老年患者全麻下全髋置换术后下肢深静脉血栓发生情况及危险因素
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摘要
目的探讨全麻下全髋置换的老年患者术后下肢深静脉血栓的发生情况及其危险因素。方法选取南京鼓楼医院和南京市浦口医院2015年1月至2018年6月在全麻下择期行全髋置换的老年患者共计398例为研究对象,在术后5～10 d行下肢彩超检查,观察其深静脉血栓的发生情况,对影响术后下肢深静脉血栓发生的危险因素分别进行单因素和多因素Logistic回归分析。结果 398例老年全髋置换患者中有136例出现术后下肢深静脉血栓,发生率为34. 17%; Logistic回归分析结果显示:年龄大于70岁、体质指数大于25 kg/m~2、合并糖尿病、甘油三酯大于等于1. 7 mmol/L、D-二聚体大于等于500μg/L以及手术时间大于2 h等是导致老年患者全髋置换术后深静脉血栓发生的危险因素(OR>1,P <0. 05),而不使用骨水泥、仅置换单侧及术后3 d内下床活动是避免老年患者全髋置换术后深静脉血栓发生的保护性因素(OR <1,P <0. 05)。结论老年、肥胖、合并糖尿病、甘油三酯大于等于1. 7 mmol/L、D-二聚体大于等于500μg/L及较长的手术时间与老年患者全麻下全髋关节置换术后深静脉血栓的发生关系密切,应尽量避免双侧同时置换,鼓励患者术后早期下床活动,以降低老年患者全麻下全髋置换术后深静脉血栓的发生率。
Objective To investigate the incidence and the risk factors of deep venous thrombosis for the elderly patients with total hip arthroplasty under general anesthesia. Methods A total of 398 elderly patients undergoing elective total hip replacement under general anesthesia in Nanjing drum tower medical college and Nanjing Pukou hospital from January 2015 to June 2018 were selected as the study subjects. The incidence of deep venous thrombosis was observed,and color doppler ultrasound was performed in 5 ～ 10 days after operation. Single factor analysis and multivariable logistic regression analysis were performed to analyze the risk factors that may affect deep venous thrombosis in patients of hip arthroplasty. Results In 398 elderly patients with hip replacement,136 patients with deep venous thrombosis of the lower extremities were found,and the incidence was 34. 17%. The results of logistic regression analysis showed: age > 70 years old,body mass index> 25 kg/m~2,suffering from diabetes,triglyceride≥1. 7 mmol/L,the numerical value of D-Dimer≥500 μg/L and the operation time > 2 hours were the risk factors of deep venous thrombosis for the elderly patients with hip arthroplasty( OR > 1,P < 0. 05). While without the use of bone cement,only unilateral replacement and out of bed activity within 3 days after operation were the protective factors of deep venous thrombosis for the elderly patients of hip arthroplasty( OR < 1,P < 0. 05). Conclusion Older age,obesity,diabetes mellitus,triglyceride( ≥1. 7 mmol/L),D-dimer( ≥500 μg/L) and longer operation time are closely related to the occurrence of deep venous thrombosis after total hip arthroplasty under general anesthesia. Therefore,we should try to avoid bilateral simultaneous replacement,encourage patients to get out of bed early after surgery,and ultimately reduce the incidence of deep vein thrombosis in elderly patients undergoing total hip replacement under general anesthesia.
