腰-硬联合麻醉下子宫肌瘤剔除术后发生下肢深静脉血栓形成的影响因素分析  

Analysis of factors of deep venous thrombosis of lower extremity after combined lumbar-epidural anesthesia for uterine myomectomy

作　　者：王玥[1] 康凯[1] 白云波[1] 韩斌[1] 刘野[1] 张晓峰[2] Wang Yue;Kang Kai;Bai Yunbo;Han Bin;Liu Ye;Zhang Xiaofeng(Department of Anesthesiology,Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing 100026,China;Department of Radiology,Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing 100026,China)

机构地区：[1]首都医科大学附属北京妇产医院麻醉科,北京100026 [2]首都医科大学附属北京妇产医院放射科,北京100026

出　　处：《血管与腔内血管外科杂志》2021年第6期686-690,702,共6页Journal of Vascular and Endovascular Surgery

基　　金：北京市卫生与健康科技成果和适宜技术推广项目(2018-TG-21)。

摘　　要：目的探讨腰-硬联合麻醉下子宫肌瘤剔除术后发生下肢深静脉血栓形成的影响因素。方法收集2018年9月至2020年9月在首都医科大学附属北京妇产医院接受腰-硬联合麻醉下子宫肌瘤剔除术的292例患者临床资料。根据术后下肢深静脉血栓形成的发生情况进行分组,分为发生组(n=31)和未发生组(n=261)。统计患者的相关数据资料,采用Logistic回归模型分析术后发生下肢深静脉血栓形成影响因素。结果单因素分析结果显示,发生组患者年龄高于未发生组患者,合并糖尿病、合并高脂血症多于未发生组患者,术后物理抗凝治疗少于未发生组患者,术前凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)短于未发生组患者,术后卧床时间长于未发生组患者,差异有统计学意义(P<0.05)。多因素分析结果显示,年龄增高、合并糖尿病、合并高脂血症、术后没有物理抗凝治疗、术前PT和APTT缩短、术后卧床时间增长是术后发生下肢深静脉血栓形成的独立危险因素(P<0.05)。结论腰-硬联合麻醉下行子宫肌瘤剔除术后存在下肢深静脉血栓形成风险,对于可进行人工干预的因素,需给予针对性的措施,提升围手术期的安全性。Objective To investigate the factors of deep venous thrombosis of lower extremity after combined lumbarepidural anesthesia for uterine myomectomy.Method The clinical data of 292 patients undergoing uterine fibroids surgery under combined lumbar-epidural anesthesia at the Beijing Obstetrics and Gynecology Hospital,Capital Medical University from September 2018 to September 2020 were collected.According to the occurrence of deep venous thrombosis of the lower extremities after the operation,all subjects were divided into an occurrence group(n=31)and a non-occurring group(n=261).Their clinical data were counted and calculated,and Logistic regression was used to analyze the factors of deep venous thrombosis of the lower extremities after the operation.Result The univariate results indicated that patients in the occurrence group were older,combined diabetes and hyperlipidemia were more,while postoperative physical anticoagulation therapy was less,preoperative prothrombin time(PT)and activated partial thromboplastin time(APTT)were lower,and the postoperative bed time was longer than that in the non-occurring group.The differences were statistically significant(P<0.05).Multivariate results showed that increased age,combined diabetes mellitus and hyperlipidemia,no physical anticoagulation therapy after surgery,decreased preoperative PT and APTT,and increased postoperative bed time were independent risk factors for postoperative deep venous thrombosis of the lower extremities(P<0.05).Conclusion There is a risk of deep venous thrombosis in the lower extremities after combined lumbarepidural anesthesia for uterine myomectomy.To improve the perioperative period safety,the symptomatic and targeted treatment should be given to control the factors that can be manually intervention.

关 键 词：子宫肌瘤 深静脉血栓形成 危险因素 手术 凝血指标 

分 类 号：R543[医药卫生—心血管疾病]