髋部骨折患者术前发生下肢深静脉血栓的影响因素  

Influencing factors of lower extremity deep vein thrombosis in patients with hip fracture before operation

作　　者：刘平 叶勇军[2] 朱宁[1] 陈建 胡超华[1] LIU Ping;YE Yongjun;ZHU Ning;CHEN Jian;HU Chaohua(Department of Orthopedics,the Third Affiliated Hospital of Gannan Medical University,Jiangxi Province,Ganzhou341000,China;Department of Orthopedics,the First Affiliated Hospital of Gannan Medical University,Jiangxi Province,Ganzhou341000,China)

机构地区：[1]赣南医学院第三附属医院骨科,江西赣州341000 [2]赣南医学院第一附属医院骨科,江西赣州341000

出　　处：《中国当代医药》2023年第2期81-84,共4页China Modern Medicine

基　　金：江西省卫生厅科技计划项目(20195370);江西省赣州市科技局指导性科技计划(GZ2020ZSF105)。

摘　　要：目的分析髋部骨折患者术前发生下肢深静脉血栓形成(LEDVT)的影响因素。方法选取赣南医学院第三附属医院和赣南医学院第一附属医院2018年1月至2021年12月收治的254例髋部骨折患者为研究对象,根据是否发生LEDVT分为LEDVT组(n=60)和非LEDVT组(n=194)。收集患者的临床基础资料,采用logistic回归分析对髋部骨折患者术前LEDVT发生的影响因素进行分析。结果本组患者术前的LEDVT发生率为23.62%。单因素分析结果提示,LEDVT组与非LEDVT组的年龄≥65岁、体重指数≥25 kg/m^(2)、吸烟史、高血压史、高脂血症史、静脉血栓栓塞症史、骨折至手术时间≥5 d比例和血红蛋白(Hb)、同型半胱氨酸(Hcy)、纤维蛋白原(FIB)、红细胞比容(HCT)水平比较,差异有统计学意义(P<0.05)。多因素logistic回归分析显示,年龄≥65岁(β=1.303,OR=3.680,95%CI:1.685~8.035)、吸烟史(β=0.843,OR=2.323,95%CI:1.016~5.312)、静脉血栓栓塞症史(β=1.337,OR=3.809,95%CI:1.295~11.206)、骨折至手术时间≥5 d(β=1.703,OR=5.493,95%CI:1.680~17.960)、高Hb水平(β=0.175,OR=1.191,95%CI:1.085~1.308)、高HCT水平(β=0.118,OR=1.125,95%CI:1.033~1.226)、高Hcy水平(β=0.118,OR=1.125,95%CI:1.033~1.226)、高D-二聚体(D-D)水平(β=0.266,OR=1.305,95%CI:1.088~1.565)为髋部骨折患者术前LEDVT发生的独立危险因素(P<0.05)。结论年龄≥65岁、吸烟史、静脉血栓栓塞症史、骨折至手术时间≥5 d、高Hb水平、高HCT水平、高Hcy水平、高D-D水平会增加髋部骨折患者术前LEDVT的发生风险,术前应积极给予抗凝治疗,确保手术顺利进行。Objective To analyze the influencing factors of lower extremity deep vein thrombosis(LEDVT)in patients with hip fracture before operation.Methods A total of 254 hip fracture patients treated in the Third Affiliated Hospital of Gannan Medical University and the First Affiliated Hospital of Gannan Medical University from January 2018 to December 2021 were selected as the research objects.According to whether LEDVT occurred,they were divided into the LEDVT group(n=60)and the non-LEDVT group(n=194).The basic clinical data of patients were collected.Logistic regression analysis was used to analyze the influencing factors of preoperative LEDVT in patients with hip fractures.Results The preoperative LEDVT incidence rate in this group of patients was 23.62%.Univariate analysis showed that there were significant differences between the LEDVT group and the non-LEDVT group in the ratio of age≥65 years,body mass index≥25 kg/m^(2),smoking history,hypertension history,hyperlipidemia history,venous thromboembolism history,fracture to operation time≥5 days and the levels of hemoglobin(Hb),homocysteine(Hcy),fibrinogen(FIB),hematocrit(HCT)(P<0.05).Multivariate logistic regression analysis showed that age≥65 years old(β=1.303,OR=3.680,95%CI:1.685-8.035),smoking history(β=0.843,OR=2.323,95%CI:1.016-5.312),venous thromboembolism history(β=1.337,OR=3.809,95%CI:1.295-11.206),time from fracture to operation≥5 d(β=1.703,OR=5.493,95%CI:1.680-17.960),high Hb level(β=0.175,OR=1.191,95%CI:1.085-1.308),high HCT level(β=0.118,OR=1.125,95%CI:1.033-1.226),high Hcy level (β=0.118, OR=1.125, 95%CI: 1.033-1.226), high D-dimer (D-D) level (β=0.266, OR=1.305, 95%CI: 1.088-1.565) were independent risk factors for preoperative LEDVT in patients with hip fracture (P<0.05). Conclusion Age ≥65 years, smoking history, venous thromboembolism history, time from fracture to operation ≥5 days, high Hb level, high HCT level, high Hcy level, high D-D level will increase the risk of preoperative LEDVT in patients with hip fractures. Anticoag

关 键 词：髋部骨折 术前 下肢深静脉血栓形成 影响因素 抗凝 

分 类 号：R683.42[医药卫生—骨科学]