腹腔镜肝血管瘤切除术后深静脉血栓形成的危险因素分析
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摘要
目的分析影响腹腔镜肝血管瘤切除术后深静脉血栓形成(deep venous thrombosis,DVT)的危险因素。方法回顾性分析2015年1月至2018年1月于本院行腹腔镜肝血管瘤切除术的186例患者的临床资料,将术后发生DVT的21例患者纳入DVT组,术后未发生DVT的165例患者纳入非DVT组。比较两组患者性别、年龄、体质指数(body mass index,BMI)≥25kg/m~2患者占比、合并高血压患者占比、合并糖尿病患者占比、病灶位置、手术时间、术中肝血流阻断时间、术中失血量、术后血小板计数、术后白细胞计数、有肝切除史患者占比、肝切除量、术后第3天D-二聚体(D-dimer,D-D)水平、术后第7天血清丙氨酸转氨酶(alanine aminotransferase,ALT)水平、住ICU天数、术后住院天数的差异,经Logistic回归分析筛选影响腹腔镜肝血管瘤切除术后DVT的独立危险因素。结果两组患者年龄、BMI≥25 kg/m~2患者占比、合并高血压患者占比、合并糖尿病患者占比、手术时间、术中肝血流阻断时间、术中失血量、术后血小板计数、肝切除量、术后第3天D-D水平、住ICU天数、术后住院天数、术后第7天血清ALT水平比较差异均具有显著差异(P_均<0.05);Logistic回归分析显示:术中肝血流阻断时间> 14.39 min、术中失血量≥1000 ml、肝切除量≥35%、术后第3天D-D水平≥0.5μg/ml、术后第7天血清ALT水平> 231.42 U/L均为影响腹腔镜肝血管瘤切除术后出现DVT的独立危险因素(P_均<0.05)。结论术中肝血流阻断时间> 14.39 min、术中失血量≥1000 ml、肝切除量≥35%、术后第3天D-D水平≥0.5μg/ml、术后第7天血清ALT水平>231.42 U/L的腹腔镜肝血管瘤切除术后患者出现DVT的风险相对较高,重视上述情况并及时予以低分子肝素等预防措施对降低DVT发生风险有一定帮助。
Objective To analyze the risk factors of deep venous thrombosis(DVT) after laparoscopic resection of hepatic hemangioma. Method The clinical data of 186 patients who underwent laparoscopic resection of hepatic hemangioma in our hospital from January 2015 to January 2018 were analyzed retrospectively, and 21 patients with DVT after operation were included in DVT group,and 165 patients without DVT after operation were included in non-DVT group. Gender, age, proportion of patients with body mass index(BMI) ≥ 25 kg/m~2, proportion of patients with hypertension, proportion of patients with diabetes mellitus, location of focus, operation time, intraoperative hepatic blood ?ow blocking time, intraoperative blood loss, postoperative platelet count, postoperative leukocyte count, proportion of patients with history of hepatectomy, hepatectomy volume, D-dimer(D-D) level on the 3~(rd) day after operation, serum alanine aminotransferase(ALT) level on the 7 th day after operation, ICU stay and postoperative hospital stay were compared between the two groups. Logistic regression analysis was used to screen out independent risk factors for DVT after laparoscopic resection of hepatic hemangioma. Result There were signi?cant differences in age, proportion of patients with BMI ≥ 25 kg/m~2, proportion of patients with hypertension, proportion of patients with diabetes mellitus, operation time, intraoperative hepatic blood flow blocking time, intraoperative blood loss, postoperative platelet count, hepatectomy volume, D-D level on the 3~(rd) day after operation, ICU stay and postoperative hospital stay and serum ALT level on the 7 th day after operation between the two groups(P_all< 0.05). Logistic regression analysis showed that intraoperative hepatic blood ?ow blocking time > 14.39 min, intraoperative blood loss ≥ 1000 ml, hepatectomy volume ≥ 35%, D-D level ≥ 0.5 μg/ml on the 3~(rd) day after operation and serum ALT level > 231.42 U/L on the 7 th day after operation were the independent risk factor for DVT after laparoscopic resection of hepatic hemangioma(P_all< 0.05). Conclusion Patients with intraoperative hepatic blood ?ow blocking time > 14.39 min, intraoperative blood loss ≥ 1000 ml, hepatectomy volume ≥ 35%, D-D level ≥ 1000 μg/ml on the 3~(rd) day after operation and serum ALT level > 231.42 U/L on the 7 th day after operation have a relatively higher risk of DVT after laparoscopic resection of hepatic hemangioma, and paying attention to the above situation and timely giving low mole cular weight heparin and other preventive measures are helpful to reduce the risk of DVT.
