高龄内科住院患者下肢深静脉血栓临床资料分析  

Analysis of clinical data of lower limbs deep vein thrombosis in inpatients with advanced age in internal medicine

作　　者：武东[1] 王征[1] 刘慧琳[1] 张帆[1] Wu Dong;Wang Zheng;Liu Huilin;Zhang Fan(Department of Geriatrics,Peking University Third Hospital,Beijing 10191 China)

机构地区：[1]北京大学第三医院老年内科,北京100191

出　　处：《中华老年医学杂志》2022年第4期451-455,共5页Chinese Journal of Geriatrics

摘　　要：目的分析高龄内科住院患者合并下肢深静脉血栓形成(DVT)的治疗及预后情况。方法回顾性分析, 收集2016年3月至2019年3月北京大学第三医院老年内科收治高龄老年人, 其中确诊下肢DVT患者106例, 男性58例(54.7%), 女性48例(45.3%), 年龄80~99岁。单纯DVT患者91例(85.9%), 合并肺栓塞15例(15.2%), 随访半年内的治疗情况及预后。结果 106例患者中有症状45例(42.5%), 无症状61例(57.6%)。累及下肢近端深静脉(腘静脉及以上静脉)28例(26.4%), 仅累及远端深静脉78例(73.6%)。除高龄外, 其他DVT危险因素为肺部感染60例(56.6%)、卧床(>3 d)58例(54.7%)、2型糖尿病50例(47.2%)、脑梗死46例(43.4%)、心力衰竭37例(34.9%)、活动性恶性肿瘤28例(26.4%)。静脉血栓评分高风险80例(75.5%), 出血高风险68例(64.2%)。74例接受抗凝治疗(69.8%), 与抗凝组(32例, 30.2%)患者比较, 未抗凝组卧床、肾功能不全、心力衰竭、脑梗死的患病率及全因死亡率高(P<0.05或P<0.01)。未抗凝患者出血高风险高于抗凝患者(P<0.01)。抗凝患者合并肺栓塞、近端深静脉受累比率及复查好转率高于未抗凝患者(P<0.05或P<0.01)。抗凝患者中, 26例接受住院期间短期的低分子肝素抗凝, 48例(45.3%)出院后继续口服抗凝药物。3个月时抗凝治疗率为31.1%(33例), 6个月为24.5%(26例)。抗凝患者4例发生非致死性出血, 但与未抗凝患者比较, 差异无统计学意义(P>0.05)。结论高龄内科住院患者应警惕肺部感染、卧床、脑梗死、恶性肿瘤等DVT危险因素;高龄内科住院患者出血高风险比例较高, 接受规律抗凝治疗比例偏低, 需全面评估患者抗凝治疗的风险及获益, 给予个体化治疗。Objective To analyze the treatment and prognosis of advanced age inpatients in Medical Department with lower limbs deep venous thrombosis(DVT),Methods This was a retrospective study of elderly medical inpatients with DVT,including 58 males(54.7%)and 48 females(45.3%),aged from 80 to 99 years old,in Geriatric Medicine of Peking University Third Hospital from March 2016 to March 2019.There were 91 patients(85.9%)with DVT alone and 15 patients(15.2%)with pulmonary embolism.The clinical data of patients were analyzed,and treatment and prognosis within half a year after discharge were followed-up.Results A total of 106 elderly medical patients were included,the ratio of male to female was 1.2;1.0,the age range was 80-99 years old,the median age was 86 years old.Of a total of 106 DVT patients,forty five cases(42.5%)developed symptoms,sixty-one cases(57.6%)were asymptomatic.Twenty-eight cases(26.4%)involved the proximal lower limb deep veins(popliteal veins and above),seventy-eight cases(73.6%)only involved distal deep veins.Except for advanced age,other DVT risk factors included sixty cases(56.6%)of lung infection,58 cases(54.7%)being bedridden(>3 d),50 cases(47.2%)of type 2 diabetes,46 cases(43.4%)of cerebral infarction,37 cases(34.9%)of heart failure.and 28 cascs(26.4%)of active malignancies.etc.Of a total of 106 DVT patients,80 cases(75.5%)had high risk of venous thrombosis score.and 68 cases(64.2%)had high risk of bleeding.74 cases received anticoagulant treatment,the rate of anticoagulant treatment was 69.8%.Compared with anticoagulant patients»non-anticoagulant group showed that renal insufficiency»being bedridden»heart failure,cerebral infarction prevalence,and all-cause mortality were increased(P VO.05 or PVO.01).The rate of high risk of bleeding was significantly higher in the non-anticoagulation group than in the anticoagulation group(P<0.01).The pulmonary embolism rate*proximal deep vein involvement rate and their improvement rate when timely rechecking were significantly higher in anticoagulation group t

关 键 词：下肢 静脉血栓形成 抗凝药 老年人 80岁以上 预后 

分 类 号：R543.6[医药卫生—心血管疾病]