老年心脏瓣膜置换术后入住ICU期间发生VTE的诱导因素及预防策略

Induction factors and prevention strategies for venous thromboembolism in elderly patients admitted to the intensive care unit after heart valve replacement

目的 分析老年心脏瓣膜置换(Heart valve replacement,HVR)术后入住重症监护室(intensive care unit,ICU)期间发生静脉血栓栓塞症(Venous thromboembolism,VTE)的诱导因素,并提出相应预防策略。方法 回顾性选取2020年2月至2022年8月于该院心外科行HVR术老年患者90例,根据术后入住ICU期间有无发生VTE,将患者分为发生VTE组(17例)与未发生VTE组(73例),收集并比较两组患者一般资料,将差异有统计学意义的项目进行多因素Logistic回归分析,探讨相应预防干预策略。结果 两组性别、心率、病程、有无肝硬化、是否贫血、是否心房颤动组间比较,差异无统计学意义(P>0.05);两组是否合并高血压、是否合并糖尿病、手术时间、术后6h D-二聚体水平、术后卧床时间、体重指数(BMI)、既往有无VTE史组间比较,差异有统计学意义(P<0.05)。Logistics回归分析显示:合并高血压、合并糖尿病、手术时间>1 h、术后6 h D-二聚体水平>480μg/L、术后卧床时间>1d、BMI>35 kg/m^(2)、既往有VTE史与患者HVR术后发生VTE相关(P<0.05),是老年HVR术后入住ICU期间发生VTE的诱导因素。结论 对老年患者HVR术后应特别注意合并高血压、合并糖尿病、手术时间>1 h、术后6 h D-二聚体水平>480μg/L、术后卧床时间>1 d、BMI>35 kg/m^(2)、既往有VTE史这类群体,心脏外科护士可对其采取相应有效预防策略,以降低HVR术后发生VTE的风险。

Objective To investigate the induction factors and prevention strategies for venous thromboembolism(VTE)during hospitalization in the intensive care unit(ICU)after heart valve replacement(HVR)in elderly patients.Methods A retrospective analysis was performed for 90 elderly patients who underwent HVR surgery in Department of Cardiac Surgery in our hospital from February 2020 to August 2022,and according to the presence or absence of VTE during postoperative ICU stay,the patients were divided into VTE group with 17 patients and non-VTE group with 73 patients.General data were collected and compared between the two groups,and the multivariate logistic regression analysis was performed for the items with statistical significance to explore corresponding preventive intervention strategies.Results There were no significant differences between the two groups in sex,heart rate,course of disease,liver cirrhosis,anemia,and atrial fibillation(P>0.05),while there were significant diferences between the two groups in comorbidity with hypertension or diabetes,time of operation,D-dimer level at 6 hours after surgery,duration of postoperative bed rest,body mass index(BMI),and past history of VTE(P<0.05).The logistic regression analysis showed that comorbidity with hypertension or diabetes,time of operation>1 hour,D-dimer level>480μg/L at 6 hours after surgery,duration of postoperative bed rest>1 day,BMI>35 kg/m^(2),and past history of VTE were associated with VTE after HVR surgery(P<0.05),and they were induction factors for VTE during postoperative ICU stay in elderly patients undergoing HVR.Conclusion Special attention should be paid to the elderly patients with hypertension,diabetes,time of operation>1 hour,D-dimer level>480μg/L at 6 hours after surgery,duration of postoperative bed rest>1 day,BMI>35 kg/m^(2),and past history of VTE after HVR surgery.Cardiac surgery nurses can take appropriate prevention strategies for these patients to reduce the risk of VTE after HVR.