Objective To analyze the risk factors of deep venous thrombosis(DVT) after laparoscopic resection of hepatic hemangioma. Method The clinical data of 186 patients who underwent laparoscopic resection of hepatic hemangioma in our hospital from January 2015 to January 2018 were analyzed retrospectively, and 21 patients with DVT after operation were included in DVT group,and 165 patients without DVT after operation were included in non-DVT group. Gender, age, proportion of patients with body mass index(BMI) ≥ 25 kg/m~2, proportion of patients with hypertension, proportion of patients with diabetes mellitus, location of focus, operation time, intraoperative hepatic blood ?ow blocking time, intraoperative blood loss, postoperative platelet count, postoperative leukocyte count, proportion of patients with history of hepatectomy, hepatectomy volume, D-dimer(D-D) level on the 3~(rd) day after operation, serum alanine aminotransferase(ALT) level on the 7 th day after operation, ICU stay and postoperative hospital stay were compared between the two groups. Logistic regression analysis was used to screen out independent risk factors for DVT after laparoscopic resection of hepatic hemangioma. Result There were signi?cant differences in age, proportion of patients with BMI ≥ 25 kg/m~2, proportion of patients with hypertension, proportion of patients with diabetes mellitus, operation time, intraoperative hepatic blood flow blocking time, intraoperative blood loss, postoperative platelet count, hepatectomy volume, D-D level on the 3~(rd) day after operation, ICU stay and postoperative hospital stay and serum ALT level on the 7 th day after operation between the two groups(P_all< 0.05). Logistic regression analysis showed that intraoperative hepatic blood ?ow blocking time > 14.39 min, intraoperative blood loss ≥ 1000 ml, hepatectomy volume ≥ 35%, D-D level ≥ 0.5 μg/ml on the 3~(rd) day after operation and serum ALT level > 231.42 U/L on the 7 th day after operation were the independent risk factor for DVT after laparoscopic resection of hepatic hemangioma(P_all< 0.05). Conclusion Patients with intraoperative hepatic blood ?ow blocking time > 14.39 min, intraoperative blood loss ≥ 1000 ml, hepatectomy volume ≥ 35%, D-D level ≥ 1000 μg/ml on the 3~(rd) day after operation and serum ALT level > 231.42 U/L on the 7 th day after operation have a relatively higher risk of DVT after laparoscopic resection of hepatic hemangioma, and paying attention to the above situation and timely giving low mole cular weight heparin and other preventive measures are helpful to reduce the risk of DVT.
引文
[1]王峰杰,陈焕伟.腹腔镜肝切除治疗巨大肝血管瘤23例[J].中国微创外科杂志,2016,16(7):586-589.
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[13]赵宁,张加乐,江婷,等.ICU患者外周静脉置入中心静脉导管相关上肢深静脉血栓形成的危险因素[J].中华危重病急救医学,2017,29(2):167-171.
[14]史枫,刘海龙,李桢,等.腹腔镜与开腹手术后下肢DVT发生率比较的Meta分析[J].山东医药,2015,55(10):48-50.
[15]张成欢,刘云.Autar血栓风险评估量表评估骨科关节置换患者深静脉血栓形成风险的研究[J].医学研究生学报,2017,30(9):968-972.
[16]张晶,杜耿,刘伟,等.全髋关节置换患者注射低相对分子质量肝素与口服利伐沙班对深静脉血栓形成的预防效果比较[J].血栓与止血学,2017,23(5):756-758.
[17]尚清,邢小芬,李军霞,等.低分子肝素钙预防剖宫产术后深静脉血栓形成的临床价值分析[J].湖南师范大学学报(医学版),2018,15(1):19-22.
