重症监护病房患者下肢深静脉血栓形成的风险评估及预防效果分析

Analysis of risk assessment and prevention of lower limb deep venous thrombosis in intensive care unit patients

目的探讨重症监护病房(ICU)患者下肢深静脉血栓形成(DVT)的风险评估实施情况及预防效果。方法收集2022年7月1日至2023年6月30日于航空总医院ICU住院的148例患者的临床资料进行回顾性分析。根据入ICU 24 h内是否发生DVT分为DVT组(45例)和无DVT组(103例),无DVT组患者进而根据入ICU 2周内(24 h后)评估结果分为新发DVT组(16例)及无新发DVT组(87例)。总结通过DVT风险评分、D-二聚体、纤维蛋白原水平对ICU患者DVT的评估情况,观察针对DVT给予相关预防措施后的效果。结果DVT组急性生理学与慢性健康状况评分系统Ⅱ评分高于无DVT组(P<0.05)。DVT组、无DVT组、无新发DVT组、新发DVT组组内内外科患者DVT风险评分差异均无统计学意义(均P>0.05)。DVT组的D-二聚体、纤维蛋白原水平均显著高于无DVT组[(10.7±3.4)mg/L比(3.8±1.7)mg/L、(486±133)g/L比(376±133)g/L](均P<0.05)。在无DVT组中,接受基础预防、机械预防、单纯药物预防、机械预防+药物预防者院内DVT的发生率分别为70.0%(7/10)、8.9%(4/45)、14.3%(2/14)、8.8%(3/34),机械预防、单纯药物预防及机械预防+药物预防患者院内DVT发生率均明显低于单纯基础预防患者,机械预防及机械预防+药物预防患者院内DVT发生率低于单纯药物预防患者(均P<0.05)。结论入住ICU的患者下肢DVT发生率较高,可采用D-二聚体、纤维蛋白原水平以及DVT风险评分综合评估患者DVT发生风险,并指导相应预防措施,通过对ICU患者采用积极的预防措施,可有效避免DVT的发生。

Objective To explore the implementation of risk assessment and prevention effect of lower limb deep venous thrombosis(DVT)in intensive care unit(ICU)patients.Methods The clinical data of 148 patients admitted to the ICU of Aviation General Hospital from July 1,2022 to June 30,2023 were collected and retrospectively analyzed.According to whether DVT occurred within 24 h of ICU admission,the patients were divided into DVT group(45 cases)and non-DVT group(103 cases).The patients in the non-DVT group were further divided into new-onset DVT group(16 cases)and non-new-onset DVT group(87 cases)according to the evaluation results within 2 weeks of ICU admission(after 24 h).The evaluation of DVT in ICU patients was summarized through DVT risk score,D-dimer,and fibrinogen levels,and the effectiveness of relevant preventive measures for DVT was observed.Results Acute physiology and chronic health status scoring systemⅡscore in DVT group was higher than that in non-DVT group(P<0.05).There was no significant difference in DVT risk score between medical and surgical patients in DVT group,non-DVT group,non-new-onset DVT group and new-onset DVT group(all P>0.05).The levels of D-dimer and fibrinogen in the DVT group were significantly higher than those in the non-DVT group[(10.7±3.4)mg/L vs(3.8±1.7)mg/L,(486±133)g/L vs(376±133)g/L](both P<0.05).In the non-DVT group,the rates of hospital-acquired DVT were 70.0%(7/10),8.9%(4/45),14.3%(2/14),and 8.8%(3/34)for basic prophylaxis,mechanical prophylaxis,pharmacological prophylaxis alone and mechanical and pharmacological prophylaxis,respectively.The incidences of DVT in patients with mechanical prevention,simple drug prevention and mechanical prevention combined with drug prevention were significantly lower than those in patients with simple basic prevention.The incidence of DVT in patients with mechanical prevention and mechanical prevention combined with drug prevention is lower than that in patients with drug prevention alone(all P<0.05).Conclusions The incidence of lower limb DVT in ICU patients is high.D-dimer,fibrinogen level and DVT risk score can be used to assess the risk of DVT in patients and guide the corresponding preventive measures.The occurrence of DVT can be effectively avoided by using positive preventive measures for ICU patients.