颅内出血后发生下肢深静脉血栓高危因素的分析及预警模型的建立

Analysis of high risk factors of VTE after intracranial hemorrhage and establishment of warning model

目的 分析颅内出血后患者发生静脉血栓栓塞(VTE)的危险因素,并建立预警模型。方法 收集2020年1月至2023年2月绍兴文理学院附属医院神经外科收治颅内出血后发生VTE的39例患者为观察组,随机抽取颅内出血后未发生VTE的39例患者为对照组,分析比较两组患者的检验及检查资料,并用logistic回归分析影响VTE发生的高危因素,进行ROC曲线效能分析,最终建立预警模型。结果单因素分析发现观察组D-二聚体、年龄明显高于对照组(P<0.05),且颅内出血后发生VTE与脱水剂使用、卧床时间、骨盆或下肢骨折、肌力大小、中心静脉置管、下肢肌张力增高、手术及心脑血管病史有关;多因素Logistic回归分析发现年龄≥60岁(OR=5.417,95%CI:1.234~23.775)、D-二聚体(OR=10.402,95%CI:2.081~52.001)、肌力≤3级(OR=5.426,95%CI:1.314~24.083)、骨盆或下肢骨折(OR=6.901,95%CI:1.090~43.672)、中心静脉置管(OR=4.489,95%CI:1.024~20.554)、心脑血管病史(OR=5.165,95%CI:1.020~26.166)是颅内出血后发生VTE的独立危险因素(P<0.05)。将各OR值取整后建立预警模型,该模型总评分为36分,进行ROC曲线效能分析后发现评分>14分时为高风险。结论 该颅内出血后VTE预警模型预测准确性较好,对于高风险评分的患者采取必要的预防措施,能降低VTE的发生率及死亡率。

Objective To analyze the risk factors of venous thromboembolism(VTE) after intracranial hemorrhage and establish an warning model.Methods 39 patients with VTE after neurosurgical intracranial hemorrhage in our hospital from January 2020 to February 2023 were col-lected as the observation group,and 39 patients without VTE after intracranial hemorrhage were randomly collected as the control group.The general information and clinical data were collected and compared.The high-risk factors affecting VTE were analyzed by logistic regression,and the efficiency of ROC curve was analyzed.Finally,the warning model was established.Results Univariate analysis showed that D-dimer levels and age in the observation group were significantly higher than those in the control group(P<0.05).And VTE after intracranial hemorrhage was related to the use of dehydrating agent,bed time,pelvic or lower limb fracture,muscle strength,central venous catheterization,increased muscle tension of lower limbs,operation and cardiovascular and cerebrovascular history.Multivariate logistic regression analysis showed that age ≥ 60 years old(OR=5.417,95%CI:1.234~23.775),D-Dimer(OR=10.402,95%CI:2.081~52.001),muscle strength ≤ grade 3(OR=5.426,95%CI:1.314~24.083),pelvic or lower limb fracture(OR=6.901,95%CI:1.090~43.672),central venous catheterization(OR=4.489,95%CI:1.024~20.554),and cardiovascular and cerebrovascular history(OR=5.165,95%CI:1.020~26.166) were independent risk factors for VTE after intracranial hemorrhage(P<0.05).After rounding the values,an early warning model was established.The total score of the model was 36 points.After ROC curve effectiveness analysis,it was found that the score >14 points is a high risk.Conclusion The prediction accuracy of the VTE warning model after intracranial hemorrhage is good.Taking necessary preventive measures for patients with high risk score can reduce the incidence and mortality of VTE.