老年脓毒症患者重症监护室内发生下肢深静脉血栓的危险因素

Risk factors for lower extremity deep vein thrombosis in elderly sepsis patients in intensive care unit

目的探讨老年脓毒症患者重症监护室(ICU)内发生下肢深静脉血栓(DVT)的危险因素。方法收集2020年4月至2021年9月首都医科大学附属北京天坛医院收治的83例老年脓毒症患者的临床资料,根据ICU住院期间是否发生下肢DVT将患者分为DVT组(n=25)和对照组(n=58)。收集所有患者入住ICU的临床资料,包括年龄、性别、主要疾病、既往病史、化验结果、检查结果、ICU住院期间治疗情况及ICU住院结局等。比较两组患者的临床特征和住院期间治疗情况,采用多因素Logistic回归模型分析老年脓毒症患者ICU内发生下肢深静脉血栓(DVT)的危险因素。结果DVT组患者的糖尿病比例、下肢功能障碍比例、入院时D-二聚体水平升高比例及使用呼吸机的比例均高于对照组患者,差异均有统计学意义(P﹤0.05)。多因素分析结果显示,糖尿病、下肢功能障碍、入院时D-二聚体水平升高及使用呼吸机均是老年脓毒症患者ICU住院期间发生下肢DVT的危险因素(P﹤0.05)。结论糖尿病、下肢功能障碍、入院时D-二聚体水平升高及使用呼吸机均会增加老年脓毒症患者ICU住院期间发生下肢DVT的风险,临床中应对这些患者强化预防和监测。

Objective To investigate the risk factors of lower extremity deep vein thrombosis(DVT)in elderly sepsis patients in the intensive care unit(ICU).Method The clinical data of 83 elderly patients with sepsis admitted to Beijing Tiantan Hospital,Capital Medical University from April 2020 to September 2021 were collected.The patients were divided into DVT group(n=25)and control group(n=58)based on whether lower extremity DVT occurred during ICU hospitalization.The baseline data for all patients admitted to the ICU,including age,gender,major diseases,past medical history,laboratory results,examination results,treatment during ICU hospitalization,and ICU hospitalization outcomes were collected.The clinical characteristics and hospitalization treatment between two groups of patients were compared,and a multivariate Logistic regression model was used to analyze the risk factors of lower extremity DVT in elderly sepsis patients in the ICU.Result The ratio of patients with diabetes,lower extremity dysfunction,D-dimer increase at admission,and ventilator use during hospitalization in DVT group were higher than those in control group,and the differences were statistically significant(P<0.05).Multivariate analysis showed that diabetes,lower extremity dysfunction,D-dimer increase at admission,and ventilator use during hospitalization were all risk factors for lower extremity DVT in elderly sepsis patients during hospitalization in ICU(P<0.05).Conclusion The diabetes,lower extremity dysfunction,D-dimer increase at admission and ventilator use during hospitalization significantly increase the risk of lower extremity DVT in elderly sepsis patients during hospitalization in ICU.In clinical practice,these patients should strengthen prevention and monitoring.