老年髋部骨折患者围手术期深静脉血栓危险因素的Meta分析

Meta-analysis of perioperative risk factors for deep vein thrombosis in aged patients with hip fractures

目的系统评价老年髋部骨折患者围手术期深静脉血栓(DVT)形成的危险因素。方法计算机检索中国知网、维普网、万方数据库、PubMed、Web of Science、Cochrane Library和Embase数据库, 纳入有关老年髋部骨折患者DVT危险因素的研究。检索时限为2000年1月1日-2023年1月31日。结果共纳入55篇文献, 其中病例对照研究41篇、队列研究14篇。Meta分析结果显示, 年龄、女性、体重指数、高血压病、高血脂、糖尿病、肺部疾病、脑血管疾病、吸烟史、血栓史、静吸复合麻醉、术中出血、术中输血、血红蛋白、白蛋白、活化部分凝血活酶时间、D-二聚体、纤维蛋白原、股骨转子间骨折、高能量损伤、长时间卧床、受伤至入院时间和受伤到手术时间延长是老年髋部骨折患者发生DVT的危险因素(P<0.05);使用抗凝药物治疗为保护因素(P<0.05)。结论老年髋部骨折患者发生DVT是多种因素共同作用的结果, 涉及危险因素较多;护理人员应加强对DVT的评估和筛查, 尽可能地减少老年髋部骨折患者DVT的发生。

Objective To systematically evaluate the perioperative risk factors for deep vein thrombosis(DVT)in aged patients with hip fractures.Methods A comprehensive search was conducted in CNKI,VIP,Wanfang,PubMed,Web of Science,Cochrane Library,and Embase for studies on DVT risk factors in aged patients with hip fractures.The search timeframe was from January 1,2000,to January 31,2023.Results A total of 55 studies were included,comprising 41 case-control studies and 14 cohort studies.Meta-analysis results showed that age,female,body mass index,hypertension,hyperlipidemia,diabetes,pulmonary disease,cerebrovascular disease,smoking history,thrombosis history,combined anesthesia,intraoperative bleeding,intraoperative blood transfusion,hemoglobin,albumin,activated partial thromboplastin time,D-dimer,fibrinogen,intertrochanteric fractures,high-energy injury,prolonged bed rest,time from injury to admission,and time from injury to surgery were risk factors for DVT in aged hip fracture patients(P<0.05);the use of anticoagulants was found to be a protective factor(P<0.05).Conclusions The occurrence of DVT in aged hip fracture patients is influenced by multiple factors.Nursing staff should enhance the assessment and screening for DVT and take measures to minimize its incidence in this patient population.