老年腹腔镜手术患者术后深静脉血栓形成发生情况及危险因素分析
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摘要
目的探讨老年腹腔镜手术患者术后深静脉血栓形成(deep venous thrombosis,DVT)发生情况并分析其危险因素。方法选取2016年2月至2018年2月本院收治的270例老年腹腔镜手术患者为研究对象,根据术后是否发生DVT将其分为DVT组和非DVT组,记录影响术后DVT发生的相关因素,采用Logistic多元回归分析筛选其危险因素。结果 270例腹腔镜手术患者中有10例术后发生DVT,发生率为3.70%;Logistic多元回归分析显示,年龄≥70岁、手术时间> 2 h、下腹及盆腔手术、术中头高脚低位、术后卧床时间≥30 h、术后1 d、3 d血浆D-二聚体水平≥0.5 mg/L均是腹腔镜手术后患者发生DVT的独立危险因素(均P <0.05)。结论老年腹腔镜手术患者术后发生DVT与年龄、手术时间、手术部位、术中体位、术后卧床时间、术后血浆D-二聚体水平密切相关,临床上应予以重视并采取适当的预防措施。
Objective To investigate the occurrence of postoperative deep venous thrombosis(DVT) in elderly patients undergoing laparoscopic surgery and to analyze the risk factors. Method 270 cases of elderly patients underwent laparoscopic surgery from February 2016 to February 2018 in our hospital were selected for the study, and they were divide into DVT group and non-DVT group according to whether DVT occurred. The factors affecting the occurrence of postoperative DVT were recorded, and the risk factors were screened by Logistic multiple regression analysis. Result DVT occurred in 10 of 270 patients underwent laparoscopic surgery,with an incidence of 3.70%. Logistic multivariate regression analysis showed that the age ≥ 70 years old, operative time > 2 h, lower abdomen and pelvic surgery, reverse trendelenburg position during operation, postoperative bed rest time ≥ 30 h, plasma D-dimer level at one and three days after operation ≥ 0.5 mg/L were independent risk factors for DVT occurrence after laparoscopic surgery(all P < 0.05). Conclusion Postoperative DVT in elderly patients undergoing laparoscopic surgery is closely related to age, operation time, operation site, intraoperative position, postoperative bed rest time and postoperative plasma D-dimer level, so it should be paid attention to and appropriate preventive measures should be taken.
Objective To investigate the occurrence of postoperative deep venous thrombosis(DVT) in elderly patients undergoing laparoscopic surgery and to analyze the risk factors. Method 270 cases of elderly patients underwent laparoscopic surgery from February 2016 to February 2018 in our hospital were selected for the study, and they were divide into DVT group and non-DVT group according to whether DVT occurred. The factors affecting the occurrence of postoperative DVT were recorded, and the risk factors were screened by Logistic multiple regression analysis. Result DVT occurred in 10 of 270 patients underwent laparoscopic surgery,with an incidence of 3.70%. Logistic multivariate regression analysis showed that the age ≥ 70 years old, operative time > 2 h, lower abdomen and pelvic surgery, reverse trendelenburg position during operation, postoperative bed rest time ≥ 30 h, plasma D-dimer level at one and three days after operation ≥ 0.5 mg/L were independent risk factors for DVT occurrence after laparoscopic surgery(all P < 0.05). Conclusion Postoperative DVT in elderly patients undergoing laparoscopic surgery is closely related to age, operation time, operation site, intraoperative position, postoperative bed rest time and postoperative plasma D-dimer level, so it should be paid attention to and appropriate preventive measures should be taken.
引文
[1]龙家才,王刚.输尿管上段结石经尿道输尿管硬镜碎石术与腹膜后腹腔镜切开取石术的临床疗效比较[J].成都医学院学报,2017,12(6):711-714.
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[11]秦翠英,全丽丽,杜娜,等.全子宫切除术后患者发生下肢静脉血栓的临床特点、危险因素及预防性护理[J].血栓与止血学,2017,23(3):524-526.
