骨科大手术后静脉血栓栓塞症的危险因素研究

Risk factors of venous thromboembolism after major orthopedic surgery

摘要:

目的 探讨骨科大手术患者术后静脉血栓栓塞症（VTE）的危险因素。方法 选取2016 年1 月— 2017 年12 月于山东中医药大学附属医院行骨科大手术的患者220 例。其中术后3 个月内并发VTE 的102 例 患者作为观察组，选取同期未发生VTE 的118 例患者作为对照组。记录患者的各种危险因素，并采用Caprini 血栓风险评估模型进行评分，分析危险因素与VTE 之间的关系。结果 两组患者的年龄、既往病史、纤维蛋 白原、D- 二聚体、同型半胱氨酸、手术体位、手术时间、输血史及输血量比较，差异有统计学意义（P <0.05）； 观察组Caprini 血栓风险因素评分高于对照组（P <0.05）；经多因素Logistic 回归分析显示，既往病史、纤维 蛋白原、D- 二聚体、手术体位和手术时间是骨科大手术患者易栓的独立危险因素（P <0.05）。结论 骨科 大手术患者术后发生VTE 是多种危险因素共同作用的结果，Caprini 评分可较好地评估骨科大手术患者VTE 发病的危险程度，而患者的既往病史、纤维蛋白原、D- 二聚体、手术体位和手术时间是骨科大手术患者易 栓的独立危险因素，应给予充分重视。

Abstract:

Objective To explore the risk factors of venous thromboembolism (VTE) after major orthopaedic surgery. Methods A retrospective case-control study was conducted to collect 220 patients undergoing major orthopaedic surgery. 102 patients complicated with VTE within 3 months after operation were selected as the observation group and 118 patients without VTE were selected as the control group. Various risk factors were recorded and scored by Caprini thrombosis risk assessment model, and the relationship between risk factors and VTE was analyzed. Results There were significant differences in age, history, fibrinogen, D-dimer, homocysteine, operation position, operation time and blood transfusion between the two groups (P < 0.05). The risk factor score of Caprini thrombosis in the observation group was significantly higher than that in the control group (P < 0.05). Logistic regression analysis showed that the past history, fibrinogen, D-dimer, operation position and operation time were independent risk factors for thrombosis in patients undergoing major orthopaedic surgery (P < 0.05). Conclusions VTE after major orthopaedic surgery is the result of multiple risk factors. Caprini score can better assess the risk of VTE in patients with major orthopaedic surgery. The patient’s past history, fibrinogen, D-dimer, operation position and operation time are independent risk factors for thrombosis in patients with major orthopaedic surgery, which should be given full attention.