Objective To investigate the incidence and the risk factors of deep venous thrombosis for the elderly patients with total hip arthroplasty under general anesthesia. Methods A total of 398 elderly patients undergoing elective total hip replacement under general anesthesia in Nanjing drum tower medical college and Nanjing Pukou hospital from January 2015 to June 2018 were selected as the study subjects. The incidence of deep venous thrombosis was observed,and color doppler ultrasound was performed in 5 ～ 10 days after operation. Single factor analysis and multivariable logistic regression analysis were performed to analyze the risk factors that may affect deep venous thrombosis in patients of hip arthroplasty. Results In 398 elderly patients with hip replacement,136 patients with deep venous thrombosis of the lower extremities were found,and the incidence was 34. 17%. The results of logistic regression analysis showed: age > 70 years old,body mass index> 25 kg/m~2,suffering from diabetes,triglyceride≥1. 7 mmol/L,the numerical value of D-Dimer≥500 μg/L and the operation time > 2 hours were the risk factors of deep venous thrombosis for the elderly patients with hip arthroplasty( OR > 1,P < 0. 05). While without the use of bone cement,only unilateral replacement and out of bed activity within 3 days after operation were the protective factors of deep venous thrombosis for the elderly patients of hip arthroplasty( OR < 1,P < 0. 05). Conclusion Older age,obesity,diabetes mellitus,triglyceride( ≥1. 7 mmol/L),D-dimer( ≥500 μg/L) and longer operation time are closely related to the occurrence of deep venous thrombosis after total hip arthroplasty under general anesthesia. Therefore,we should try to avoid bilateral simultaneous replacement,encourage patients to get out of bed early after surgery,and ultimately reduce the incidence of deep vein thrombosis in elderly patients undergoing total hip replacement under general anesthesia.
引文
[1]何学军,范朝铭.老年髋关节置换术致深静脉血栓60例影响因素分析[J].陕西医学杂志,2016,45(5):591-592. doi:10. 3969/j.issn. 1000-7377. 2016. 05. 035.
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[3]姚刚,尚希福,史国光,等.全髋置换术后下肢深静脉血栓形成的危险因素[J].中国临床保健杂志,2015,18(4):408-410. doi:10.3969/J. issn. 1672-6790. 2015. 04. 025.
[4]钟环,郑鸿,陈继铭,等.全髋关节置换术后深静脉栓塞发生的相关因素研究[J].中国实验诊断学,2012,16(6):1058-1061.doi:10. 3969/j. issn. 1007-4287. 2012. 06. 037.
[5]李兴华.人工关节置换术后深静脉血栓的形成及其影响因素[J].解放军医学杂志,2016,41(8):701-702. doi:10. 11855/j. issn.0577-7402. 2016. 08. 18.
[6]姚杰,孟尽海,王文娟,等.不同麻醉方法对骨科手术患者深静脉血栓形成的影响[J].宁夏医科大学学报,2013,35(1):29-31.doi:10. 3969/j. issn. 1674-6309. 2013. 01. 008.
[7]姜琳琳,赵庆春.全髋关节置换术后下肢深静脉血栓形成影响因素分析[J].临床军医杂志,2018,46(9):1051-1054. doi:10. 16680/j. 1671-3826. 2018. 09. 20.
[8]屈霜威,张斌飞,王鹏飞,等.膝关节周围骨折患者围手术期DVT发生规律及危险因素分析[J].中国骨与关节损伤杂志,2018,33(8):850-852. doi:10. 7531/j. issn. 1672-9935. 2018. 08. 022.
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[10]戴小宇,姚尧,徐志宏,等.膝髋骨性关节炎关节置换术后下肢深静脉血栓发生的常见危险因素分析[J].中国矫形外科杂志,2014,22(21):1939-1942. doi:10. 3977/j. issn. 1005-8478.2014. 21. 04.
[11]林旺,张栋,王盈盈,等.髋部以下创伤患者术前下肢深静脉血栓形成的影响因素分析[J].山东医药,2017,57(32):53-55.doi:10. 3969/j. issn. 1002-266X. 2017. 32. 016.
[12]吴丽梅.老年髋部骨折患者下肢深静脉血栓形成危险因素分析及其转归[J].中华全科医学,2017,15(4):605-607. doi:10. 16766/j. cnki. issn. 1674-4152. 2017. 04. 019.
[13]孙灏,王瑜,魏俊强,等.下肢及骨盆骨折患者围手术期下肢静脉血栓形成的危险因素分析[J].现代医学,2017,45(7):910-914. doi:10. 3969/j. 1671-7562. 2017. 07. 004.
