骨科手术患者深静脉血栓的危险因素及改良Padua评分的预测价值  

Risk factors of deep vein thrombosis in patients undergoing orthopedic surgery and the predictive value of modified Padua score

作　　者：蒋伟兴[1] 丁晓娟[1] 王萍[1] 白婧[1] 武雪亮[1] 马维江[1] 袁美锦[1] 屈明[1] Jiang Weixing;Ding Xiaojuan;Wang Ping;Bai Jing;Wu Xueliang;Ma Weijiang;Yuan Meijin;Qu Ming(Intervention Operating Room,the First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,Hebei,China)

机构地区：[1]河北北方学院附属第一医院介入手术室,河北张家口075000

出　　处：《血管与腔内血管外科杂志》2023年第6期687-690,700,共5页Journal of Vascular and Endovascular Surgery

基　　金：河北省医学科学研究重点课题计划(20180846)。

摘　　要：目的探讨骨科手术患者深静脉血栓(DVT)的危险因素及改良Padua评分的预测价值。方法收集2020年7月至2022年6月于河北北方学院附属第一医院就诊的473例骨科手术患者的临床资料,按照是否发生DVT将其分为DVT组(n=52)和非DVT组(n=421)。收集两组患者的基本资料及手术相关指标,采用改良Padua评分预测骨科手术患者DVT的发生情况,分析骨科手术患者发生DVT的危险因素及改良Padua评分的预测价值。结果473例患者中,367例改良Padua评分低危患者,其中,3例发生DVT;106例改良Padua评分高危患者,其中,49例发生DVT。改良Padua评分预测DVT的灵敏度为46.23%(49/106),特异度为99.18%(364/367)。DVT组患者年龄≥60岁、体重指数(BMI)≥25 kg/m^(2)、高血压、糖尿病、股骨转子间骨折、全身麻醉、骨折至入院时间≥24 h患者比例均高于非DVT组患者,差异均有统计学意义(P﹤0.05)。多因素分析结果显示,年龄≥60岁、BMI≥25 kg/m^(2)、高血压、股骨转子间骨折、全身麻醉、骨折至入院时间≥24 h均是骨科手术患者发生DVT的危险因素(P﹤0.05),而糖尿病不是骨科手术患者发生DVT的危险因素(P﹥0.05)。结论改良Padua评分作为排除骨科手术患者DVT发生的工具价值较高,但预测价值有限。骨科手术患者发生DVT的危险因素为年龄≥60岁、BMI≥25 kg/m^(2)、高血压、股骨转子间骨折、骨折至入院时间≥24 h、全身麻醉。Objective To investigate the risk factors of deep vein thrombosis(DVT)in patients undergoing orthopedic surgery and the predictive value of the modified Padua score.Method The clinical data of 473 patients undergoing orthopedic surgery in the First Affiliated Hospital of Hebei North University from July 2020 to June 2022 were collected.They were divided into DVT group(n=52)and non-DVT group(n=421)according to the occurrence of lower extremity DVT.The baseline data and surgery-related indicators of the two groups of patients were collected.The modified Padua score was used to predict the occurrence of DVT in orthopedic surgery patients.The risk factors of DVT in patients undergoing orthopedic surgery and the predictive value of the modified early warning score were analyzed.Result Among the 473 patients,367 patients were low-risk patients with modified Padua score,3 patients with DVT;106 patients with high-risk modified Padua score,49 patients with DVT.The sensitivity of the modified Padua score in predicting DVT was 46.23%(49/106),and the specificity was 99.18%(364/367).The proportion of patients in the DVT group with age≥60 years old,body mass index(BMI)≥25 kg/m2,hypertension,diabetes,intertrochanteric fracture,general anesthesia,and time from fracture to admission≥24 h was higher than that in the non-DVT group,the differences were statistically significant(P﹤0.05).Multivariate analysis showed that age≥60 years old,BMI≥25 kg/m2,hypertension,intertrochanteric fracture,general anesthesia,and time from fracture to admission≥24 h were risk factors for DVT in patients undergoing orthopedic surgery(P﹤0.05).Diabetes was not the risk factor for lower extremity DVT in patients undergoing orthopedic surgery(P﹥0.05).Conclusion The modified Padua score has a high value as a tool for excluding DVT in patients undergoing orthopedic surgery,while its predictive value is limited.Age≥60 years old,BMI≥25 kg/m2,hypertension,intertrochanteric fracture,time from fracture to admission≥24 h,and general anesthes

关 键 词：骨科 深静脉血栓 危险因素 改良Padua评分 预测价值 

分 类 号：R543[医药卫生—心血管疾病]