超声评价院内获得性深静脉血栓特点及其相关危险因素分析

Ultrasonic evaluation of hospital-acquired deep venous thrombosis characteristics and related risk factors analysis

目的探讨超声评价院内获得性深静脉血栓(HA-DVT)特点及其相关危险因素。方法收集2021年1—12月于烟台毓璜顶医院入院接受治疗的846例下肢DVT患者的临床资料,按照入院首次下肢静脉超声检查结果将其分为HA-DVT组(n=402)和非HA-DVT组(n=444),再将HA-DVT组患者按不同临床分期分为急性期组(n=212)、亚急性期组(n=130)、慢性期组(n=60)。根据患者的临床特征、超声检查特征分析HA-DVT的超声特点及其相关危险因素。结果2021年本院住院总例数为307340例,HA-DVT年发病率为0.13%(402/307340)。HA-DVT组患者年龄≥65岁,重症加强护理病房(ICU)、外科、五官科、妇科入住率,手术率,周围型血栓发生率,血栓再通率,肿瘤发生率,未继发肺血栓栓塞(PTE)发生率均高于非HA-DVT组患者,差异均有统计学意义(P﹤0.05)。846例下肢DVT中左侧多于右侧,单侧多于双侧。HA-DVT组患者中,双侧下肢DVT发生率高于单侧下肢DVT发生率,差异有统计学意义(P﹤0.05)。HA-DVT组患者主要集中在急性期,其血栓宽度最大(P﹤0.05)。继发PTE患者的DVT血栓宽度为6.70(5.00,8.35)mm,高于未继发PTE的4.60(3.80,5.80)mm,差异有统计学意义(P﹤0.05)。结论ICU、外科、五官科、妇科均为HA-DVT的高发科室,高龄(≥65岁)、外科手术、患有肿瘤均是发生HA-DVT的高危因素,当患者处于急性期且DVT血栓宽度≥6.70 mm时继发PTE的发生率较高,下肢静脉超声检查可为临床提供有效的HA-DVT诊断依据,并对HA�DVT的治疗进行效果评价。

Objective To evaluate the characteristics and risk factors of hospital-acquired deep venous thrombosis(HA-DVT)by ultrasonography.Method Clinical data of 846 patients with lower extremity DVT admitted to Yantai Yuhuangding Hospital from January to December 2021 were collected,and they were divided into HA-DVT group(n=402)and non-HA-DVT group(n=444)according to the results of the first lower extremity venous ultrasound examination.Then,patients in HA-DVT group were divided into acute group(n=212),subacute group(n=130)and chronic group(n=60)according to different clinical stages.According to the clinical and ultrasonic characteristics of the patients,the ultrasonic characteristics and related risk factors of HA-DVT were analyzed.Result The total number of inpatients in our hospital in 2021 was 307340,and the annual incidence of HA-DVT was 0.13%(402/307340).The age≥65 years old,the occupancy rates of intensive care unit(ICU),surgery,facial features,and gynecology,the incidence rate of peripheral thrombosis,thrombus recanalization,tumor,and non secondary pulmonary thromboembolism(PTE)in HA-DVT group weare all higher than those of the non HA-DVT group,the differences were statistically significant(P<0.05).Among 846 cases of lower extremity DVT,the left side was more than the right side,and one side was more than both sides.In the HA-DVT group,the incidence of bilateral lower extremity DVT was higher than that of unilateral lower extremity DVT,the difference was statistically significant(P<0.05).Patients in the HA-DVT group were mainly concentrated in the acute phase,with the largest thrombus width(P<0.05).The DVT thrombus width of secondary PTE patients was 6.70(5.00,8.35)mm,higher than that of non secondary PTE patients at 4.60(3.80,5.80)mm,the difference was statistically significant(P<0.05).Conclusion ICU,surgery,facial features,and gynecology are all high-risk departments for HA-DVT.Age≥65 years old,surgery,and tumor are all high-risk factors for HA-DVT.When patients are in the acute phase and the DVT thrombus width≥6.70 mm,the incidence of secondary PTE is higher.Lower extremity venous ultrasound examination can provide effective diagnostic basis for HA-DVT in clinical practice and evaluate the effectiveness of HA-DVT treatment.