髋关节置换术后深静脉血栓的危险因素:系统回顾和荟萃分析  

Risk factors of DVT after total hip replacement:A systematic rev iew and meta-analysis

作　　者：韩哲[1] 曹东东 孙翔[1] 韩超[1] 谢梦琦 董强[1] HAN Zhe;CAO Dong-dong;SUN Xiang(Department of Hip Trauma,Tianjin Hospital,Tianjin 3002ll,China;Tianjin University Traditional Chinese Medicine,Tianjin 30038l,China)

机构地区：[1]天津市天津医院创伤髋关节二科,天津300211 [2]天津中医药大学,天津300381

出　　处：《中国实验诊断学》2023年第4期379-389,共11页Chinese Journal of Laboratory Diagnosis

基　　金：国家自然科学基金(81902740)。

摘　　要：目的探讨髋关节置换术后发生下肢深静脉血栓(DVT)形成的危险因素。方法检索PubMed、Embase、Cochrane Library、中国知网(CNKI)、万方、维普和中国生物医学文献数据库(CBM),收集数据库建立至2022年8月期间髋关节置换术患者DVT危险因素的病例对照研究、队列研究和横断面研究。由两位作者独立筛选文献、提取数据并评估纳入文献的偏倚风险后,采用Stata 16.0软件进行荟萃分析。结果纳入27项研究,共82872名患者,存在16个危险因素。荟萃分析结果显示:女性[OR=3.06,95%CI(1.36,6.88),P=0.0001]、年龄[OR=2.04,95%CI(1.73,2.42),P<0.0001]、BMI[OR=0.73,95%CI(0.45,1.19),P=0.21]、高血压[OR=2.52,95%CI(1.42,4.46),P<0.0001]、高脂血症[OR=2.47,95%CI(1.44,4.24),P<0.0001]、合并心血管基础疾病[OR=2.53,95%CI(1.47,4.37),P<0.0001]、既往静脉曲张或DVT[OR=4.21,95%CI(3.24,5.47),P=0.012]、麻醉方法[OR=3.55,95%CI(1.85,6.82),P<0.0001]、手术时间[OR=2.33,95%CI(1.35,4.04),P<0.0001]、骨水泥假体[OR=2.79,95%CI(2.37,3.29),P<0.0001]是髋关节置换术后患者发生DVT的危险因素。男性[OR=0.0001]存在偏倚风险。术后康复训练可以降低患者DVT发生的风险[OR=0.40,95%CI(0.32,0.51),P=0.02]。结论女性、高龄、高BMI、高血压、高血脂、合并心血管基础疾病、静脉曲张或深静脉疾病、全身麻醉、手术时间延长和骨水泥假体的使用是髋关节置换术患者发生DVT的危险因素。术后康复训练则可以降低患者DVT的风险。Objectivee To systematically evaluate the risk factors for deep vein thrombosis(DVT)in patients after hip replacement.Methods We searched PubMed,EMbase,The Cochrane Library,CBM,CNKI,VIP and WanFang Data databases to collect case-control studies,cohort studies and cross-sectional studies on risk factors for DVT in hip replacement patients from the establishment of the database to November 2021.Meta-analysis was carried out by Stata 16.O software after two researchers independently screened the literatures,extracted data and evaluated the risk of bias of the included studies.Results A total of 27 studies were included,including 82,872 subjects with 16 risk factors,and the results of the Meta-analysis showed that Women[OR=3.06,95%CI(1.36,6.88),P=0.0001],Age[OR=2.04,95%CI(1.73,2.42),P<0.0001],BMI[OR=0.73,95%CI(0.45,1.19),P=0.21],Hypertension[OR=2.52,95%CI(1.42,4.46),P<0.0001],Hyperlipidemia[OR=2.47,95%CI(1.44,4.24),P<0.0001].Combined cardio-vascular underlying diseases[OR=2.53,95%CI(1.47,4.37),P<0.0001],Varicose veins or DVT[OR=4.21,95%CI(3.24,5.47),P=0.012],Anaesthetic methods[OR=3.55,95%CI(1.85,6.82),P<0.0001],Duration of operation[OR=2.33,95%CI(1.35,4.04),P<0.0001],Bone cement prosthesis[OR=2.79,95%CI(2.37,3.29),P<0.0001]are risk factors for DVT in hip replacement patients,and appropriate postoperative training reduces the risk of DVT in these patients[OR=0.40,95%CI(0.32,0.51)].Men[OR=0.0001]were at risk of bias.Conclusion Current evidence of this study suggests that women,older age,high BMI,hypertension,hyperlipidemia,combined cardio-vascular underlying diseases,varicose veins or deep vein disease,general anesthesia,prolonged operation time and the use of bone cement prosthesis are risk factors for the development of DVT in hip replacement patients.Healthcare professionals should enhance the protection of high-risk patients with these risk factors in order to reduce the incidence of DVT after hip replacement and to improve the clinical outcome of patients.

关 键 词：髋关节置换 DVT 危险因素 并发症 

分 类 号：R687.42[医药卫生—骨科学]