中华骨科杂志
中華骨科雜誌
중화골과잡지
Chinese Journal of Orthopaedics
2015年
11期
1077-1083
,共7页
董玉金%张铁慧%钟声%任远飞%郑志强
董玉金%張鐵慧%鐘聲%任遠飛%鄭誌彊
동옥금%장철혜%종성%임원비%정지강
骨折%静脉血栓形成%危险因素
骨摺%靜脈血栓形成%危險因素
골절%정맥혈전형성%위험인소
Fractures,bone%Venous thrombosis%Risk factors
目的 探讨创伤骨折患者深静脉血栓(deep vein thrombosis, DVT)形成的发生率及危险因素,为DVT的预防提供参考.方法 以2010年1月至2013年12月大连市中心医院收治的新鲜四肢及骨盆骨折患者534例为研究对象,对与DVT发生可能相关的因素(包括患者一般情况、受伤类型、骨折情况、手术情况及化验室检查)进行统计分析,并以3次彩色超声多普勒检查结果为诊断依据.结果 534例创伤骨折患者中DVT总发生率为11.99％.分析结果显示一般情况包括男性、年龄≥60岁、身体质量指数(body mass index,BMI)≥25 kg/m2、有吸烟史、缺乏锻炼者DVT的发生率较高;既往有糖尿病、高血压、冠心病者DVT的发生率亦高于总体水平.不同受伤类型中坠落伤患者DVT的发生率最高(达45.71％).不同部位骨折患者DVT的发生率不同,股骨干骨折最高(达20.69％).3处以上骨折患者DVT的发生率为50.00％,2处为15.29％,而单处骨折仅为3.98％.粉碎性骨折患者DVT发生率明显高于总体水平.DVT发生率随手术持续时间延长呈逐渐升高趋势,术中大量输血或全身麻醉患者DVT的发生率明显增高.抗心磷脂抗体(anti-cardiolipin anti-body, ACA)阳性,D-二聚体、纤维蛋白原(fibrinogen,Fib)和C反应蛋白(C reactive protein, CRP)升高的患者DVT发生率明显增高.结论 DVT在创伤骨折患者中具有一定的发生率,年龄≥60岁、BMI≥25 kg/m2、有吸烟史、坠落伤、股骨干及髋部骨折、3处以上骨折及粉碎性骨折、手术持续时间≥2 h、术中大量输血、全身麻醉及ACA阳性,D-二聚体、Fib和CRP升高等均与DVT发生相关,必须引起骨科临床医生的足够重视,并采取预防措施以防止肺栓塞的发生.
目的 探討創傷骨摺患者深靜脈血栓(deep vein thrombosis, DVT)形成的髮生率及危險因素,為DVT的預防提供參攷.方法 以2010年1月至2013年12月大連市中心醫院收治的新鮮四肢及骨盆骨摺患者534例為研究對象,對與DVT髮生可能相關的因素(包括患者一般情況、受傷類型、骨摺情況、手術情況及化驗室檢查)進行統計分析,併以3次綵色超聲多普勒檢查結果為診斷依據.結果 534例創傷骨摺患者中DVT總髮生率為11.99％.分析結果顯示一般情況包括男性、年齡≥60歲、身體質量指數(body mass index,BMI)≥25 kg/m2、有吸煙史、缺乏鍛煉者DVT的髮生率較高;既往有糖尿病、高血壓、冠心病者DVT的髮生率亦高于總體水平.不同受傷類型中墜落傷患者DVT的髮生率最高(達45.71％).不同部位骨摺患者DVT的髮生率不同,股骨榦骨摺最高(達20.69％).3處以上骨摺患者DVT的髮生率為50.00％,2處為15.29％,而單處骨摺僅為3.98％.粉碎性骨摺患者DVT髮生率明顯高于總體水平.DVT髮生率隨手術持續時間延長呈逐漸升高趨勢,術中大量輸血或全身痳醉患者DVT的髮生率明顯增高.抗心燐脂抗體(anti-cardiolipin anti-body, ACA)暘性,D-二聚體、纖維蛋白原(fibrinogen,Fib)和C反應蛋白(C reactive protein, CRP)升高的患者DVT髮生率明顯增高.結論 DVT在創傷骨摺患者中具有一定的髮生率,年齡≥60歲、BMI≥25 kg/m2、有吸煙史、墜落傷、股骨榦及髖部骨摺、3處以上骨摺及粉碎性骨摺、手術持續時間≥2 h、術中大量輸血、全身痳醉及ACA暘性,D-二聚體、Fib和CRP升高等均與DVT髮生相關,必鬚引起骨科臨床醫生的足夠重視,併採取預防措施以防止肺栓塞的髮生.
