 2021.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was conducted using the t test.Count data were described as absolute numbers,and comparison between groups was conducted using the chi‑square test.The univariate analysis was conducted using the corresponding statistical methods based on data type.The Logistic regression model was used for multivariate analysis.Results(1)Treatment and follow‑up.Of the 352 inguinal hernia patients,there were 18 cases with irreducible hernia and 334 cases with reducible hernia.All the 352 patients underwent laparoscopic herniorrhaphy successfully,including 95 cases with totally extraperitoneal prosthetic,257 cases with transabdominal preperitoneal prosthesis.The operation time and volume of intraoperative blood loss of the 352 patients were(70±7)minutes and(8.0±1.5)mL,respectively.There were 39 cases with intraoperative blood transfusion and 313 cases without intraoperative blood transfusion,167 cases with common patch,185 cases with light patch.The compression time of operative area,time to first out‑of‑bed activities,duration of postoperative hospital stay of the 352 patients were(19.7±2.9)hours,(5.6±1.8)hours,(3.0±1.9)days,respectively.All the 352 patients were followed up for 6 months after operation.During the follow-up,there were 7 patients with deep vein thrombosis.(2)Analysis of influencing factors for postoperative deep vein thrombosis.Results of univariate analysis showed that age,body mass index,smoking history,alcoholism history,hypertension,chronic obstructive pulmonary disease,coronary heart disease,cerebrovascular disease,varicose veins,intraoperative blood transfusion,time to postoperative first out‑of‑bed activities,duration of postoperative hospital stay were related factors for postoperative deep vein thrombosis in elderly patients with inguinal hernia(t=2.19,2.06,χ^(2)=9.86,9.02,7.90,14.36,17.12,36.25,28.27,7.32,t=3.30,3.04,P<0.05).Results of multivariate analysis showed that age,hypertension,chronic obstructive pulmonary disease,coronary heart disease,cerebrovascular disease,varicose veins,intraoperative blood transfusion,time to postoperative first out‑of‑bed activities,duration of postoperative hospital stay were independent influencing factors for postoperative deep vein thrombosis in elderly patients with inguinal hernia(odds ratio=4.32,5.95,6.44,15.85,9.63,7.61,9.88,7.27,7.96,95%confidence intervals as 0.92‒8.72,4.45‒12.74,1.74‒19.46,3.97‒36.84,4.95‒16.26,2.65‒18.03,3.50‒21.47,1.48‒16.37,2.08‒14.73,P<0.05).Conclusion Age,hypertension,chronic obstructive pulmonary disease,coronary heart disease,cerebrovascular disease,varicose veins,intraoperative blood transfusion,time to postoperative first out‑of‑bed activities,duration of postoperative hospital stay are independent influencing factors for postoperative deep vein thrombosis in elderly patients with inguinal hernia.