骨科老年大手术患者中心静脉置管后静脉血栓发生的初步临床研究  

A Preliminary Clinical Study of Venous Thrombosis after Central Venous Catheterization in Elderly Patients Undergoing Major Orthopedic Surgery

作　　者：赵克聪[1] 高伟 王学华 张宝翠[1] 杨威[1] 张鑫茹 田旭影 曹艳媛 闵红巍[1] ZHAO Kecong;GAO Wei;WANG Xuehua(Boai Hospital of China Rehabilitation Research Center,Beijing 100068)

机构地区：[1]中国康复研究中心北京博爱医院,北京100068

出　　处：《中国伤残医学》2023年第18期1-4,20,共5页Chinese Journal of Trauma and Disability Medicine

基　　金：中国康复研究中心科研基金项目(No.2020-15)。

摘　　要：目的:探究骨科大手术患者中心静脉置管所致静脉血栓(PICC-RVT)及其危险因素。方法:我院骨科2018年1月-2022年4月行PICC置管的骨科大手术患者285例作为研究对象,采用一般资料调查表、临床资料收集表等对其进行调查,按照是否有静脉血栓形成,将其分为观察组(血栓组)(n=26)和对照组(非血栓组)(n=259)。借助二元Logistic回归分析形成PICC-RVT的相关因素。结果:285例患者中,发生PICC-RVT26例,血栓发生率为9.1%。观察组和对照组比较,患者的年龄[(75.5±5.2)岁vs(69.0±4.7)岁]和体质量指数(BMI)[(27.5±2.3)kg/m²vs(24.9±2.0)kg/m²]、血栓史(38.5%vs 11.2%)D-二聚体(D-D)>0.5mg/L[69.2%vs27.8%],观察组显著高于对照组,差异具有统计学意义(P<0.05)。二元Logistic回归分析结果显示,年龄>70岁(OR=3.698)BMI>25kg/m²(OR=9.358)、D-D>0.5mg/L(OR=4.014)、血栓形成史(OR=4.515)是PICC-RVT形成的独立危险因素(P<0.05)。结论:年龄>70岁、BMI>25kg/m²、D-D>0.5mg/L、血栓形成史是骨科大手术PICC-RVT的独立危险因素,对高危人群置管后应采取针对性护理干预,以期减少静脉血栓形成。Objective:Exploring the central venous catheterization induced venous thrombosis(PICC-RVT)and its risk factors in patients undergoing major orthopedic surgeries.Methods:258 patients undergoing orthopedic surgery who had PICC catheterization from January 2018 April 2022 in our hospital were selected as the study subjects.The patients were investigated by the demographic and clinical information questionare and'were divided into thrombus group(n=26)and control group(n=259)according to whether there was vein thrombosis.Logistic regression model was used to analyze the risk factors of PICC-RVT.Using Binary Logistic Regression Analysis to Analyze the Related Factors of PICC-RVT Formation.Results:PICC-RVT occurred in 26 of 285 patients and the incidence of thrombosis was 9.1%.The age[(75.5±5.2)years vs(69.0±4.7)years],Body Mass Index[(27.5±2.3)vs(24.9±2.0)Kg/m²],thrombosis history(38.5%vs 11.2%),D-Dimer(D-D)>0.5mg/L[69.2%vs 27.8%]in the thrombosis group were higher than those in the control group and there were significantly statistical difference(P<0.05).Multivariate Logistic analysis showed that age>70 years(OR=3.698),Body Mass Index(BMI)>25kg/m²(OR=9.358),D-Dimer(D-D)>0.5mg/L(OR=4.014),thrombosis history(OR=4.515)were independent risk factors for PICC-RVT(P<0.05).Conclusion:Age>70years,BMI>25kg/m²,D-D>0.5mg/L and thrombosis history were the independent risk factors for PICC-RVT in orthopedic surgery.Targeted nursing intervention should be taken in high-risk groups after catheterization in order to reduce occurrence of venous thrombosis.

关 键 词：骨科大手术 外周静脉置入中心静脉导管 静脉血栓 危险因素 

分 类 号：R683[医药卫生—骨科学]