CAJ | 학술논문

目的：探讨并分析脊柱手术术后并发下肢深静脉血栓（ DVT）的影响因素，为预防术后血栓形成提供依据。方法回顾性分析我院骨科2012年1～10月间行脊柱手术术后发生下肢DVT的31例患者，选择同期入选行脊柱手术但术后未发生DVT患者50例作为匹配对照，对比两组患者生物学特征、吸烟酗酒史、凝血状况、下肢血管状况、手术相关指标及术后临床处置等指标，并采用Logistic回归模型进行多因素分析，探求发生DVT的影响因素。结果（1）单因素分析显示，两组患者在年龄构成、是否患有糖尿病、术前凝血四项检查结果构成、术中是否输血、术中失血量构成、术后卧床时间等指标上存在明显差异（ P＜0.05）。（2） Logistic回归模型显示，年龄、术前凝血功能异常、术中失血量多、术中输血、术后卧床时间长与术后发生DVT具有统计学关联（ P＜0.05）。结论高龄、术前凝血功能异常、术中输血、术后卧床时间长是脊柱手术术后并发DVT的独立高危因素，尽量缩短手术时间、减少术中出血，术后采用物理抗凝治疗并督促患者早期下床活动是减少下肢DVT发生的必要和有效手段。
목적：탐토병분석척주수술술후병발하지심정맥혈전（ DVT）적영향인소，위예방술후혈전형성제공의거。방법회고성분석아원골과2012년1～10월간행척주수술술후발생하지DVT적31례환자，선택동기입선행척주수술단술후미발생DVT환자50례작위필배대조，대비량조환자생물학특정、흡연후주사、응혈상황、하지혈관상황、수술상관지표급술후림상처치등지표，병채용Logistic회귀모형진행다인소분석，탐구발생DVT적영향인소。결과（1）단인소분석현시，량조환자재년령구성、시부환유당뇨병、술전응혈사항검사결과구성、술중시부수혈、술중실혈량구성、술후와상시간등지표상존재명현차이（ P＜0.05）。（2） Logistic회귀모형현시，년령、술전응혈공능이상、술중실혈량다、술중수혈、술후와상시간장여술후발생DVT구유통계학관련（ P＜0.05）。결론고령、술전응혈공능이상、술중수혈、술후와상시간장시척주수술술후병발DVT적독립고위인소，진량축단수술시간、감소술중출혈，술후채용물리항응치료병독촉환자조기하상활동시감소하지DVT발생적필요화유효수단。
Objective To analyze the factors associated with the lower extremity deep venous thrombosis ( DVT) after spinal surgery ,and to provide method for the prevention of DVT .Methods In a retrospective study from Jan.2012 to Oct.2012,31 cases undergoing spinal surgery occurred DVT were chosen as study objects ,50 cases undergoing spinal surgery with no postoperative DVT were chosen as matching objects .The biological characteristics , smoking and drinking history , coagulation status , lower extremity vascular condition , operational indexes and postoperative clinical management indexes were evaluated between 2 groups,based on which logistic regression model for multivariate analysis was employed to explore affecting factors leading to DVT .Results (1) Single factor analysis showed two groups were different obviously in these factors:age,diabetes,blood coagulation abnormalities ,operative blood loss ,intraoperative blood transfusion , and postoperative bed time ( P<0.05 ) .( 2 ) Logistic regression model showed age,preoperative coagulation abnormalities ,intraoperative blood loss and blood transfusion ,postoperative bed time were statistically correlated with postoperative DVT occurrence ( P <0.05 ) .Conclusion Age, preoperative coagulation abnormalities ,postoperative bed time ,blood transfusion are independent risk factors for lower extremity DVT after spinal surgery .Shortening operation time , reducing intraoperative bleeding , postoperative anticoagulant therapy and early ambulation are effective methods for prevention of DVT′s incidence .