髋膝关节置换术后肌间静脉血栓形成影响因素分析  

Analysis of influencing factors of muscular calf vein thrombosis after hip and knee arthroplasty

作　　者：谷思琪 李佳惠 宋咪 李晓芳 孔丹[2] 陈玉娥[2] 高远[3] GU Siqi;LI Jiahui;SONG Mil;LI Xiaofang;KONG Dan;CHEN Yu'e;GAO Yuan(Medical School of Chinese PLA,Beijing 100853,P.R.China;Department of Orthopedics,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,P.R.China;Department of Nursing,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,P.R.China)

机构地区：[1]解放军医学院,北京100853 [2]解放军总医院第一医学中心骨科,北京100853 [3]解放军总医院第一医学中心护理部,北京100853

出　　处：《华西医学》2022年第10期1497-1502,共6页West China Medical Journal

基　　金：解放军总医院军事医学转化项目(ZH19009);国家骨科与运动康复临床医学研究中心创新基金(2021-NCRCCXJJ-ZH-36)。

摘　　要：目的 探讨髋膝关节置换术后肌间静脉血栓形成(muscular calf vein thrombosis,MCVT)的影响因素。方法 采用便利抽样法,选取2021年3月-2022年5月北京市、江苏省和海南省4所医院行髋膝关节置换术的患者作为研究对象。按照术后第3天是否出现下肢MCVT将其分为MCVT组和非MCVT组。采用广义线性混合模型分析MCVT的影响因素。结果 共纳入278例患者,其中MCVT组47例,占16.91%,非MCVT组231例,占83.09%。广义线性混合模型分析显示,术后第1天下床活动[比值比=0.364,95%置信区间(0.159,0.832),P=0.017]、术前活化部分凝血活酶时间(activated partial thromboplastin time,APTT)[比值比=0.884,95%置信区间(0.785,0.994),P=0.040]是髋膝关节置换术后MCVT的保护性因素。结论 术后第1天下床活动、术前APTT是髋膝关节置换术后MCVT的保护性因素,高血压、引流等与MCVT的关系仍需进一步探究。临床医护人员应密切关注髋膝关节置换术患者的术后活动能力,鼓励并指导患者早期下床活动,综合评估患者情况和术后MCVT发生风险,灵活制定个性化防治方案,避免MCVT的发生,从而改善预后。Objective To explore the influencing factors of muscle calf vein thrombosis(MCVT) after hip and knee arthroplasty. Methods Convenience sampling method was used to select patients who underwent hip or knee arthroplasty in 4 hospitals in Beijing, Jiangsu and Hainan between March 2021 and May 2022 as the research subjects.They were divided into MCVT group and non-MCVT group according to whether the lower limb MCVT occurred on the3rd postoperative day. Generalized linear mixed model was used to analyze the influencing factors of MCVT. Results A total of 278 patients were included, including 47 patients in the MCVT group, accounting for 16.91%, and 231 patients in the non-MCVT group, accounting for 83.09%. Generalized linear mixed model analysis showed that the ambulation on the first postoperative day [odds ratio=0.364, 95% confidence interval(0.159, 0.832), P=0.017] and preoperative activated partial thromboplastin time [odds ratio=0.884, 95% confidence interval(0.785, 0.994), P=0.040] were protective factors for MCVT after hip and knee arthroplasty. Conclusions The ambulation on the first postoperative day and preoperative activated partial thromboplastin time are protective factors for MCVT after hip and knee arthroplasty. The relationship between hypertension, drainage and MCVT needs to be further explored. Clinical medical staff should pay close attention to the postoperative ambulation of patients undergoing hip and knee arthroplasty, encourage and guide patients to get out of bed early, comprehensively assess the patients’ condition and the risk of postoperative MCVT,and flexibly formulate individualized prevention and treatment plans to avoid the occurrence of MCVT and improve the prognosis.

关 键 词：肌间静脉血栓形成 全关节置换术 早期下床活动 引流 

分 类 号：R687.4[医药卫生—骨科学]