血红蛋白量与下肢骨折下肢深静脉血栓形成发生率的关系分析  

Association between preoperative hemoglobin amount and incidence of lower limb deep vein thrombosis following lower limb fracture

作　　者：李树灏 张堃[1] 宋哲[1] 衡立松[1] 冯东旭[1] 樊伟 王晓龙 王晨[1] 乔瑞 杨佳瑞 王鹏飞[1] 朱养均[1] Li Shuhao;Zhang Kun;Song Zhe;Heng Lisong;Feng Dongxu;Fan Wei;Wang Xiaolong;Wang Chen;Qiao Rui;Yang Jiarui;Wang Pengfei;Zhu Yangjun(Department of Orthopaedics Trauma,Honghui Hospital Affiliated to Xi'an Jiaotong University,Xi'an 710054,China)

机构地区：[1]西安交通大学医学院附属红会医院创伤骨科,710054

出　　处：《中华创伤骨科杂志》2021年第10期864-870,共7页Chinese Journal of Orthopaedic Trauma

基　　金：陕西省重点研发计划项目(2017ZDXM-SF-009)。

摘　　要：目的研究下肢骨折患者血红蛋白量与下肢深静脉血栓形成(DVT)的关系。方法回顾性研究2014年7月至2019年8月西安交通大学医学院附属红会医院创伤骨科收治的下肢骨折患者2482例,男1174例,女1308例;年龄为(60.6±19.3)岁。收集患者的性别、年龄、受伤时间、血红蛋白量、D-二聚体、合并内科疾病、双下肢静脉超声检查时间和结果。根据超声结果将患者分为血栓组和非血栓组,比较两组患者血红蛋白量的差异;采用logistic回归分析血红蛋白量与DVT的关系。根据血红蛋白量的五分位数将患者分为5组,比较各组血栓发生率的差异。结果DVT的总发生率为29.53%(733/2482)。血栓组的血红蛋白量为(116.57±19.24)g/L,显著低于非血栓组的(124.76±19.79)g/L,差异有统计学意义(P<0.05)。血红蛋白量(OR=0.985,95%CI:0.980~0.990,P<0.001)是影响下肢骨折后发生DVT的危险因素。随着血红蛋白量五分位水平的增高,DVT的发生率呈下降趋势,DVT发生率最高组别(40.58%)与最低组组别(17.27%)相比,发生DVT的风险增加2.386倍(95%CI:1.718~3.315)。结论血红蛋白量可以影响下肢骨折后DVT的发生,低的血红蛋白量更容易发生下肢DVT。Objective To study the association between preoperative hemoglobin amount and incidence of lower limb deep vein thrombosis(DVT)in patients with lower limb fracture.Methods A retrospective study was performed of the 2,482 patients with lower limb fracture who had been treated at Department of Orthopaedics Trauma,Honghui Hospital Affiliated to Xi'an Jiaotong University from July 2014 to August 2019.They were 1,174 males and 1,308 females with an age of(60.6±19.3)years.Recorded were the patients'age,gender,injury time,hemoglobin amount,D-dimer measurement,combined medical conditions,time and results of ultrasound vein examination on both lower extremities.According to the ultrasound results,the patients were divided into a thrombosis group and a thrombosis-free group.The 2 groups were compared in hemoglobin amount.Logistic regression was used to analyze the relationship between preoperative hemoglobin amount and incidence of lower limb DVT.The patients were divided into 5 groups according to the quintile of hemoglobin amount;the incidences of thrombosis were compared between the 5 groups.Results The total incidence of DVT in this cohort was 29.53%(733/2,482).The hemoglobin amount in the thrombosis group was(116.57±19.24)g/L,significantly lower than that in the thrombosis-free group(124.76±19.79)g/L(P<0.05).The preoperative hemoglobin amount was a risk factor for incidence of DVT after a lower limb fracture(OR=0.985,95%CI:0.980 to 0.990,P<0.001).As the quintile level of hemoglobin increased,the incidence of DVT showed a downward trend.In comparison of the group with the highest DVT incidence(40.58%)and the group with the lowest DVT incidence(17.27%),the risk increased by 2.386 times(95%CI:1.718 to 3.315).Conclusions The preoperative hemoglobin amount can affect the DVT incidence after a lower limb fracture,and a low hemoglobin amount may more likely lead to lower limb DVT.

关 键 词：骨折 血红蛋白测定 静脉血栓形成 下肢 

分 类 号：R683.42[医药卫生—骨科学] R543.6[医药卫生—外科学]