髋、膝关节置换术后发生院内静脉血栓栓塞症的高危因素分析

发布时间：2018-06-03 17:03

本文选题：深静脉血栓形成 + 危险因素　；参考：《重庆医学》2015年19期

【摘要】：目的分析影响人工全髋及全膝关节置换术后院内静脉血栓栓塞症(VTE)形成的围术期高危因素。方法采用前瞻性队列研究,筛选纳入该科2012年10月至2013年7月分别行全髋及全膝关节置换的174例患者(共205侧手术),包括132例髋(122侧),73例膝(52侧)。术前及术后3~5d行双下肢血管彩超检查,确定有无血栓形成。根据术后是否发生深静脉血栓(DVT)将患者分为DVT组和非DVT组,将DVT发生与否作为因变量,年龄、性别、高血压病等10余项临床因素作为自变量,分析其相关性并筛选出DVT发生的主要影响因素。结果经双下肢血管彩超检查,174例患者中43例发现DVT,发生率24.7%。多因素Logistic回归分析表明:年龄大于或等于70岁、类风湿、术前凝血酶原时间国际标准化比值(PT-INR)相对降低差异有统计学意义(P0.05);术前血浆D-二聚体值升高和全身麻醉差异有统计学意义(P0.01);使用受试者工作特征曲线(ROC)得出结果:术前D-二聚体作为诊断测试的临界值为764μg/L。结论年龄大于或等于70岁、PT-INR相对降低、术前血浆D-二聚体值升高、类风湿和全身麻醉的患者发生VTE的风险高,是髋、膝关节置换术后VTE发生的重要因素,术前D-二聚体值为764μg/L时用作临床排除诊断较合适。
[Abstract]:Objective to analyze the perioperative high risk factors influencing the formation of VTEs after total hip arthroplasty and total knee arthroplasty. Methods A prospective cohort study was used to screen 174 patients (including 132 patients with 122 hips and 73 patients with total knee arthroplasty) who underwent total hip replacement and total knee arthroplasty from October 2012 to July 2013. Before and 3 days after operation, both lower extremities were examined by color Doppler ultrasonography to determine whether there was thrombosis. Patients were divided into DVT group and non-DVT group according to whether DVT occurred or not. More than 10 clinical factors such as age, sex and hypertension were taken as independent variables. The correlation was analyzed and the main influencing factors of DVT were screened out. Results DVT was found in 43 out of 174 patients by color Doppler ultrasound of both lower extremities, the incidence of DVT was 24.7%. Multivariate Logistic regression analysis showed that age was greater than or equal to 70 years old, rheumatoid, rheumatoid, There was significant difference in the relative decrease of PT-INR between preoperative prothrombin time and plasma D- dimer and general anesthesia. The results were obtained by using the operating characteristic curve of subjects. : the critical value of preoperative D- dimer as diagnostic test was 764 渭 g / L. Conclusion the PT-INR of patients aged more than 70 years old is relatively lower, the plasma D-dimer level is increased before operation, and the risk of VTE in patients with rheumatoid and general anesthesia is high, which is an important factor in the occurrence of VTE after hip and knee arthroplasty. Preoperative D-dimer value of 764 渭 g / L is more suitable for clinical exclusion diagnosis.
【作者单位】：第三军医大学大坪医院野战外科研究所骨科;
【分类号】：R687.4

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