下肢骨折患者深静脉血栓的危险因素及不同量表的预测价值  

Risk factors of deep vein thrombosis in patients with lower extremity fractures and the predictive value of different risk assessment scales

作　　者：侍冬成[1] 封启明[1] 李永霞[1] 朱晓光 姜家梅 SHI Dongcheng;FENG Qiming;LI Yongxia;ZHU Xiaoguang;JIANG Jiamei(Department of Emergency,Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200233,China)

机构地区：[1]上海交通大学医学院附属第六人民医院急诊医学科,上海200233

出　　处：《同济大学学报（医学版）》2023年第4期519-525,共7页Journal of Tongji University(Medical Science)

基　　金：上海交通大学医学院附属第六人民医院院级课题(ynhg202208)。

摘　　要：目的分析下肢骨折患者深静脉血栓(deep vein thrombosis,DVT)发生的独立危险因素,研究RAPT量表、Autar量表、Caprini量表对下肢骨折患者DVT的预测价值。方法回顾性分析上海交通大学医学院附属第六人民医院急诊医学科2016年8月—2021年12月EICU中胫骨骨折、股骨骨折、胫骨合并股骨骨折患者的临床资料,统计DVT的发生率;采用Logistic回归分析患者发生DVT的独立危险因素;采用ROC曲线评估RAPT量表、Autar量表、Caprini量表对下肢骨折患者DVT的预测价值。结果共511例患者纳入本研究,其中99例(19.37%)出现DVT。胫骨骨折207例,19例(9.18%)出现DVT;股骨骨折245例,66例(26.94%)出现DVT;胫骨合并股骨骨折59例,14例(23.73%)出现DVT;3组间DVT发生率有统计学意义(P<0.001)。多因素Logistic回归分析显示,合并多发伤(OR=2.676,95%CI:1.3755.209,P=0.004)、骨折部位(相对于胫骨骨折组,股骨骨折组DVT风险情况:OR=4.634,95%CI:2.5318.486,P<0.001;胫骨合并股骨骨折组DVT风险情况:OR=2.879,95%CI:1.3236.264,P=0.008)、Autar评分(OR=1.319,95%CI:1.0201.708,P=0.035)为下肢骨折患者发生DVT的独立危险因素。Autar量表、Caprini量表、RAPT量表预测下肢骨折患者发生DVT的ROC曲线下面积分别为0.598、0.576、0.566,三者间差异无统计学意义(P>0.05)。结论股骨骨折或合并多发伤的患者发生DVT的风险更高。RAPT量表、Autar量表、Caprini量表对EICU下肢骨折患者是否发生DVT有一定的预测价值,但均不够理想。Objective To investigate the risk factors of deep vein thrombosis(DVT)in patients with lower extremity fracture and to study the predictive value of RAPT scale,Autar scale and Caprini scale.Methods Clinical data of patients with tibial fracture and/or femur fracture admitted in the emergency intensive care unit(EICU)of Shanghai Six People's Hospital from August 2016 to December 2021 were retrospectively analyzed,and the incidence of DVT was calculated.The independent risk factors of DVT were analyzed with Logistic regression,and the predictive values of RAPT scale,Autar scale and Caprini scale for DVT were evaluated with ROC curve.Results A total of 511 patients were included in this study,of which 99(19.37%)had DVT.Among 207 patients with tibial fracture,19(9.18%)had DVT;among 245 cases of femur fracture,66(26.94%)cases had DVT;among 59 patients with tibial and femur fracture,14(23.73%)had DVT(P<0.001).Multivariate Logistic regression analysis showed multiple injuries(OR=2.676,95%CI:1.375-5.209,P=0.004),fracture site(compared to tibial fracture group,femur fracture group OR=4.634,95%CI:2.531-8.486,P<0.001;tibia combined with femoral fracture group(OR=2.879,95%CI:1.323-6.264,P=0.008),Autar score(OR=1.319,95%CI:1.020-1.708,P=0.035)were independent risk factors for DVT in patients with lower extremity fracture.The area under ROC curve predicted by Autar scale,Caprini scale and RAPT scale for the occurrence of DVT in patients with lower extremity fracture was 0.598,0.576 and 0.566,respectively,and there was no statistical difference among them.Conclusion Patients with femoral fractures or multiple injuries are at higher risk for DVT.RAPT scale,Autar scale and Caprini scale had certain predictive value for the occurrence of DVT in patients with lower extremity fracture in EICU,but they are not ideal ones.

关 键 词：急诊重症监护室 下肢骨折 深静脉血栓 危险因素 

分 类 号：R683[医药卫生—骨科学]