体表慢性难愈合创面患者下肢深静脉血栓形成的发生情况及影响因素  

Prevalence of deep venous thrombosis in chronic refractory wounds and its influencing factors

作　　者：张伟[1] 张俊峰[2] 王觅 曹心慧[3] 王莉杰 牛希华[4] 黄红军[4] 丘宁宁 Zhang Wei;Zhang Junfeng;Wang Mi;Cao Xinhui;Wang Lijie;Niu Xihua;Huang Hongjun;Qiu Ningning(Department of Interventional Radiology,First People′s Hospital of Zhengzhou,Zhengzhou 450004,China;Department of Orthopedics,First People′s Hospital of Zhengzhou,Zhengzhou 450004,China;Department of Neurology,First People′s Hospital of Zhengzhou,Zhengzhou 450004,China;Department of Wound Treatment Center,First People′s Hospital of Zhengzhou,Zhengzhou 450004,China)

机构地区：[1]郑州市第一人民医院介入科,郑州450004 [2]郑州市第一人民医院骨科,郑州450004 [3]郑州市第一人民医院神经内科,郑州450004 [4]郑州市第一人民医院创面治疗中心,郑州450004

出　　处：《中华医学杂志》2020年第4期291-294,共4页National Medical Journal of China

摘　　要：目的探讨体表慢性难愈合创面(慢性创面)患者下肢深静脉血栓形成(DVT)的发生情况及危险因素。方法回顾性分析郑州市第一人民医院2015年1月1日至2018年12月31日收治的符合入选标准的722例慢性创面患者的临床资料,收集性别、年龄、创面累及下肢、创面分型、创面持续时间、D-二聚体水平以及合并糖尿病、高血压、冠心病、脑梗死、肺炎及脓毒症/感染性休克等临床资料。根据入院后彩色超声结果,确诊为DVT者作为DVT组,无DVT者为非DVT组,行多因素二元Logistic回归分析筛选慢性创面患者DVT发生的独立危险因素。结果全部患者中DVT组55例(7.6%),其中44例(80.0%)系入院时常规下肢静脉超声检查确诊为慢性DVT,余11例(20.0%)系院内新发DVT;DVT组与非DVT组在性别、创面累及下肢、创面持续时间、合并糖尿病及高血压5个方面差异均无统计学意义(均P>0.05);在年龄、创面分型、D-二聚体水平以及合并冠心病、脑梗死、肺炎和脓毒症/感染性休克7个方面差异均有统计学意义(均P<0.05);多因素二元Logistic回归分析结果:年龄[OR=2.260(95%CI:1.584~3.224)]、D-二聚体水平[OR=14.201(95%CI:6.101~33.055)]、合并冠心病[OR=2.731(95%CI:1.210~6.162)]及脓毒症/感染性休克[OR=3.170(95%CI:1.115~9.016)]是发生DVT的独立危险因素(均P<0.05)。结论慢性创面患者DVT发生率较高,其中多为慢性DVT,年龄、D-二聚体水平、合并冠心病及脓毒症/感染性休克是慢性创面患者并发DVT的独立危险因素。Objective To investigate the incidence and risk factors of lower extremities deep venous thrombosis(DVT)in patients with chronic refractory wounds(chronic wounds).Methods A retrospective analysis of 722 cases of chronic wounds admitted to the First People′s Hospital of Zhengzhou from January 1,2015 to December 31,2018 was carried out,and clinical data such as gender,age,wound involves the lower extremities,wound type,duration of wound,D-dimer level and complicated diabetes,hypertension,coronary heart disease,cerebral infarction,pneumonia and sepsis/septic shock were collected.The patients were divided into DVT group and non-DVT group according to the color ultrasound test.Multivariate binary logistic regression analysis was used to screen the independent risk factors of DVT in patients with chronic wounds.Results There were 55(7.6%)patients in DVT group,of which 44(80.0%)were diagnosed as chronic DVT by conventional lower extremities venous color ultrasound screening at admission,and the remaining 11(20.0%)were newly diagnosed during hospitalization.There were no significant differences in gender,wound involves the lower extremities,duration of wound,complicated diabetes and hypertension between DVT group and non-DVT group(all P>0.05);and the differences were statistically significant in age,wound type,D-dimer level,complicated coronary heart disease,cerebral infarction,pneumonia and sepsis/septic shock(all P<0.05).Multivariate binary logistic regression analysis showed age[OR=2.260(95%CI:1.584-3.224)],D-dimer level[OR=14.201(95%CI:6.101-33.055)],complicated coronary heart disease[OR=2.731(95%CI:1.210-6.162)]and sepsis/septic shock[OR=3.170(95%CI:1.115-9.016)]were independent risk factors for DVT(all P<0.05).Conclusion Chronic wounds patients have a higher incidence of DVT,most of which are chronic DVT,and age,D-dimer level,complicated coronary heart disease and sepsis/septic shock are independent risk factors for DVT in chronic wounds.

关 键 词：慢性创面 静脉血栓形成 发病率 危险因素 

分 类 号：R54[医药卫生—心血管疾病] R6[医药卫生—内科学]