[14]贾星海.老年髋关节置换术后深静脉形成高危风险因素分析[J].现代诊断与治疗,2015,26(4):755-756. doi:10. 5432/j. 1638-2664. 2015. 04. 055.
[15]张杰,陈平,荣冬明,等.人工关节置换术后并发深静脉血栓形成的危险因素评估[J].中国矫形外科杂志,2016,24(11):1001-1005. doi:10. 3977/j. issn. 1005-8478. 2016. 11. 09.
[16]Hur M,Park SK,Koo CH,et al. Comparative efficacy and safety of anticoagulants for prevention of venous thromboembolism after hip and knee arthroplasty[J]. Acta Orthop,2017,88(6):634-641. doi:10.1080/17453674. 2017. 1361131.
[17]吴晨光,宗军,蒋臻欢.导致骨科手术患者术后发生下肢深静脉血栓的危险因素[J].中国临床医生杂志,2015,43(11):67-69.doi:10. 3969/j. issn. 2095-8552. 2015. 11. 025.
[18]王峰,张安珍,李政勋,等.中青年股骨干骨折并发DVT相关危险因素Logistic回归分析[J].中国骨与关节损伤杂志,2017,32(6):577-579. doi:10. 7531/j. issn. 1672-9935. 2017. 06. 006.
[19]范吉星,李宁,龚晓峰,等.老年髋部骨折术前下肢深静脉血栓形成的影响因素研究[J].中国矫形外科杂志,2017,25(22):2027-2030. doi:10. 3977/j. issn. 1005-8478. 2017. 22. 03.
[20]Prandoni P,Milan M,Sarolo L,et al. Optimal duration of anticoagulation in patients with unprovoked venous thromboembolism:theimpact of novel anticoagulants[J]. Int Angiol,2017,36(5):395-401. doi:10. 23736/S0392-9590. 16. 03785-8.
[21]易伟林,梁斌,陈峰,等.腰椎融合术后早期下肢深静脉血栓形成的相关危险因素分析[J].中国脊柱脊髓杂志,2017,27(9):823-828. doi:10. 3969/j. issn. 1004-406X. 2017. 09. 10.
[22]尹星华,周一新,唐杞衡,等.人工髋膝关节置换术后症状性静脉血栓栓塞性疾病的危险因素分析[J].中国矫形外科杂志,2016,24(19):1765-1769. doi:10. 3977/j. issn. 1005-8478. 2016. 19. 08.
[2]陆蓉,马国平.不同麻醉方案对骨科老年患者术后深静脉血栓发生率的影响[J].实用临床医药杂志,2017,21(11):208-209. doi:10. 7619/jcmp. 201711075.
[3]姚刚,尚希福,史国光,等.全髋置换术后下肢深静脉血栓形成的危险因素[J].中国临床保健杂志,2015,18(4):408-410. doi:10.3969/J. issn. 1672-6790. 2015. 04. 025.
[4]钟环,郑鸿,陈继铭,等.全髋关节置换术后深静脉栓塞发生的相关因素研究[J].中国实验诊断学,2012,16(6):1058-1061.doi:10. 3969/j. issn. 1007-4287. 2012. 06. 037.
[5]李兴华.人工关节置换术后深静脉血栓的形成及其影响因素[J].解放军医学杂志,2016,41(8):701-702. doi:10. 11855/j. issn.0577-7402. 2016. 08. 18.
[6]姚杰,孟尽海,王文娟,等.不同麻醉方法对骨科手术患者深静脉血栓形成的影响[J].宁夏医科大学学报,2013,35(1):29-31.doi:10. 3969/j. issn. 1674-6309. 2013. 01. 008.
[7]姜琳琳,赵庆春.全髋关节置换术后下肢深静脉血栓形成影响因素分析[J].临床军医杂志,2018,46(9):1051-1054. doi:10. 16680/j. 1671-3826. 2018. 09. 20.
