开腹子宫肌瘤剔除术后血红蛋白下降值影响因素及其对下肢深静脉血栓形成的预测价值  

Influencing factors of hemoglobin decline after open hysteromyomectomy and its predictive value for lower extremity deep venous thrombosis

作　　者：周海燕 单莉 沈红良 贾亮 ZHOU Haiyan;SHAN Li;SHEN Hongliang;JIA Liang(Department of Gynecology,Northwest Women’s and Children’s Hospital,Xi’an 710061,China)

机构地区：[1]西北妇女儿童医院妇科,陕西西安710061 [2]西安交通大学第一附属医院检验科,陕西西安710061

出　　处：《陕西医学杂志》2022年第2期168-171,185,共5页Shaanxi Medical Journal

基　　金：陕西省卫生健康科研基金资助项目(2018D039)。

摘　　要：目的:分析开腹子宫肌瘤剔除术后血红蛋白(Hb)下降值的影响因素及其对下肢深静脉血栓(LDVT)形成的预测价值。方法:选择148例行开腹子宫肌瘤剔除术患者作为研究对象,根据术后Hb下降值是否≥15 g/L进行分组,其中≥15 g/L组(46例)、<15 g/L组(102例),使用单因素方差和多因素Logistic回归分析术后Hb下降值的独立影响因素,随访观察LDVT发生情况,比较LDVT组与非LDVT组的血液相关指标,通过受试者工作特征曲线(ROC)下面积(AUC)评价术后Hb下降值对LDVT的预测效能。结果:≥15 g/L组术中剔除肌瘤数、直径≥5 cm肌瘤的数量多于<15 g/L组,术中进宫腔率、输血率、使用止血带率、血浆D-二聚体(D-D)水平均高于<15 g/L组,手术时间长于<15 g/L组,血小板(PLT)及红细胞压积(PCV)下降值均大于<15 g/L组,差异均有统计学意义(均P<0.05);经多因素Logistic回归分析,术中剔除肌瘤数、直径≥5 cm肌瘤的数量,术中进宫腔、使用止血带均是术后Hb下降值的独立影响因素(均P<0.05);在148例患者中,LDVT发生率为22.97%(34/148);经ROC曲线分析,术后Hb下降值预测LDVT的最佳诊断截值为19.86 g/L,AUC为0.912,大于术后PLT下降值的0.634和血浆D-D的0.714,差异均有统计学意义(均P<0.05)。结论:开腹子宫肌瘤剔除术后Hb下降值受剔除肌瘤数、肌瘤直径≥5 cm数量、术中进宫腔的影响,术中使用止血带是保护性因素,其预测LDVT的效能较好,值得临床重视。Objective:To analyze the influencing factors of hemoglobin(HB)decline after open hysteromyomectomy and its predictive value for lower extremity deep venous thrombosis(LDVT).Methods:A total of 148 patients undergoing open hysteromyomectomy were selected as the research objects,according to whether the postoperative Hb decline value was≥15 g/L,the group was divided into≥15 g/L group(46 cases)and<15 g/L group(102 cases).The independent influencing factors of postoperative Hb decline was analyzed using single factor variance and multivariate Logistic regression.The occurrence of LDVT was followed-up to observe.The blood-related indicators of LDVT group and non-LDVT group were compared.The AUC of ROC curve was used to evaluate the predictive power of the postoperative Hb decline for LDVT.Results:The number of fibroids removed during the operation and the number of fibroids≥5 cm in diameter in the≥15 g/L group were more than those in the<15 g/L group,and the intrauterine cavity entry rate,blood transfusion rate,tourniquet rate,plasma D-Dimer(DD)level were higher than those in the<15 g/L group,and operation time was longer than that in the<15 g/L group,and platelet(PLT)and hematocrit(PCV)decline values were greater than those in the<15 g/L group(all P<0.05).Multivariate Logistic regression analysis showed that the number of fibroids removed during the operation,the number of fibroids with a diameter of≥5 cm,the intrauterine cavity and the use of tourniquets were independent influencing factors influencing the postoperative Hb decline(all P<0.05).Among 148 patients,the incidence of LDVT was 22.97%(34/148).ROC curve analysis showed that the best diagnostic cut-off value for predicting LDVT was 19.86 g/L,AUC was 0.912,which was greater than 0.634 of postoperative PLT decline value and 0.714 of plasma DD(all P<0.05).Conclusion:The Hb decline value after open hysteromyomectomy is affected by the number of fibroids removed,the number of fibroids≥5 cm in diameter,and the intrauterine cavity entry during operation.T

关 键 词：开腹子宫肌瘤剔除术 血红蛋白 下肢深静脉血栓 肌瘤直径 止血带 预测价值 

分 类 号：R713.4[医药卫生—妇产科学]