목적 탐토창상골절환자심정맥혈전(deep vein thrombosis, DVT)형성적발생솔급위험인소,위DVT적예방제공삼고.방법 이2010년1월지2013년12월대련시중심의원수치적신선사지급골분골절환자534례위연구대상,대여DVT발생가능상관적인소(포괄환자일반정황、수상류형、골절정황、수술정황급화험실검사)진행통계분석,병이3차채색초성다보륵검사결과위진단의거.결과 534례창상골절환자중DVT총발생솔위11.99％.분석결과현시일반정황포괄남성、년령≥60세、신체질량지수(body mass index,BMI)≥25 kg/m2、유흡연사、결핍단련자DVT적발생솔교고;기왕유당뇨병、고혈압、관심병자DVT적발생솔역고우총체수평.불동수상류형중추락상환자DVT적발생솔최고(체45.71％).불동부위골절환자DVT적발생솔불동,고골간골절최고(체20.69％).3처이상골절환자DVT적발생솔위50.00％,2처위15.29％,이단처골절부위3.98％.분쇄성골절환자DVT발생솔명현고우총체수평.DVT발생솔수수술지속시간연장정축점승고추세,술중대량수혈혹전신마취환자DVT적발생솔명현증고.항심린지항체(anti-cardiolipin anti-body, ACA)양성,D-이취체、섬유단백원(fibrinogen,Fib)화C반응단백(C reactive protein, CRP)승고적환자DVT발생솔명현증고.결론 DVT재창상골절환자중구유일정적발생솔,년령≥60세、BMI≥25 kg/m2、유흡연사、추락상、고골간급관부골절、3처이상골절급분쇄성골절、수술지속시간≥2 h、술중대량수혈、전신마취급ACA양성,D-이취체、Fib화CRP승고등균여DVT발생상관,필수인기골과림상의생적족구중시,병채취예방조시이방지폐전새적발생.
Objective To explore the incidence rate and the risk factors of deep vein thrombosis (DVT) in patients with traumatic fractures so as to provide references for prevention of DVT.Methods All of 534 Patients with fresh four extremities or pelvic fracture between January 2010 and December 2013 were involved in this study.The incidence of DVT under 5 risk factors including general state, injury type, fracture condition, operation and laboratory examination were analyzed.Each patient underwent three Doppler ultrasound exams in actions as the epidemiology diagnostic criterion for DVT.Results The total incidence rate of DVT in 534 patients was 11.99％.The univariate analysis showed that male patients with age≥60 years, BMI≥25 kg/m2, history of smoking, lack of exercises, history of diabetes, hypertension and coronary artery disease had higher incidence rate of DVT.In different injury types, the fall injury caused the highest incidence rate of DVT (45.71％).There were different DVT rates for different fracture sites, with the highest incidence rate of DVT for femur shaft fracture (20.69％).The incidence rate of DVT was 50.00％ for fractures of more than three parts, 15.29％ for fractures of two parts and only 3.98％ for sole part.The incidence rate of DVT for comminuted fractures was higher than others.The operation duration, massive transfusion during operation and general anesthesia were related with the increase of incidence of DVT.Positive ACA and enhancement of D-dimer, Fib and CRP were related with the increase of incidence of DVT.Conclusion The incidence of DVT in patients with traumatic fractures approaches a considerable level.It has relationships with age≥60 years, BMI≥25 kg/m2, history of smoking, fall injury, fracture of femoral shaft and hip, more than three parts of fractures, comminuted fractures, operation duration≥2 hours, largely blood transfused, massive transfusion during operation, general anesthesia, positive ACA, enhancement of D-dimer, Fib and CRP.The surgeons should recognize the importance to prevent DVT and PE in the traumatic patients.