[8]屈霜威,张斌飞,王鹏飞,等.膝关节周围骨折患者围手术期DVT发生规律及危险因素分析[J].中国骨与关节损伤杂志,2018,33(8):850-852. doi:10. 7531/j. issn. 1672-9935. 2018. 08. 022.
[9]于时魁.全膝关节置换术后下肢深静脉血栓发生的危险因素[J].中国矫形外科杂志,2018,26(8):703-705. doi:10. 3977/j. issn.1005-8478. 2018. 08. 07.
[10]戴小宇,姚尧,徐志宏,等.膝髋骨性关节炎关节置换术后下肢深静脉血栓发生的常见危险因素分析[J].中国矫形外科杂志,2014,22(21):1939-1942. doi:10. 3977/j. issn. 1005-8478.2014. 21. 04.
[11]林旺,张栋,王盈盈,等.髋部以下创伤患者术前下肢深静脉血栓形成的影响因素分析[J].山东医药,2017,57(32):53-55.doi:10. 3969/j. issn. 1002-266X. 2017. 32. 016.
[12]吴丽梅.老年髋部骨折患者下肢深静脉血栓形成危险因素分析及其转归[J].中华全科医学,2017,15(4):605-607. doi:10. 16766/j. cnki. issn. 1674-4152. 2017. 04. 019.
[13]孙灏,王瑜,魏俊强,等.下肢及骨盆骨折患者围手术期下肢静脉血栓形成的危险因素分析[J].现代医学,2017,45(7):910-914. doi:10. 3969/j. 1671-7562. 2017. 07. 004.
[14]贾星海.老年髋关节置换术后深静脉形成高危风险因素分析[J].现代诊断与治疗,2015,26(4):755-756. doi:10. 5432/j. 1638-2664. 2015. 04. 055.
[15]张杰,陈平,荣冬明,等.人工关节置换术后并发深静脉血栓形成的危险因素评估[J].中国矫形外科杂志,2016,24(11):1001-1005. doi:10. 3977/j. issn. 1005-8478. 2016. 11. 09.
[16]Hur M,Park SK,Koo CH,et al. Comparative efficacy and safety of anticoagulants for prevention of venous thromboembolism after hip and knee arthroplasty[J]. Acta Orthop,2017,88(6):634-641. doi:10.1080/17453674. 2017. 1361131.
[17]吴晨光,宗军,蒋臻欢.导致骨科手术患者术后发生下肢深静脉血栓的危险因素[J].中国临床医生杂志,2015,43(11):67-69.doi:10. 3969/j. issn. 2095-8552. 2015. 11. 025.
[18]王峰,张安珍,李政勋,等.中青年股骨干骨折并发DVT相关危险因素Logistic回归分析[J].中国骨与关节损伤杂志,2017,32(6):577-579. doi:10. 7531/j. issn. 1672-9935. 2017. 06. 006.
[19]范吉星,李宁,龚晓峰,等.老年髋部骨折术前下肢深静脉血栓形成的影响因素研究[J].中国矫形外科杂志,2017,25(22):2027-2030. doi:10. 3977/j. issn. 1005-8478. 2017. 22. 03.
[20]Prandoni P,Milan M,Sarolo L,et al. Optimal duration of anticoagulation in patients with unprovoked venous thromboembolism:theimpact of novel anticoagulants[J]. Int Angiol,2017,36(5):395-401. doi:10. 23736/S0392-9590. 16. 03785-8.
[21]易伟林,梁斌,陈峰,等.腰椎融合术后早期下肢深静脉血栓形成的相关危险因素分析[J].中国脊柱脊髓杂志,2017,27(9):823-828. doi:10. 3969/j. issn. 1004-406X. 2017. 09. 10.
[22]尹星华,周一新,唐杞衡,等.人工髋膝关节置换术后症状性静脉血栓栓塞性疾病的危险因素分析[J].中国矫形外科杂志,2016,24(19):1765-1769. doi:10. 3977/j. issn. 1005-8478. 2016. 19. 08.