腰椎间盘突出症术前下肢深静脉血栓发生风险因素

发布时间：2018-08-30 16:26

【摘要】：[目的]回顾分析腰椎间盘突出症(lumbar disc herniation,LDH)预手术患者下肢深静脉血栓(deep vein thrombosis,DVT)形成的发生率,探讨LDH术前DVT形成的危险因素。[方法]山东省立医院2014年9月~2015年9月住院治疗患者220例,入院常规行D-二聚体检查(D-dimer concentration,DD),DD0.5 mg/L或出现DVT症状(下肢肿胀、疼痛)的患者行下肢彩超检查。比较DVT组与无DVT组在年龄、性别、病史、基础疾病等方面的差异。[结果]LDH术前DVT发生率为5.90%(13/220),16侧肢体。未发生症状性肺栓塞。血栓组与非血栓组相比,在年龄、DD水平方面差异具有统计学意义,分别为(60.92±9.25)岁vs.(45.42±12.92)岁(P=0.001)、(1.87±1.41.15)mmol/L vs.(0.39±0.59)mmol/L(P=0.003)。两组在心脑血管病史、血脂异常方面差异具有统计学意义,分别为23.1%vs.0.5%(P=0.001)、61.5%vs.15.5%(P=0.000)。两组在性别、病程、糖尿病史、高血压病史方面无统计学差异。DD预测下肢深静脉血栓的受试者工作特征曲线(ROC)下面积0.895(95%可信区间:0.846,0.932;P0.001)。DD0.57 mg/L时对DVT预测的敏感度和特异度分别为84.62%和85.00%。[结论]LDH患者具有较高的术前DVT发生率。术前下肢血管评估是必要的。特别是高龄、心脑血管病史、高血脂患者尤为重要。
[Abstract]:[Objective] To retrospectively analyze the incidence of deep vein thrombosis (DVT) in patients with lumbar disc herniation (LDH) who underwent pre-operation, and to explore the risk factors of DVT formation before LDH. [Methods] 220 patients hospitalized in Shandong Provincial Hospital from September 2014 to September 2015 were admitted for routine D-dimer examination. Dimer concentration, DD, DD 0.5 mg/L or DVT symptoms (lower extremity swelling, pain) were examined by color Doppler ultrasonography. The differences in age, sex, medical history and underlying diseases between the DVT group and the non-DVT group were compared. [Results] The incidence of DVT before LDH was 5.90% (13/220), 16 extremities. No symptomatic pulmonary embolism occurred. There were significant differences in age and DD levels between the two groups (60.92+9.25) vs. (45.42+12.92) vs. (P = 0.001), (1.87+1.41.15) mmol/L vs. (0.39+0.59) mmol/L (P = 0.003). There were significant differences in the history of cardiovascular and cerebrovascular diseases and in the abnormal blood lipid levels between the two groups, 23.1% vs. 0.5% (P = 0.001), 61.5% vs. 15.5% (P = 0.000). There was no significant difference in sex, course of disease, history of diabetes mellitus, and history of hypertension. The sensitivity and specificity of DD for predicting DVT were 84.62% and 85.00% in LDH patients, respectively. Preoperative evaluation of lower extremity blood vessels is necessary, especially in elderly patients with a history of cardiovascular and cerebrovascular diseases and hyperlipidemia.
【作者单位】：中国人民解放军第一四八医院骨科;淄博市第七人民医院儿科;山东省立医院脊柱外科;山东省医学影像研究所超声科;
【基金】：山东省自然科学基金(项目编号:2012GGB14026;ZR2013HQ013) 山东省医药卫生发展计划项目(编号:2013WS0183)
【分类号】：R687.3

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