老年患者全膝关节置换术后下肢深静脉血栓形成相关危险因素探究
|
摘要
目的探讨老年患者全膝关节置换术(total knee arthroplasty,TKA)后下肢深静脉血栓形成(deep venous thrombosis,DVT)的危险因素。方法选取2013年3月至2018年2月本院收治的行单侧TKA的188例老年患者为研究对象,术后行双下肢彩色多普勒超声检查判断是否发生DVT,根据检查结果将其分为DVT组和非DVT组,比较两组患者的临床资料,应用多因素Logistic回归分析探讨DVT发生的影响因素。结果 33例患者纳入DVT组,DVT总发生率为17.6%,血栓均位于小腿远端,26例(78.8%)患者无明显临床症状。DVT组患者无一例出现肺栓塞和死亡,全部康复。DVT组中女性、年龄> 70岁、体质指数> 25.0 kg/m~2、凝血四项有2～4项异常、术前D-二聚体(D-dimer,D-D)水平> 1.5 mg/L、甘油三酯水平> 1.7 mmol/L、全身麻醉、手术时间> 1.5 h、骨水泥型假体、术中输血、术后卧床时间> 5 d的患者比率均显著高于非DVT组(P_均<0.05)。多因素Logistic回归分析结果表明,女性、术前D-D水平> 1.5 mg/L、骨水泥型假体置入均为老年患者TKA术后DVT发生的独立危险因素(P_均<0.05)。结论高龄(> 70岁)患者TKA术后DVT的发生率较高,女性、术前D-D水平> 1.5 mg/L、骨水泥型假体置入是老年患者TKA术后DVT发生的独立危险因素,临床应加强对此类患者的早期干预。
Objective To analyze the risk factors of deep venous thrombosis(DVT) in lower extremity after total knee arthroplasty(TKA) in elderly patients. Method 188 elderly patients underwent unilateral TKA from March 2013 to February 2018 were enrolled for the study and divided into DVT group and non-DVT group according to the result of postoperative color Doppler ultrasound examination of both lower limbs. Clinical data were compared between two groups, and multivariate Logistic regression analysis was performed to screen out the independent influencing factors of DVT. Result 33 patients were included in DVT group, and the total incidence of DVT was 17.6%. All thrombus were located in the distal leg, and 26 cases(78.8%) patients had no obvious clinical symptoms. None of the patients in DVT group developed pulmonary embolism and death, and all recovered. The proportion of women, age > 70 years old, body mass index > 25.0 kg/m~2, 2 ～ 4 abnormal items of four blood coagulation indexes, preoperative level of D-dimer(D-D) > 1.5 mg/L,triglyceride > 1.7 mmol/L, general anesthesia, operation time > 1.5 h, cemented prosthesis, intraoperative blood transfusion and postoperative time in bed > 5 d in DVT group were significantly higher than those in non-DVT group(P_(all)< 0.05). Result of multivariate Logistic regression analysis showed that women, preoperative level of D-D > 1.5 mg/L and cemented prosthesis were the independent risk factors of postoperative DVT(P_(all)< 0.05). Conclusion The incidence of DVT in elderly patients( > 70 years old) after TKA are relatively higher. Women, preoperative level of D-D > 1.5 mg/L and cemented prosthesis are the independent risk factors of DVT after TKA in elderly patients, so the comprehensive prevention and control should be strengthened for this kind of patients.
Objective To analyze the risk factors of deep venous thrombosis(DVT) in lower extremity after total knee arthroplasty(TKA) in elderly patients. Method 188 elderly patients underwent unilateral TKA from March 2013 to February 2018 were enrolled for the study and divided into DVT group and non-DVT group according to the result of postoperative color Doppler ultrasound examination of both lower limbs. Clinical data were compared between two groups, and multivariate Logistic regression analysis was performed to screen out the independent influencing factors of DVT. Result 33 patients were included in DVT group, and the total incidence of DVT was 17.6%. All thrombus were located in the distal leg, and 26 cases(78.8%) patients had no obvious clinical symptoms. None of the patients in DVT group developed pulmonary embolism and death, and all recovered. The proportion of women, age > 70 years old, body mass index > 25.0 kg/m~2, 2 ～ 4 abnormal items of four blood coagulation indexes, preoperative level of D-dimer(D-D) > 1.5 mg/L,triglyceride > 1.7 mmol/L, general anesthesia, operation time > 1.5 h, cemented prosthesis, intraoperative blood transfusion and postoperative time in bed > 5 d in DVT group were significantly higher than those in non-DVT group(P_(all)< 0.05). Result of multivariate Logistic regression analysis showed that women, preoperative level of D-D > 1.5 mg/L and cemented prosthesis were the independent risk factors of postoperative DVT(P_(all)< 0.05). Conclusion The incidence of DVT in elderly patients( > 70 years old) after TKA are relatively higher. Women, preoperative level of D-D > 1.5 mg/L and cemented prosthesis are the independent risk factors of DVT after TKA in elderly patients, so the comprehensive prevention and control should be strengthened for this kind of patients.
