食管癌根治术患者术后发生下肢深静脉血栓的危险因素及血栓风险评估

Risk factors of lower extremity deep venous thrombosis and thrombosis risk assessment after radical surgery for esophageal carcinoma

目的评估食管癌根治术患者术后的血栓风险,探究患者术后发生下肢深静脉血栓(DVT)的危险因素。方法回顾性分析2020年1月至2021年1月在商洛市中心医院接受食管癌根治术治疗的156例食管癌患者的临床资料,根据DVT发生情况分为DVT组(n=38)和非DVT组(n=118),对患者术后发生DVT的相关因素进行单因素分析,再采用多因素Logistic回归分析确定DVT发生的独立危险因素。结果单因素分析结果显示,DVT组患者的年龄大于非DVT组[(67.94±8.48)岁vs(64.25±7.62)岁],差异有统计学意义(P<0.05),合并糖尿病、心血管疾病、骨折、呼吸道疾病、肝肾疾病、凝血因子功能亢进患者的比例明显高于非DVT组(36.84%vs 20.34%、31.58%vs 15.25%、26.32%vs 12.71%、28.95%vs 10.17%、21.05%vs 8.47%、52.63%vs 26.27%),术中出血量、术后卧床时间、D-二聚体水平明显多(长)于非DVT组[(62.63±12.46)m L vs(57.68±10.42)m L、(32.71±5.48)d vs(28.63±4.72)d、(6.76±1.04)mg/L vs(2.18±0.65)mg/L],差异均有统计学意义(P<0.05);DVT组患者的Caprini评分为(6.48±2.01)分,明显高于非DVT组的(3.57±1.14)分,差异有统计学意义(P<0.05),DVT组患者的血栓风险高危险度和极高危险度的总比例为92.10%,明显高于非DVT组的73.73%,差异有统计学意义(P<0.05);经多因素Logistic回归分析结果显示,年龄、合并呼吸道疾病、肝肾疾病、术后卧床时间、D-二聚体水平和凝血因子功能亢进均是影响食管癌根治术患者术后发生DVT的独立危险因素(P<0.05)。结论Caprini血栓风险模型能够有效预测食管癌根治术后DVT发生的风险,年龄、呼吸道疾病、肝肾疾病、术后卧床、D-二聚体和凝血因子功能亢进是影响食管癌根治术患者发生DVT的危险因素。

Objective To evaluate the thrombosis risk after radical surgery for esophageal carcinoma,and investigate the risk factors for lower extremity deep venous thrombosis(DVT)after surgery.Methods This study retrospectively analyzed the clinical data of 156 patients who underwent radical surgery for esophageal carcinoma in Shangluo Central Hospital between January 2020 and January 2021.The patients were divided into DVT group(n=38)and non-DVT group(n=118)according to the presence or absence of DVT.Univariate analysis and multivariate logistic regression analysis were performed to screen the independent risk factors for DVT.Results Univariate analysis results showed that patients in the DVT group were significantly older than those in the non-DVT group:(67.94±8.48)years old vs(64.25±7.62)years old,P<0.05.The proportions of patients with diabetes,cardiovascular disease,fracture,respiratory disease,liver and kidney disease,and hyperfunction of coagulation factors were significantly higher than those in the non-DVT group(P<0.05):36.84%vs 20.34%,31.58%vs 15.25%,26.32%vs 12.71%,28.95%vs 10.17%,21.05%vs 8.47%,52.63%vs 26.27%.The intraoperative blood loss,postoperative time in bed,and D-dimer level were more,longer or higher than those of the non-DVT group(P<0.05):(62.63±12.46)mL vs(57.68±10.42)mL,(32.71±5.48)d vs(28.63±4.72)d,(6.76±1.04)mg/L vs(2.18±0.65)mg/L.The Caprini score of the DVT group was significantly higher than that of the non-DVT group:(6.48±2.01)vs(3.57±1.14),P<0.05.The proportion of high risk and extremely high risk of thrombosis in DVT group was significantly higher than that in non-DVT group(92.10%vs 73.73%,P<0.05).Multivariate logistic regression analysis showed that age,respiratory disease,liver and kidney disease,postoperative time in bed,D-dimer level,and hyperfunction of coagulation factors were independent risk factors for DVT after radical surgery for esophageal carcinoma(P<0.05).Conclusion The Caprini thrombosis risk model can effectively help to predict the risk of DVT after radical surgery for esophageal carcinoma.Age,respiratory disease,liver and kidney disease,postoperative rest in bed,D-dimer,and hyperfunction of coagulation factors are risk factors for DVT after radical surgery for esophageal carcinoma.