严重创伤患者发生急性下肢深静脉血栓形成的危险因素分析

Analysis of risk factors for acute lower extremity deep vein thrombosis in patients with severe trauma

目的探讨严重创伤患者发生急性下肢深静脉血栓形成(ALDVT)的危险因素。方法收集2020年1月至2022年8月南京医科大学第一附属医院(江苏省人民医院)收治的严重创伤患者的临床资料,根据是否发生ALDVT将患者分为ALDVT组(n=31)和非创伤后急性下肢深静脉血栓(NALDVT)组(n=155)。分析严重创伤患者发生ALDVT的危险因素及其对严重创伤患者发生ALDVT的诊断价值。结果单因素分析结果显示,ALDVT组患者下肢骨折、脊柱/骨盆骨折、下肢深静脉创伤、创伤严重程度评分(ISS)、血糖水平、D-二聚体(D-D)水平均高于NALDVT组患者,胸腹部创伤的比例低于NALDVT组患者,差异均有统计学意义(P﹤0.05)。多因素分析结果显示,下肢骨折、脊椎/骨盆骨折、下肢深静脉创伤、ISS、血糖水平较高及D-D水平较高均是严重创伤患者发生ALDVT的危险因素(P﹤0.05)。受试者工作特征(ROC)曲线分析结果显示,血糖水平对严重创伤患者发生ALDVT具有较高的诊断价值,D-D水平、ISS对严重创伤患者发生ALDVT具有中等诊断价值(P﹤0.05)。结论严重创伤患者成功救治后,应根据患者的入院血糖水平、创伤位置与程度、凝血功能等危险因素尽早进行ALDVT风险的评估,并根据评估结果给予对症治疗,以降低创伤后ALDVT及继发肺栓塞的风险。

Objective To investigate the risk factors for acute lower extremity deep vein thrombosis(ALDVT)in patients with severe trauma.Method The clinical data of severe trauma patients admitted to the First Affiliated Hospital with Nanjing Medical University(Jiangsu Province Hospital)from January 2020 to August 2022 were collected.Patients were divided into ALDVT group(n=31)and non acute lower extremity deep vein thrombosis(NALDVT)group(n=155)according to the occurrence of ALDVT.the risk factors for ALDVT in patients with severe trauma and their diagnostic value for ALDVT in patients with severe trauma were also analyzed.Result The results of the univariate analysis showed that the proportion of lower limb fractures,spine/pelvic fractures,lower extremity deep vein system trauma,injury severity score(ISS),blood sugar levels on admission,and D-dimer(D-D)levels in the ALDVT group were all higher than those in the NALDVT group,the proportion of chest and abdominal trauma in the ALDVT group was lower than that in NALDVT group patients,and the differences were statistically significant(P<0.05).Multivariate analysis showed that lower extremity fractures,spine/pelvic fractures,lower extremity deep venous system trauma,ISS,higher blood glucose level,and higher D-D level were all risk factors for ALDVT in patients with severe trauma(P<0.05).The receiver operating characteristic(ROC)curve analysis results showed that the blood glucose level on admission has a high diagnostic value for ALDVT in patients with severe trauma,and the D-D level and ISS have a medium diagnostic value for ALDVT in patients with severe trauma(P<0.05).Conclusion After successful treatment of patients with severe trauma,the risk of ALDVT should be assessed as early as possible based on their admission blood glucose level,location and extent of trauma,coagulation function,and other risk factors.Symptomatic treatment will be given based on the assessment results to reduce the risk of ALDVT and secondary pulmonary embolism after trauma.