引文
[1]张新宇,王永成,李华,等.全膝关节置换术后关节功能恢复效果的影响因素研究[J].中国医学前沿杂志(电子版),2016,8(10):64-67.
[2]张霞.人工全膝关节置换手术配合与体会[J].临床医药文献电子杂志,2018,5(95):53.
[3]文材,尹立.人工膝关节置换术的发展概况与进展[J].中国医药指南,2018,16(31):31-34.
[4]孟祥臣.人工膝关节置换术治疗膝骨性关节炎合并胫骨平台骨折临床疗效分析[J].中国伤残医学,2019,27(1):35-36.
[5]王威明.股内侧肌下入路和有限髌旁入路微创全膝关节置换术早期临床效果比较研究[J].中国临床医生杂志,2018,46(5):560-562.
[6]李松生,连艳红,马利阁.人工全膝关节置换术治疗膝关节骨性关节炎体会[J].深圳中西医结合杂志,2018,28(22):122-123.
[7]闫卫东,仪凤群,王亚楠.护理干预在预防老年腹部创伤患者术后深静脉血栓中的作用分析[J].转化医学电子杂志,2016,3(12):73-75.
[8]许克文,刘苏麟.多层螺旋CT双期血管成像技术在下肢深静脉血栓形成中的诊断价值研究[J].转化医学电子杂志,2016,3(5):44-46.
[9]Song K,Xu Z,Rong Z,et al.The incidence of venous thromboe mbolism following total knee arthroplasty:a prospective study by using computed tomographic pulmonary angiography in combination with bilateral lower limb venography[J].Blood Coagul Fibrinolysis,2016,27(3):266-269.
[10]Najafzadeh M,Kim SC,Patterson C,et al.Patients'perception about risks and benefits of antithrombotic treatment for the prevention of venous thromboembolism(VTE)after orthopedic surgery:a qualitative study[J].BMC Musculoskelet Disord,2015,16:319.
[11]王坤,李海燕,苏晴晴,等.人工全膝关节置换术后深静脉血栓形成相关危险因素及护理的研究进展[J].中西医结合护理(中英文),2017,3(11):198-201.
[12]Intiso D,Di Rienzo F,Iarossi A,et al.Thrombocytosis after hip and knee surgery in the rehabilitation setting:is it an occasional pheno menon?Relationship with deep venous thrombosis and functi onal outcome[J].BMC Musculoskelet Disord,2015,16:90.
[13]Friedman RJ.New oral anticoaulants for venous thrombo embolism prophylaxis in orthopaedic surgery[J].Instr Course Lect,2011,60:291-300.
[14]Fujita Y,Nakatsuka H,Namba Y.The incidence of pulmonary embolism and deep vein thrombosis and their predictive risk factors after lower extremity arthroplasty:aretrospective analysis based on diagnosis using multidetector CT[J].J Anesth,2015,29(2):235-241.
[15]于时魁.全膝关节置换术后下肢深静脉血栓发生的危险因素[J].中国矫形外科杂志,2018,26(8):703-706.
[16]高石军,李军,陆博,等.全膝关节置换术后下肢深静脉血栓形成的相关因素分析[J].中国骨肿瘤骨病,2010,9(1):6-9.
[17]Shimoyama Y,Sawai T,Tatsumi S,et al.Perioperative risk factors for deep vein thrombosis after total hip arthroplasty or total knee arthroplasty[J].J Clin Anesth,2012,24(7):531-536.
[18]唐华林,李洪文.浅析进行人工膝关节置换术后影响下肢深静脉血栓形成的因素[J].当代医药论丛,2015(15):1-2.
