重症急性胰腺炎患者ICU期间下肢深静脉血栓形成的发生率和危险因素分析  

Incidence and risk factors of lower extremity deep venous thrombosis in severe acute pancreatitis patients during intensive care unit period

作　　者：程家浩 刘正东 CHENG Jiahao;LIU Zhengdong(Department of Intensive Care Unit,the Affiliated Lu'an Hospital,Anhui Medical University,the Lu'an People's Hospital,Lu'an,Anhui,237005,China)

机构地区：[1]安徽医科大学附属六安医院(六安市人民医院)重症医学科,安徽六安237005

出　　处：《临床急诊杂志》2021年第9期597-602,共6页Journal of Clinical Emergency

摘　　要：目的:探讨重症急性胰腺炎(SAP)患者ICU期间下肢深静脉血栓的发生率和危险因素。方法:回顾2017年1月-2020年10月期间发病72 h内收住于安徽医科大学附属六安医院ICU的117例SAP患者,收集患者性别、年龄、体重指数(BMI),转入时血脂、血糖、血小板、D-二聚体以及ICU期间是否发生腹腔内高压(IAH)和序贯器官衰竭评分(SOFA)等。根据其在ICU期间是否发生下肢深静脉血栓分为血栓组与非血栓组,采用单因素分析比较两组患者临床资料的差异,采用多因素Logistic回归分析筛选患者发生下肢深静脉血栓的独立危险因素,并采用受试者工作特征曲线(ROC)评估各独立危险因素的预测价值。结果:117例患者中共有33例(28.20%)发生下肢深静脉血栓,84例未发生血栓。单因素分析显示,血栓组与非血栓组在入院时BMI,血脂,D-二聚体水平,以及ICU期间发生IAH,股静脉置管,SOFA评分差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示BMI,IAH,SOFA评分为患者发生下肢深静脉血栓的独立危险因素(OR=1.345,95%CI:1.040~1.739,P=0.024;OR=5.440,95%CI:1.444~20.497,P=0.012;OR=1.718,95%CI:1.176~2.510,P=0.005)。ROC曲线显示3项独立危险因素联合预测下肢深静脉血栓发生的曲线下面积为0.871(P<0.001),敏感度为78.79%,特异度为84.52%。结论:高体重指数、腹腔内高压、高SOFA评分是SAP患者形成下肢深静脉血栓的高危因素,在这种严重炎症性疾病背景下,下肢深静脉血栓的预防可能是不充分的。Objective:To explore the incidence rate and risk factors affecting the occurrence of lower extremity deep venous thrombosis in patients with severe acute pancreatitis during intensive care unit period.Methods:A total of 117 patients with severe acute pancreatitis within 72 hours of onset admitted to the ICU of Lu’an Hospital Affiliated to Anhui Medical University from January 2017 to October 2020 were enrolled.The clinical data were collected,including gender,age,body mass index(BMI),blood fat,blood glucose,platelets,D-dimer at the time of transfer,the occurence of intra-abdominal hypertension(IAH)or not,Sequential Orginal Failure assessment(SOFA)scores during ICU period,and so on.According to occurrence of lower extremity deep venous thrombosis or not,these patients were divided into thrombosis group and non-thrombosis group.Univariate analysis was used to compare the differences in clinical data between the two groups.Multivariate Logistic regression analysis was used to screen the independent risk factors for lower extremity deep vein thrombosis,and the predictive efficacy was evaluated by receiver operating characteristic(ROC)curve.Results:Thirty-three patients(28.20%)were diagnosed as having lower extremity deep venous thrombosis.There were statistical differences between two groups in BMI,blood fat,D-dimer levels at admission,the incidence of IAH,femoral vein catheterization rate and SOFA score during ICU period(P<0.05).Results of multivariate Logistic regression analysis showed that BMI,IAH,and SOFA score during ICU period were independent risk factors for lower extremity deep venous thrombosis(OR=1.345,95%CI:1.040-1.739,P=0.024;OR=5.440,95%CI:1.444-20.497,P=0.012;OR=1.718,95%CI:1.176-2.510,P=0.005).ROC curve showed the area under the curve by combining these three factors was 0.871(P<0.001),with sensitivity of 78.79%and specificity of 84.52%.Conclusion:High body mass index,intra-abdominal hypertension and high SOFA score are high risk factors for the formation of lower extremity deep vein thrombosis in

关 键 词：重症急性胰腺炎 腹腔内高压 序贯器官衰竭评分 下肢深静脉血栓 危险因素 

分 类 号：R657.51[医药卫生—外科学]