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[13]李梅.腹腔镜与开腹手术对妇科疾病患者凝血功能及术后静脉血栓相关事件的影响[J].血栓与止血学,2017,23(6):950-952.
[14]马红滔,梁章焱,梁思重,等.腹腔镜术后下肢深静脉血栓形成危险因素的临床分析[J].中国现代普通外科进展,2016,19(1):66-68.
[15]陈峰,蔡莹,李文军,等.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.
[16]Hultcrantz M,Bj?rkholm M,Landgren O,et al.Risk for Arterial and Venous Thrombosis in Patients With Myeloproliferative Neoplasms[J].Ann Intern Med,2018,169(4):268.
[17]巨爱宁,杨瑞芳.中心静脉导管置管后患者静脉血栓栓塞的危险因素及凝血指标变化[J].检验医学与临床,2017,14(2):285-287.
[18]李俊涛,潘扬,姜庆,等.D-二聚体在评估下肢深静脉血栓形成溶栓效果中的价值[J].贵州医科大学学报,2017,42(2):205-208.
[2]王霞,杨梅,盛楠,等.妇科良性疾病患者腹腔镜与开腹手术术后静脉血栓发生率的Meta分析[J].现代妇产科进展,2018,27(2):81-85.
[3]Denny N,Musale S,Edlin H,et al.Chronic deep vein thrombosis[J].Acute Med,2018,17(3):144-147.
[4]余格.应用周期性充气压力泵预防妇科腹腔镜手术患者深静脉血栓的效果[J].护理与康复,2017,16(12):1327-1329.
[5]姬霞,金娜,傅金英,等.醋酸戈舍瑞林缓释植入剂在子宫内膜异位囊肿腹腔镜术后患者中的应用研究[J].成都医学院学报,2017,12(4):469-472.
[6]朱新贤,初磊,董健,等.子宫切除术后下肢深静脉血栓形成的危险因素及手术方式影响的研究[J].中国血管外科杂志(电子版),2017,9(2):95-98.
[7]刘思彤,黄运兰.腹腔镜在老年女性妇科手术中的应用[J].中国妇幼保健,2017,32(14):3378-3380.
[8]黄润强,郭振鹏,袁修琼,等.低分子肝素钙在妇科肿瘤腹腔镜术后预防深静脉血栓中的临床效果[J].现代肿瘤医学,2017,25(3):444-447.
[9]李相文,涂明利.早期应用低分子肝素预防腹腔镜脾切除食管胃底静脉断流术后门静脉血栓形成临床研究[J].实用肝脏病杂志,2017,20(2):179-182.
[10]陈忆.腹腔镜结直肠手术术后静脉血栓事件发生的危险因素及护理干预[J].血栓与止血学,2016,22(2):209-211.
[11]秦翠英,全丽丽,杜娜,等.全子宫切除术后患者发生下肢静脉血栓的临床特点、危险因素及预防性护理[J].血栓与止血学,2017,23(3):524-526.
[12]饶婕,张向宁.妇科手术后深静脉血栓形成高危因素的临床分析[J].安徽医药,2018,22(4):663-666.
[13]李梅.腹腔镜与开腹手术对妇科疾病患者凝血功能及术后静脉血栓相关事件的影响[J].血栓与止血学,2017,23(6):950-952.
[14]马红滔,梁章焱,梁思重,等.腹腔镜术后下肢深静脉血栓形成危险因素的临床分析[J].中国现代普通外科进展,2016,19(1):66-68.
[15]陈峰,蔡莹,李文军,等.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.
[16]Hultcrantz M,Bj?rkholm M,Landgren O,et al.Risk for Arterial and Venous Thrombosis in Patients With Myeloproliferative Neoplasms[J].Ann Intern Med,2018,169(4):268.
[17]巨爱宁,杨瑞芳.中心静脉导管置管后患者静脉血栓栓塞的危险因素及凝血指标变化[J].检验医学与临床,2017,14(2):285-287.
[18]李俊涛,潘扬,姜庆,等.D-二聚体在评估下肢深静脉血栓形成溶栓效果中的价值[J].贵州医科大学学报,2017,42(2):205-208.