[19]尹向辉,张庆恩,张雪松,等.下肢关节置换术后下肢深静脉血栓形成的影响因素分析及防治对策[J].中国药业,2014(22):30-32,33.
[20]Qiu XS,Wang F,Yao C,et al.Association between deep vein thrombosis and the temperature at the popliteal fossa during cement curing in total knee arthroplasty[J].J Arthroplasty,2011,26(3):414-418.
[2]张霞.人工全膝关节置换手术配合与体会[J].临床医药文献电子杂志,2018,5(95):53.
[3]文材,尹立.人工膝关节置换术的发展概况与进展[J].中国医药指南,2018,16(31):31-34.
[4]孟祥臣.人工膝关节置换术治疗膝骨性关节炎合并胫骨平台骨折临床疗效分析[J].中国伤残医学,2019,27(1):35-36.
[5]王威明.股内侧肌下入路和有限髌旁入路微创全膝关节置换术早期临床效果比较研究[J].中国临床医生杂志,2018,46(5):560-562.
[6]李松生,连艳红,马利阁.人工全膝关节置换术治疗膝关节骨性关节炎体会[J].深圳中西医结合杂志,2018,28(22):122-123.
[7]闫卫东,仪凤群,王亚楠.护理干预在预防老年腹部创伤患者术后深静脉血栓中的作用分析[J].转化医学电子杂志,2016,3(12):73-75.
[8]许克文,刘苏麟.多层螺旋CT双期血管成像技术在下肢深静脉血栓形成中的诊断价值研究[J].转化医学电子杂志,2016,3(5):44-46.
[9]Song K,Xu Z,Rong Z,et al.The incidence of venous thromboe mbolism following total knee arthroplasty:a prospective study by using computed tomographic pulmonary angiography in combination with bilateral lower limb venography[J].Blood Coagul Fibrinolysis,2016,27(3):266-269.
[10]Najafzadeh M,Kim SC,Patterson C,et al.Patients'perception about risks and benefits of antithrombotic treatment for the prevention of venous thromboembolism(VTE)after orthopedic surgery:a qualitative study[J].BMC Musculoskelet Disord,2015,16:319.
[11]王坤,李海燕,苏晴晴,等.人工全膝关节置换术后深静脉血栓形成相关危险因素及护理的研究进展[J].中西医结合护理(中英文),2017,3(11):198-201.
[12]Intiso D,Di Rienzo F,Iarossi A,et al.Thrombocytosis after hip and knee surgery in the rehabilitation setting:is it an occasional pheno menon?Relationship with deep venous thrombosis and functi onal outcome[J].BMC Musculoskelet Disord,2015,16:90.
[13]Friedman RJ.New oral anticoaulants for venous thrombo embolism prophylaxis in orthopaedic surgery[J].Instr Course Lect,2011,60:291-300.
[14]Fujita Y,Nakatsuka H,Namba Y.The incidence of pulmonary embolism and deep vein thrombosis and their predictive risk factors after lower extremity arthroplasty:aretrospective analysis based on diagnosis using multidetector CT[J].J Anesth,2015,29(2):235-241.
[15]于时魁.全膝关节置换术后下肢深静脉血栓发生的危险因素[J].中国矫形外科杂志,2018,26(8):703-706.
[16]高石军,李军,陆博,等.全膝关节置换术后下肢深静脉血栓形成的相关因素分析[J].中国骨肿瘤骨病,2010,9(1):6-9.
[17]Shimoyama Y,Sawai T,Tatsumi S,et al.Perioperative risk factors for deep vein thrombosis after total hip arthroplasty or total knee arthroplasty[J].J Clin Anesth,2012,24(7):531-536.
[18]唐华林,李洪文.浅析进行人工膝关节置换术后影响下肢深静脉血栓形成的因素[J].当代医药论丛,2015(15):1-2.
[19]尹向辉,张庆恩,张雪松,等.下肢关节置换术后下肢深静脉血栓形成的影响因素分析及防治对策[J].中国药业,2014(22):30-32,33.
[20]Qiu XS,Wang F,Yao C,et al.Association between deep vein thrombosis and the temperature at the popliteal fossa during cement curing in total knee arthroplasty[J].J Arthroplasty,2011,26(3):414-418.