CAJ | 학술논문

目的探讨下肢骨折患者围手术期静脉血栓栓塞症(VTE)的发生率及影响因素,以确定下肢骨折患者VTE的高危因素,并提出预防措施. 方法回顾性分析2009年1月至2010年12月收治且获得随访的329例下肢骨折患者资料,男141例,女188例;平均年龄为65.2岁(16 ～ 96岁);骨折部位:髋部骨折190例,股骨干骨折10例,膝关节周围骨折46例,胫腓骨骨折8例,足踝部骨折27例,骨盆骨折6例,多发骨折42例.根据是否发生下肢VTE将所有患者分为血栓组和非血栓组,比较两组患者的一般资料,对单因素分析中P≤0.1的因素进行多因素logistic回归分析. 结果下肢骨折患者围手术期VTE的总发生率为29.8％ (98/329).血栓组与非血栓组患者的年龄、是否合并血管内皮功能损害性疾病(原发性高血压、糖尿病、冠状动脉粥样硬化性心脏病、脑血管疾病、高脂血症)及是否预防性使用抗凝药物比较差异均有统计学意义(P＜0.05).多因素logistic回归分析结果显示下肢VTE发生的独立危险因素包括:年龄≥60岁、受伤至手术时间≥3d、合并血管内皮功能损害性疾病、未预防性抗凝(P＜0.05),该回归模型能预测75.7％的下肢骨折VTE患者. 结论下肢骨折患者为下肢VTE的高发人群,对具有VTE形成危险因素[如年龄≥60岁、受伤至手术时间≥3d,合并血管内皮功能损害性疾病及部分骨折部位(骨盆、髋部、多发骨折及膝关节周围)]的下肢骨折患者提高警惕、进行预防性抗凝干预措施具有重要意义.
목적 탐토하지골절환자위수술기정맥혈전전새증(VTE)적발생솔급영향인소,이학정하지골절환자VTE적고위인소,병제출예방조시. 방법 회고성분석2009년1월지2010년12월수치차획득수방적329례하지골절환자자료,남141례,녀188례;평균년령위65.2세(16 ～ 96세);골절부위:관부골절190례,고골간골절10례,슬관절주위골절46례,경비골골절8례,족과부골절27례,골분골절6례,다발골절42례.근거시부발생하지VTE장소유환자분위혈전조화비혈전조,비교량조환자적일반자료,대단인소분석중P≤0.1적인소진행다인소logistic회귀분석. 결과 하지골절환자위수술기VTE적총발생솔위29.8％ (98/329).혈전조여비혈전조환자적년령、시부합병혈관내피공능손해성질병(원발성고혈압、당뇨병、관상동맥죽양경화성심장병、뇌혈관질병、고지혈증)급시부예방성사용항응약물비교차이균유통계학의의(P＜0.05).다인소logistic회귀분석결과현시하지VTE발생적독립위험인소포괄:년령≥60세、수상지수술시간≥3d、합병혈관내피공능손해성질병、미예방성항응(P＜0.05),해회귀모형능예측75.7％적하지골절VTE환자. 결론 하지골절환자위하지VTE적고발인군,대구유VTE형성위험인소[여년령≥60세、수상지수술시간≥3d,합병혈관내피공능손해성질병급부분골절부위(골분、관부、다발골절급슬관절주위)]적하지골절환자제고경척、진행예방성항응간예조시구유중요의의.
Objective To analyze the influencing factors of perioperative venous thromboembolism (VTE) in patients with lower extremity fractures and to propose feasible preventive measures.Methods A retrospective analysis was conducted of the medical records of 329 patients with lower extremity fracture who had been admitted to our hospital between January 2009 and December 2010.They were 141 men and 188 women,with a mean age of 65.2 years (from 16 to 96 years).There were 190 hip fractures,10 femoral shaft fractures,46 peri-knee fractures,8 tibiofibular fractures,27 ankle fractures,6 pelvic fractures,and 42 multiple fractures.The patients were divided into a VTE group and a non-VTE group.The 2 groups were compared in general clinical data.A multiple logistic regression analysis was used for factors with P ≤ 0.1 by single factor analysis.Results The overall incidence of perioperative VTE in this cohort was 29.8％ (98/329).There were statistically significant differences (P ＜ 0.05) between the 2 groups in age,presence of concomitant disease impairing the function of vascular endothelium (such as hypertension,diabetes,coronary heart disease,cerebral vascular disease and hyperlipidemia) and usage of prophylactic anticoagulants.Logistic regression analysis revealed the following risks related to lower extremity VTE:age ≥ 60 years,duration from injury to operation ≥ 3 days,concomitant disease leading to vascular endothelium dysfunction and absence of prophylactic anticoagulants.This regression model was able to predict 75.7％ of the VTE events in patients with lower extremity fracture.Conclusions Patients with lower extremity fracture are a high-risk group of VTE,especially for those older than 60 years old,receiving surgery after longer than 3 days,having comorbidity that endangers vascular endothelium function and having fracture at pelvis,hip and multiple sites,and around the knee.Prophylactic anticoagulation is of great significance to these patients.