老年髋、膝关节置换术后下肢深静脉血栓形成的影响因素及预测模型构建

Factors influencing and predictive model construction for lower extremity deep vein thrombosis after hip and knee replacement in elderly patients

目的:探讨老年患者髋、膝关节置换术后下肢深静脉血栓形成(DVT)的影响因素并构建预测列线图模型。方法:回顾性分析2018年3月至2022年3月收治的1 015例髋、膝关节置换术患者的临床资料。根据DVT诊断情况分为DVT组457例和非DVT组558例。单因素分析两组患者的一般资料、手术资料与实验室检查结果,多因素logistic回归分析髋、膝关节置换术后发生DVT的影响因素并构建预测模型。结果:DVT组中年龄≥65岁、BMI≥28 kg/m^(2)、女性、糖尿病史、骨水泥型假体、手术时间≥90 min、术后未使用机械抗凝、术后卧床时间≥72 h、D-二聚体>0.545 mg/L、血管性血友病因子(v WF)>178.55 ng/m L的患者比例较非DVT组明显升高(P<0.05)。老年患者髋、膝关节置换术后DVT的危险因素包括年龄≥65岁、BMI≥28 kg/m^(2)、女性、糖尿病史、骨水泥型假体、手术时间≥90 min、术后卧床时间≥72 h、术后未使用机械抗凝、D-二聚体>0.545 mg/L、v WF>178.55 ng/m L,预测模型为4.545+年龄×1.128+BMI×3.430+性别×2.948+糖尿病史×5.895+假体类型×3.429+手术时间×5.744+术后机械抗凝使用×2.943+术后卧床时间×6.135+D-二聚体×1.123+v WF×6.225。结论:年龄、BMI、性别、糖尿病史、假体类型、手术时间、术后抗凝、卧床时间、D-二聚体、v WF等均是髋/膝关节置换术老年患者术后DVT的影响因素,在影响因素基础上构建的DVT形成预测模型可以在临床中推广应用。

Objective:This study aimed to explore the influencing factors of lower extremity deep vein thrombosis(DVT)after hip and knee replacement in elderly patients and establish a nomogram model for predicting DVT.Methods:The clinical data of 1015 patients underwent hip/knee replacement from March 2018 to March 2022 were retrospectively analyzed.According to the diagnosis of DVT,the subjects were divided into DVT group(457 cases)and non-DVT group(558 cases).The differences in general characteristics,surgical data,and laboratory test results between the DVT group and the non-DVT group were analyzed by univariate analysis.Multivariate logistic regression analysis was performed to identify factors affecting DVT after hip/knee replacement and the prediction model for DVT was constructed.Results:Compared with the non-DVT group,the proportions of patients aged≥65 years old,BMI≥28 kg/m^(2),female,with a history of diabetes and with cement-based prosthesis were significantly higher in the DVT group(P<0.05).The DVT group also had higher proportions of patients with operation time≥90 min,no postoperative mechanical anticoagulation,and postoperative bed time≥72 h(P<0.05).Additionally,compared with the non-DVT group,the proportions of patients with D-Dimer>0.545 mg/L and von Willebrand factor(vWF)>178.55 ng/mL in the DVT group were significantly higher(P<0.05).The risk factors for DVT after hip/knee replacement in elderly patients included age≥65 years,BMI≥28 kg/m^(2),female,cement-based prosthesis,history of diabetes,no postoperative mechanical anticoagulation,operation time≥90 min,postoperative bed rest time≥72 h,D-Dimer>0.545 mg/L,and vWF>178.55 ng/mL.The predictive nomogram model was constructed as follows:4.545+age×1.128+BMI×3.430+gender×2.948+history of diabetes×5.895+prosthesis type×3.429+operation time×5.744+use of postoperative mechanical anticoagulation×2.943+bed rest time×6.135+DD×1.123+vWF×6.225.Conclusions:Age,BMI,gender,operation time,history of diabetes,prosthesis type,operation time,postoperative anticoagulation,bed rest time vWF,and D-Dimer are influencing factors for postoperative DVT in elderly patients after hip/knee replacement.The DVT prediction model based on these factors can be applied in clinical practice.