老年住院患者下肢深静脉血栓形成的临床特征和转归分析  

Clinical characteristics and prognosis of lower extremity deep venous thrombosis in elderly inpatients

作　　者：李理 王垚[1] 高亚南[1] 张云[1] 王媛[1] 刘亭亭 沙贵明 郑添茹 Li Li;Wang Yao;Gao Ya′nan;Zhang Yun;Wang Yuan;Liu Tingting;Sha Guiming;Zheng Tianru(Elderly Demonstration Ward,Beijing Geriatric Hospital,Beijing 100095,China)

机构地区：[1]北京老年医院老年示范病房,100095

出　　处：《北京医学》2022年第10期881-887,共7页Beijing Medical Journal

摘　　要：目的探讨老年住院患者下肢深静脉血栓形成(lower extremity deep venous thrombosis,LDVT)的临床特点和转归,为预防和诊治老年LDVT提供科学依据。方法选取2019年1月至2022年1月北京老年医院诊断为LDVT的老年患者180例,将其分为非高龄组(60~<80岁)和高龄组(≥80岁)。回顾性分析患者的人口学资料及临床特征,比较两组LDVT的临床特征、治疗及血栓和疾病的转归情况。结果180例患者中男81例,女99例,中位年龄77岁,其中非高年龄者76例,高年龄者104例。与非高龄组相比,高龄组吸烟比例较低(20.2%比34.2%),合并肺炎、营养不良及肾功能异常比例较高(70.2%比46.1%,45.2%比22.4%,32.7%比10.5%),差异均有统计学意义(P<0.05)。所有患者血栓分布以左侧多见(40.0%),血栓分型以周围型为主(84.4%),其中肌间静脉101例(56.1%);高龄组与非高龄组比较,中央型、股静脉血栓比例较高(14.4%比1.3%,9.6%比1.3%),肌间静脉血栓比例较低(48.1%比67.1%),差异均有统计学意义(P<0.05)。有116例患者进行治疗,其中治疗时间≥15 d者57例(31.7%),治疗方案以单用低分子肝素(low molecular weight heparin,LMWH)多见,占69.8%(81/116),治疗过程中有17例患者出现不同部位出血,以消化道出血为主。64例未治疗患者的原因为凝血功能异常/出血/贫血,占51.6%(33/64)。高龄组单用LMWH方案比例高于非高龄组(78.1%比59.6%),LMWH→抗血小板聚集药物(antiplatelet therapy,APT)方案比例低于非高龄组(1.6%比13.5%),差异有统计学意义(P<0.05)。高龄组出血发生率高于非高龄组(23.4%比3.8%),差异有统计学意义(P<0.05)。治疗时间≥15 d组的血栓好转/消失和疾病好转比例高于未治疗组(53.7%比22.0%,38.9%比32.7%),且疾病好转比例高于治疗<15 d组(28.3%),差异均有统计学意义(P<0.05)。结论老年LDVT以左下肢/周围型静脉血栓多见,高龄老人股静脉血栓风险及抗凝后出血风险均较高;目前临床针对老年LDVT的诊疗�Objective To explore the clinical characteristics and prognosis of lower extremity deep venous thrombosis(LDVT)in elderly inpatients,and provide scientific basis for the prevention,diagnosis and treatment of LDVT in the elderly patients.Methods A total of 180 elderly patients diagnosed as LDVT in Beijing Geriatric Hospital from January 2019 to January 2022 were selected and divided into non-elderly group(60-<80 years old)and elderly group(≥80 years old).The demographic and clinical data were retrospectively analyzed,and the clinical features,therapy,thrombosis and disease prognosis were analyzed and compared between the two groups.Results Among the 180 patients,81 were male and 99 were female.The median age was 77 years old,including 76 cases in non-elderly group and 104 cases in elderly group.The number of smokers in the elderly group was lower than that in the non-elderly group(20.2%vs.34.2%),the incidence of pneumonia,malnutrition and renal insufficiency in the elderly group were higher than those in the non-elderly group(70.2%vs.46.1%,45.2%vs.22.4%,32.7%vs.10.5%),the differences were statistically significant(P<0.05).Among the 180 patients,the left limb was the most part for thrombosis(40.0%),and the peripheral vein thrombosis was the main type(84.4%),among which 101 cases(56.1%)were inter-muscular veins.Compared with the non-elderly group,the elderly group had more central and femoral vein thrombosis(14.4%vs.1.3%,9.6%vs.1.3%),and the proportion of inter-muscular vein thrombosis was relatively small(48.1%vs.67.1%),the differences were all statistically significant(P<0.05).A total of 116 patients were treated,57(31.7%)were treated for more than 15 d.Low molecular weight heparin(LMWH)alone was the most common treatment,accounting for 69.8%(81/116).During the treatment,17 patients had bleeding in different parts,most of which were gastrointestinal bleeding.Sixty-four cases were not treated,mainly due to the abnormal coagulation/hemorrhage/anemia(totally 33 cases,51.6%).There were many treatment options for the

关 键 词：下肢静脉血栓形成 临床特征 抗凝治疗 预后 老年 

分 类 号：R543.6[医药卫生—心血管疾病]