中央型下肢深静脉血栓患者发生下肢静脉溃疡的危险因素分析

Risk factors for venous leg ulcers in patients with lower limb deep venous thrombosis of central type

目的探讨中央型下肢深静脉血栓(DVT)患者发生下肢静脉溃疡(VLU)的危险因素。方法采用便利抽样法,选取2020年1月—2021年1月在河南省人民医院血管外科接受治疗的268例中央型下肢DVT患者为研究对象,按是否发生VLU将患者分为病例组(n=56)和对照组(n=212),比较两组患者临床相关因素,采用单因素、多因素Logistic回归分析中央型下肢DVT患者发生VLU的危险因素。构建预测模型,采用Hosmer-Lemeshow检验拟合优度,以受试者工作特征(ROC)曲线下面积评价预测模型的效能。结果单因素分析显示,两组患者在年龄、体重指数、吸烟、饮酒、工作方式、高血压病、下肢深静脉反流、下肢DVT史、骨折史、Morisky用药依从性问卷评分、血栓后综合征、下肢静脉曲张家族史、下肢DVT家族史方面的比较差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,年龄>60岁、每天吸烟、血栓后综合征、合并高血压病、合并下肢深静脉反流是下肢DVT患者VLU的独立危险因素(P<0.05)。中央型下肢DVT患者发生VLU风险预测模型的ROC曲线下面积为0.972(95%置信区间:0.945~0.988)。结论年龄>60岁、每天吸烟、血栓后综合征、合并高血压病、合并下肢深静脉反流是中央型下肢DVT患者发生VLU的独立危险因素;护理人员应针对患者发生VLU的危险因素提供相关防治措施,以期减少中央型下肢DVT患者VLU的发生率。

Objective To explore the risk factors of venous leg ulcers(VLU)in patients with deep venous thrombosis(DVT)of central type.Methods Using the convenient sampling,268 patients with lower limb DVT of central type who were treated in the Vascular Surgery of Henan Provincial People's Hospital from January 2020 to January 2021 were selected for analysis.Patients were divided into a case group(n=56)and a control group(n=212)based on whether VLU occurred.Clinical factors were compared between the two groups.The risk factors for VLU in patients with lower limb DVT of central type were determined using univariate analysis and multivariate Logistic regression.A prediction model was constructed.The performance of the prediction model was evaluated using the Hosmer-Lemeshow test of goodness of fit and the area under the receiver operating characteristic(ROC)curve.Results Univariate analysis showed that there were statistical differences between the two groups in terms of age,body mass index,smoking,alcohol consumption,work style,hypertension,deep venous reflux of the lower limbs,history of lower limb DVT,fracture history,Morisky Medication Adherence Scale scores,post-thrombotic syndrome,family history of lower limb varicose veins and family history of lower limb DVT(P<0.05).Multivariate Logistic regression analysis showed that age>60 years old,smoking cigarettes every day,post-thrombotic syndrome,hypertension and deep venous reflux were independent risk factors for VLU in patients with lower limb DVT(P<0.05).The area under the ROC curve of the risk prediction model for VLU in patients with lower limb DVT of central type was 0.972(95%confidence interval was 0.945 to 0.988).Conclusions Age>60 years old,smoking cigarettes every day,post-thrombotic syndrome,hypertension,and deep venous reflux are independent risk factors for VLU in patients with lower limb DVT of central type.Nurses should provide prevention and treatment measures for the risk factors of VLU in patients with lower limb DVT of central type so as to reduce the incidence of VLU.