髋关节置换术后患者伴发症状性及无症状性下肢深静脉血栓的危险因素分析  

Risk factors of symptomatic and asymptomatic deep venous thrombosis in patients after hip replacement

作　　者：刘亚枫 李建军[1] 杨军[1] 顾海伦[1] 王维[1] 刘宝哲 LIU Yafeng;LI Jianjun;YANG Jun;GU Hailun;WANG Wei;LIU Baozhe(The Fifth Orthopedic Trauma Ward,Shengjing Hospital of China Medical University,Shenyang 110021,China)

机构地区：[1]中国医科大学附属盛京医院第五骨科创伤病房,沈阳110021

出　　处：《中国医科大学学报》2022年第6期524-528,共5页Journal of China Medical University

摘　　要：目的 分析髋关节置换术后患者发生下肢深静脉血栓(DVT)的时间、症状及其危险因素。方法 回顾性分析2016年3月至2019年3月在我院接受髋关节置换术患者的临床资料及1年随访资料,依据有无DVT分为非DVT组(183例)和DVT组(48例)。比较2组患者年龄、性别、吸烟、体质量指数、心脏病史、糖尿病史、手术时间、假体类型、置换类型、术后疼痛及术后3个月是否口服抗血小板药。对发生DVT的危险因素进行多元回归分析。结果 髋关节置换术后并发症状性DVT主要发生于术后1月内,无症状性DVT发病高峰在术后3~6个月,且后者发生率高于前者。单因素分析表明,糖尿病史(P <0.05)、手术时间(P <0.01)、术后疼痛(P <0.05)、术后3个月是否口服抗血小板药(P <0.05)是DVT形成的影响因素。多因素logistic回归分析证实,术后3个月口服抗血小板药(OR=0.32,95%CI:0.17~0.86,P <0.01)是DVT形成的保护性因素,术后疼痛(OR=1.89,95%CI:1.84~2.37,P <0.01)是髋关节置换术后患者发生DVT的危险因素。结论 规范抗凝剂护理的髋关节置换术后患者仍可并发DVT,且多为无症状性DVT,口服抗血小板药是DVT发生的保护性因素,术后疼痛是DVT发生的独立危险因素。Objective To analyze the time of occurrence of deep venous thrombosis(DVT) and whether affected patients exhibit typical symptoms of DVT after hip replacement,as well as to study the risk factors for DVT. Methods The clinical and 1-year follow-up data of patients who underwent hip replacement in our hospital from March 2016 to March 2019 were retrospectively analyzed. Patients were divided into non-DVT(183 cases) and DVT(48 cases) groups. The age,gender,smoking history,body mass index(BMI),history of heart disease and diabetes,operation time,prosthesis type,replacement type,postoperative pain,and use of antiplatelet drug in the 3months after operation were compared between the two groups. The risk factors for DVT were analyzed using multiple regression analysis.Results Symptomatic DVT occurred mainly within 1 month after hip replacement. The peak incidence of asymptomatic DVT was 3 to 6months after operation. The incidence of asymptomatic DVT was higher than that of symptomatic DVT. Single factor analysis showed that diabetes history(P < 0.05),operation time(P < 0.01),postoperative pain(P < 0.05),and use of antiplatelet drug in 3 months after operation(P < 0.05) were the factors influencing DVT. Multiple logistic regression analysis confirmed that use of antiplatelet drug in 3 months after operation(OR = 0.32,95%CI:0.17-0.86,P < 0.01) was protective against the occurrence of DVT. Postoperative pain(OR = 1.89,95%CI:1.84-2.37,P < 0.01) was a risk factor for DVT in patients,after hip replacement. Conclusion DVT can still occur in patients after hip replacement with standardized anti-DVT care,and most episodes are asymptomatic. Using antiplatelet drug is protective against DVT,and postoperative pain is an independent risk factor for its occurrence.

关 键 词：髋关节置换术 症状性下肢深静脉血栓 无症状性下肢深静脉血栓 术后疼痛 

分 类 号：R274.1[医药卫生—中医骨伤科学]