急诊重症下肢创伤并发静脉血栓栓塞症的危险因素与防治措施

Risk factors,prevention and treatment measures of venous thromboembolism in emergency severe lower extremity trauma

目的 探讨急诊重症下肢创伤并发静脉血栓栓塞症(VTE)的危险因素与防治措施。方法 收集2020年2月至2022年12月福建医科大学附属南平市第一医院急诊收治的90例重症下肢创伤患者的临床资料,根据是否并发静脉血栓栓塞症(VTE)将患者分为VTE组和NVTE组,每组45例。采用多因素Logistic回归模型分析急诊重症下肢创伤并发VTE的独立危险因素。通过绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),分析各项危险因素对于急诊重症下肢创伤患者并发VTE的预警效能。结果 单因素分析结果显示,VTE组患者的年龄明显大于NVTE组患者,合并大血管创伤的患者比例、入院时创伤严重程度评分(ISS)、D-二聚体(D-D)水平均明显高于NVTE组患者,术后绝对卧床时间明显长于NVTE组患者,差异均有统计学意义(P﹤0.01)。两组患者的性别、恶性肿瘤情况、基础疾病情况、相关手术史、烟酒史、致伤原因、创伤面积、手术时间、下肢血管病史比较,差异均无统计学意义(P﹥0.05)。多因素分析结果显示,年龄、合并大血管创伤、术后绝对卧床时间、入院时ISS、D-D水平均是急诊重症下肢创伤患者并发VTE的独立危险因素(P﹤0.05)。ROC曲线分析结果显示,年龄、术后绝对卧床时间对于急诊重症下肢创伤患者并发VTE均具有较高的预警价值;入院时ISS、D-D水平对于急诊重症下肢创伤患者并发VTE均具有中等预警价值。年龄≥50.93岁、术后绝对卧床时间≥3.45天、入院时ISS≥29.5分、D-D水平≥8.07 mg/L的急诊重症下肢创伤患者并发VTE的风险较高(P﹤0.05)。结论 对于急诊重症下肢创伤患者,可根据并发VTE的预警模型给予相应的防治措施,以促进患者恢复,改善患者预后。

Objective To study the risk factors,prevention and treatment measures of venous thromboembolism in emergency severe lower extremity trauma.Method Clinical data of 90 patients with severe lower Extremity trauma admitted in the Emergency Department of Nanping First Hospital Affiliated to Fujian Medical University from February 2020 to December 2022 were collected,and the patients were divided into the VTE group and NVTE group according to occurrence of venous thromboembolism(VTE),45 cases in each group.The independent risk factors of VTE in emergency severe lower extremity trauma were analyzed by using multivariate Logistic regression.The receiver operating characteristic(ROC)curve was plotted to calculated the area under the curve(AUC),the warning efficacy of each risk factor in predicting VTE in emergency severe lower extremity trauma was analyzed.Result Univariate analysis showed age in VTE group was significantly larger than that in the NVTE group,proportion of patients with concomitant large vessel trauma,injury severity score(ISS)at admission,D-dimer(D-D)level were significantly higher than those in the NVTE group,and absolute bedtime after operation in VTE group were significantly longer than that in the NVTE group(P<0.01).There was no statistically significant difference between the two groups in gender,malignant tumor,underlying disease,relevant surgical history,smoking and alcohol history,cause of injury,trauma area,surgical time,and lower extremity vascular disease history(P>0.05).Multivariate analysis showed that the age,concomitant large vessel trauma,absolute bedtime after operation,ISS at admission,and D-D level were independent risk factors of VTE in emergency severe lower extremity trauma(P<0.05).ROC curve showed age and absolute bedtime after operation had higher warning value for VTE,and ISS at admission,and D-D level had moderate warning value.Patients with age≥50.93 years old,absolute bedtime after operation≥3.45 days,ISS at admission≥29.5 points,and D-D≥8.07 mg/L had higher risk for VTE in emergency severe lower extremity trauma(P<0.05).Conclusion Prevention and treatment can be given based on warning model of VTE in emergency patients with severe lower extremity trauma to promote the recovery of patients and improve the prognosis.