CAJ | 학술논문

目的：分析全髋关节置换术后下肢深静脉血栓形成的影响因素，为围术期预防提供指导。方法收集行全髋关节置换手术患者52例，全部患者术后行彩超检查下肢静脉血栓情况，统计术后下肢深静脉血栓发生率，并从患者性别、年龄、血脂、D-二聚体、合并症及手术指标等方面分析下肢深静脉血栓形成的危险因素。结果52例患者中，术后发生下肢深静脉血栓16例（30．8％）；单因素分析显示年龄≥65岁、超重或肥胖（BMI≥25 kg／m2）、高甘油三酯（TG≥1．7 mmol／L）、高 D-二聚体水平（≥500μg／L）、合并糖尿病或高血压、大量输血的患者术后深静脉血栓发生率较高（P ＜0．05）；进一步行多因素回归分析显示年龄≥65岁、超重或肥胖、高甘油三酯、高 D-二聚体、糖尿病、大量输血是下肢深静脉血栓的独立危险因素（OR ＝15．693、1．278、9．832、3．053、1．855、1．014，均 P ＜0．05）。结论全髋关节置换术患者术前应进行静脉血栓风险评估，年龄≥65岁、超重或肥胖、高甘油三酯、高 D-二聚体水平、糖尿病、大量输血患者术后发生下肢深静脉血栓的风险较高，应重点加强围术期监测，规范应用低分子肝素、下肢静脉泵等，术后早期行下肢康复锻炼，尽量减少深静脉血栓的发生。
목적：분석전관관절치환술후하지심정맥혈전형성적영향인소，위위술기예방제공지도。방법수집행전관관절치환수술환자52례，전부환자술후행채초검사하지정맥혈전정황，통계술후하지심정맥혈전발생솔，병종환자성별、년령、혈지、D-이취체、합병증급수술지표등방면분석하지심정맥혈전형성적위험인소。결과52례환자중，술후발생하지심정맥혈전16례（30．8％）；단인소분석현시년령≥65세、초중혹비반（BMI≥25 kg／m2）、고감유삼지（TG≥1．7 mmol／L）、고 D-이취체수평（≥500μg／L）、합병당뇨병혹고혈압、대량수혈적환자술후심정맥혈전발생솔교고（P ＜0．05）；진일보행다인소회귀분석현시년령≥65세、초중혹비반、고감유삼지、고 D-이취체、당뇨병、대량수혈시하지심정맥혈전적독립위험인소（OR ＝15．693、1．278、9．832、3．053、1．855、1．014，균 P ＜0．05）。결론전관관절치환술환자술전응진행정맥혈전풍험평고，년령≥65세、초중혹비반、고감유삼지、고 D-이취체수평、당뇨병、대량수혈환자술후발생하지심정맥혈전적풍험교고，응중점가강위술기감측，규범응용저분자간소、하지정맥빙등，술후조기행하지강복단련，진량감소심정맥혈전적발생。
Objective To analyze the influence factors of lower extremities deep venous thrombosis after hip replacement,and provide guidance for perioperative prevention.Methods 52 cases of patients underwent total hip replacement were selected,who were given color doppler ultrasound examination for lower limb venous thrombosis after hip replacement.And analyzed risk factors of lower extremity deep vein thrombosis from patient's gender,age,blood lipid,D -dimer,complications and surgical index.Results During the 52 cases,16 cases were found with postopera-tive lower limb deep vein thrombosis (30.8%);Single factor analysis showed that patients with age ≥65 years,over-weight or obese (BMI≥25kg/m2 ),high triglycerides (TG ≥ 1.7mmol/L)and high D -dimer level (≥500μg/L), diabetes or high blood pressure,large blood transfusion combined with a greater incidence of postoperative deep vein thrombosis (P <0.05).Further multiple factors regression analysis showed that age ≥65 years,overweight or obesity, high triglycerides,high D -dimer,diabetes,large blood transfusions were independent risk factors of lower extremity deep vein thrombosis (OR =15.693,1.278,9.832,3.053,1.855,1.014,all P <0.05).Conclusion Patients with total hip replacement should be given preoperative vein thrombosis risk assessment,patients with age ≥65,overweight or obese,high triglycerides,D -dimer level,diabetes,large number of blood transfusions have higher risk of deep vein thrombosis,we should focus on perioperative monitoring,application of low molecular heparin,lower limb vein pump, etc.early postoperative lower limb rehabilitation exercise,to reduce the occurrence of deep vein thrombosis.