[18]张文娟,王原明.口腔外科术后并发深静脉血栓形成的临床观察及危险因素分析[J].血栓与止血学,2017,23(1):125-127.
[19]杜玉波.腹部手术对患者凝血和纤溶系统的影响[J].血栓与止血学,2017,23(5):792-794.
[20]邓月华,徐志猛,范方勇,等.肝癌切除术中肝门阻断方法及术后门静脉血栓形成机制研究进展[J].现代中西医结合杂志,2017,26(27):3072-3075.
[21]邬涛,严律南,罗艳丽.肝切除术后静脉血栓栓塞症影响因素及预防的研究进展[J].中国普外基础与临床杂志,2017,24(7):895-899.
[2]黄登,郑树国,李建伟,等.腹腔镜肝切除术治疗肝血管瘤78例临床分析[J].中国普外基础与临床杂志,2016,23(2):156-159.
[3]陈红琢,蒋菊琴,陈可.深静脉血栓形成危险因素与干预[J].现代临床护理,2016,15(9):72-77.
[4]中华医学会外科学分会血管外科学组.深静脉血栓形成的诊断和治疗指南(第三版)[J].中华普通外科杂志,2017,32(9):807-812.
[5]刘建萍.预见性护理干预在普外科手术后预防深静脉血栓形成的体会[J].中国药物与临床,2016,16(9):1378-1379.
[6]陈峰,蔡莹,李文军.腹腔镜手术后下肢深静脉血栓形成的危险因素分析[J].新乡医学院学报,2017,34(9):833-835.
[7]余立权,高涌,谢胜学,等.腹部肿瘤术后并发下肢深静脉血栓形成25例分析[J].中华全科医学,2015,13(7):1081-1084.
[8]顾静芝,刘静.高耐药性肺癌患者PICC相关性深静脉血栓形成的相关影响因素分析[J].中国医学前沿杂志(电子版),2017,9(10):128-131.
[9]袁晓燕,郭东风,顾建平.腹部手术后深静脉血栓高危因素分析[J].中国现代手术学杂志,2016,20(6):450-453.
[10]侯飞飞,吕富荣,王晓慧,等.腹腔镜与开腹手术术后静脉血栓栓塞症的临床分析[J].重庆医科大学学报,2016,41(1):102-105.
[11]孙明利,冯亚平,黄俊,等.住院患者深静脉血栓形成的临床特征[J].中华内科杂志,2017,56(12):914-918.
[12]李学莉.护理在下肢骨折术后深静脉血栓形成预防中的应用[J].血栓与止血学,2017,23(5):883-884.
[13]赵宁,张加乐,江婷,等.ICU患者外周静脉置入中心静脉导管相关上肢深静脉血栓形成的危险因素[J].中华危重病急救医学,2017,29(2):167-171.
[14]史枫,刘海龙,李桢,等.腹腔镜与开腹手术后下肢DVT发生率比较的Meta分析[J].山东医药,2015,55(10):48-50.
[15]张成欢,刘云.Autar血栓风险评估量表评估骨科关节置换患者深静脉血栓形成风险的研究[J].医学研究生学报,2017,30(9):968-972.
[16]张晶,杜耿,刘伟,等.全髋关节置换患者注射低相对分子质量肝素与口服利伐沙班对深静脉血栓形成的预防效果比较[J].血栓与止血学,2017,23(5):756-758.
[17]尚清,邢小芬,李军霞,等.低分子肝素钙预防剖宫产术后深静脉血栓形成的临床价值分析[J].湖南师范大学学报(医学版),2018,15(1):19-22.
[18]张文娟,王原明.口腔外科术后并发深静脉血栓形成的临床观察及危险因素分析[J].血栓与止血学,2017,23(1):125-127.
[19]杜玉波.腹部手术对患者凝血和纤溶系统的影响[J].血栓与止血学,2017,23(5):792-794.
[20]邓月华,徐志猛,范方勇,等.肝癌切除术中肝门阻断方法及术后门静脉血栓形成机制研究进展[J].现代中西医结合杂志,2017,26(27):3072-3075.
[21]邬涛,严律南,罗艳丽.肝切除术后静脉血栓栓塞症影响因素及预防的研究进展[J].中国普外基础与临床杂志,2017,24(7):895-899.