贫血对人工全髋关节置换术患者围术期下肢深静脉血栓形成的影响

Impact of anemia on incidence of perioperative lower limb deep vein thrombosis in patients undergoing total hip arthroplasty

目的探讨贫血对人工全髋关节置换术(total hip arthroplasty,THA)患者围术期下肢深静脉血栓形成(deep vein thrombosis,DVT)的影响。方法回顾分析2015年9月—2021年12月符合选择标准的1916例非骨折病因行THA治疗患者临床资料。男811例,女1105例;年龄18~94岁,平均59.2岁。贫血患者213例,非贫血患者1703例;术前DVT 55例,非DVT 1861例(其中术后新发DVT 75例)。对年龄、性别、身体质量指数(body mass index,BMI)、糖尿病、高血压、肿瘤史、血栓史、吸烟史、是否翻修、术前D-二聚体阳性(≥0.5 mg/L)、是否贫血、手术时间、术中出血量、是否输血及手术前后红细胞、血红蛋白、红细胞压积、血小板等变量进行单因素分析,并进一步采用logistic回归分析影响DVT形成的危险因素。结果单因素分析示,年龄、性别、高血压、翻修、术前红细胞、术前血红蛋白、术前D-二聚体阳性和贫血是术前DVT的影响因素(P<0.05);进一步logistic回归分析示,年龄(>60岁)、女性、术前D-二聚体阳性、贫血是术前DVT的独立危险因素(P<0.05)。单因素分析示,年龄、性别、翻修、术前D-二聚体阳性、贫血、输血、术后红细胞、术后血红蛋白是术后新发DVT的影响因素(P<0.05);进一步logistic回归分析示,年龄(>60岁)、女性、翻修是术后新发DVT的独立危险因素(P<0.05)。结论THA术前DVT患者中贫血发生率较高,并且贫血是术前DVT发生的独立危险因素;贫血虽然不是THA术后新发DVT的独立危险因素,但是术后新发DVT患者中贫血发生率也较高。

Objective To explore the impact of anemia on the incidence of perioperative lower limb deep vein thrombosis(DVT)in patients undergoing total hip arthroplasty(THA).Methods A retrospective analysis was conducted on clinical data of 1916 non-fracture patients who underwent THA between September 2015 and December 2021,meeting the selection criteria.Among them,there were 811 male and 1105 female patients,aged between 18 and 94 years with an average of 59.2 years.Among the patients,213 were diagnosed with anemia,while 1703 were not.Preoperative DVT was observed in 55 patients,while 1861 patients did not have DVT preoperatively(of which 75 patients developed new-onset DVT postoperatively).Univariate analysis was performed on variables including age,gender,body mass index(BMI),diabetes,hypertension,history of tumors,history of thrombosis,history of smoking,revision surgery,preoperative D-dimer positivity(≥0.5 mg/L),presence of anemia,operation time,intraoperative blood loss,transfusion requirement,and pre-and post-operative levels of red blood cells,hemoglobin,hematocrit,and platelets.Furthermore,logistic regression was utilized for multivariate analysis to identify risk factors associated with DVT formation.Results Univariate analysis showed that age,gender,hypertension,revision surgery,preoperative levels of red blood cells,preoperative hemoglobin,preoperative D-dimer positivity,and anemia were influencing factors for preoperative DVT(P<0.05).Further logistic regression analysis indicated that age(>60 years old),female,preoperative D-dimer positivity,and anemia were risk factors for preoperative DVT(P<0.05).Univariate analysis also revealed that age,female,revision surgery,preoperative D-dimer positivity,anemia,transfusion requirement,postoperative level of red blood cells,and postoperative hemoglobin level were influencing factors for postoperative new-onset DVT(P<0.05).Further logistic regression analysis indicated that age(>60 years old),female,and revision surgery were risk factors for postoperative newonset DVT(P<0.05).Conclusion The incidence of anemia is higher among patients with preoperative DVT for THA,and anemia is an independent risk factor for preoperative DVT occurrence in THA.While anemia may not be an independent risk factor for THA postoperative new-onset DVT,the incidence of anemia is higher among patients with postoperative new-onset DVT.