摘要
目的 探讨髋膝关节置换术后3个月下肢深静脉血栓形成(deep venous thrembosis,DVT)的相关危险因素.方法 回顾性分析2015年2月至2018年12月于南京大学医学院附属鼓楼医院接受关节置换术的1 782例患者临床资料,男1 298例、女484例,年龄(65.4±12.3)岁(范围18-95岁).调查术后3个月可能发生DVT的14个指标,包括年龄、性别、体质指数、手术季节、术前凝血功能、手术类型、微创入路选择、术后第1天是否发生DVT、既往血栓性疾病史、吸烟、肿瘤、糖尿病、高血压、心脏病.比较出现与未出现血栓患者上述14个指标,将差异有统计学意义的指标纳入二分类变量logis-tic 回归分析,确定术后 3 个月DVT 发生的危险因素.根据回归分析结果建立风险预测模型并绘制工作特征曲线,计算预测模型的曲线下面积.结果 1 782例患者中,术后3个月下肢多普勒超声检查结果显示187例出现血栓、1 595例未出现血栓.血栓组包括症状性血栓5例、无症状血栓182例,近端13例、远端174例,累及髂静脉1例次、股静脉10例次、腘静脉8例次、腓静脉14例次、肌间静脉168例次.单因素分析结果显示女性、年龄增大、既往血栓性疾病、高血压、秋季手术、术后第1天出现DVT与术后3个月DVT显著相关(P＜0.05).剔除数据资料不全的患者后,共1 744例纳入二分类变量logistic回归分析,结果显示术后第 1 天出现 DVT[OR=7.498,95％CI(5.312,10.584),P＜0.001]、秋季手术[OR=1.834,95％CI(1.215,2.769),P=0.004]、年龄增大[OR=1.024,95％CI(1.007,1.042),P=0.009]、女性[OR=1.863,95％CI(1.184,2.931),P=0.007]、既往血栓性疾病史[OR=0.012,95％CI(1.136,2.830),P=0.012]与术后3个月出现DVT相关.预测髋膝关节置换术后3个月出现DVT的曲线下面积为0.803[95％CI(0.761,0.844)].结论 年龄较大、女性、既往血栓性疾病、术后第1天下肢DVT形成和秋季手术是关节置换术后3个月发生下肢DVT的危险因素.
Abstract
Objective To explore the relevant risk factors for deep venous thrombosis(DVT)of lower limb occurring 3 months after joint replacement surgery.Methods A retrospective analysis was conducted on the clinical data of 1,782 patients who underwent joint replacement surgery at Drum Tower Hospital,School of Medicine of Nanjing University,from February 2015 to December 2018.Of these,1,298 were male and 484 were female,with an average age of 65.4±12.3 years(range,18-95 years).Fourteen factors associated with DVT occurrence at 3 months were investigated,including age,gender,body mass index(BMI),season of surgery,preoperative coagulation function,type of surgery,selection of minimally invasive approach,occurrence of lower limb venous thrombosis 1 day after surgery,history of previous thrombotic diseases,smoking,tumors,diabetes,hypertension,and heart disease.Independent sample t-tests and chi-square tests were used to analyze the risk factors for DVT occurrence.Indicators with statistically significant differences were included in a binary logistic regression analysis to determine the risk factors for DVT 3 months after surgery.The risk prediction model was established according to the results of logistic regression analysis,and the re-ceiver operating characteristic curve was drawn.The area under the curve of the prediction model was calculated.Results A to-tal of 1,782 patients were included.The overall incidence of DVT occurring 3 months after joint replacement surgery was 10.5％(187/1,782).The thrombosis group included 5 symptomatic cases and 182 asymptomatic cases,with 13 proximal and 174 distal cases.DVT was found in the iliac vein(1 case),femoral vein(10 cases),popliteal vein(8 cases),peroneal vein(14 cases),and in-tramuscular vein(168 cases).Single-factor analysis showed that female gender,increasing age,previous thrombotic disease,hyper-tension,surgery in autumn,and the occurrence of DVT on the first day after surgery were correlated with DVT occurring 3 months after joint replacement surgery(P＜0.05).After excluding the missing data,a total of 1,744 patients were included in the final anal-ysis.DVT occurrence on the first day after surgery[OR=7.498,95％CI(5.312,10.584),P＜0.001],surgery in autumn[OR=1.834,95％CI(1.215,2.769),P=0.004],age[OR=1.024,95％CI(1.007,1.042),P=0.009],female gender[OR=1.863,95％CI(1.184,2.931),P=0.007],and history of previous thrombotic diseases[OR=0.012,95％CI(1.136,2.830),P=0.012]were found to be asso-ciated with DVT occurrence at 3 months after surgery.The area under the curve(AUC)for predicting DVT three months after hip or knee arthroplasty was 0.803[95％CI(0.761,0.844)].Conclusion Advanced age,female gender,history of previous thrombot-ic diseases,occurrence of DVT on the first day after surgery,and surgery in autumn are risk factors for DVT occurring 3 months af-terjoint replacement surgery.
万方数据