探索骨盆与下肢骨折患者术前深静脉血栓的危险因素  

Exploring risk factors of deep vein thrombosis in the patients before the surgery of pelvic fracture and lower limb fracture

作　　者：姜家梅 封启明[1] 李永霞[1] 朱晓光 侍冬成[1] Jiang Jiamei;Feng Qiming;Li Yongxia;Zhu Xiaoguang;Shi Dongcheng(Department of Emergency,Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong 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：《中国急救医学》2024年第2期114-121,共8页Chinese Journal of Critical Care Medicine

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：目的探索引起骨盆与下肢骨折患者术前深静脉血栓(DVT)的危险因素。方法采用回顾性队列研究,分析2017年1月至2021年12月在上海交通大学医学院附属第六人民医院急诊重症监护病房住院治疗的774例骨盆与下肢骨折患者临床资料,采用修正泊松回归分析可疑暴露因素是否为骨盆与下肢骨折患者术前发生DVT的独立危险因素。根据独立危险因素构建列线图预测模型并进行内部验证,以评价其区分度、校准度和临床适用性。结果骨盆骨折患者509例,97例(19.057%)出现DVT;骨盆合并膝关节以下骨折患者79例,21例(26.582%)出现DVT;骨盆合并股骨骨折患者186例,61例(32.796%)出现DVT。分析结果显示骨盆合并股骨骨折[调整后的相对危险度(ARR)=1.619,95%CI 1.223~2.144,P=0.001]、急诊腹部手术(ARR=1.924,95%CI 1.098~3.372,P=0.022)、体重指数≥24 kg/m^(2)(ARR=1.382,95%CI 1.072~1.783,P=0.013)、创伤严重度评分(ISS)≥25分(ARR=1.439,95%CI 1.082~1.913,P=0.012)、年龄40~59岁(ARR=1.594,95%CI 1.104~2.300,P=0.013)以及年龄≥60岁(ARR=1.868,95%CI 1.279~2.730,P=0.001)为骨盆与下肢骨折患者术前发生DVT的独立危险因素;据此所构建的列线图模型对预测DVT风险以及判断是否应该采取干预措施有一定的实用价值。结论骨盆与下肢骨折患者有发生DVT的风险,骨盆合并股骨骨折、经历急诊腹部手术、BMI≥24 kg/m^(2)、ISS≥25分、年龄≥40岁是骨盆与下肢骨折患者术前发生DVT的危险因素,对具有上述特征的患者应高度重视并及时采取适当的DVT防治措施。Objective To explore the risk factors of deep vein thrombosis(DVT)in the patients before the surgery of pelvic fracture and lower limb fracture.Methods The retrospective cohort study was used to analyze the clinical data of 774 patients hospitalized in the emergency intensive care unit of Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine from January 2017 to December 2021,and the modified Poisson regression was used to analyze whether the suspected exposure factors were independent risk factors for DVT in the patients before the surgery of pelvic fracture and lower limb fracture.Based on the independent risk factors,the nomogram model was established,and the internal validation was conducted to evaluate its discrimination,calibration,and clinical applicability.Results Among 509 patients with pelvic fractures,97 patients(19.057%)had DVT;among 79 patients with pelvic fractures combined with the fractures below the knee joint,21 patients(26.582%)had DVT;among 186 patients with pelvic and femoral fractures,61 patients(32.796%)had DVT.The analysis results showed that pelvic and femoral fractures(ARR=1.619,95%CI 1.223-2.144,P=0.001),emergency abdominal surgery(ARR=1.924,95%CI 1.098-3.372,P=0.022),body mass index(BMI)≥24 kg/m^(2)(ARR=1.382,95%CI 1.072-1.783,P=0.013),injury severity score(ISS)≥25(ARR=1.439,95%CI 1.082-1.913,P=0.012),age range from 40 to 59 years(ARR=1.594,95%CI 1.104-2.300,P=0.013)and age≥60 years(ARR=1.868,95%CI 1.279-2.730,P=0.001)were independent risk factors for DVT in the patients before the surgery of pelvic and lower limb fractures;and the nomogram model expressed certain practical value in predicting DVT risk and determining whether intervention measures should be taken.Conclusions Patients with pelvic and lower limb fractures show the tendency to develop DVT.Pelvic and femoral fractures,emergency abdominal surgery,BMI≥24 kg/m^(2),ISS≥25,and age≥40 years old are closely related to the occurrence of DVT in the patients before the surgery of

关 键 词：骨盆骨折 下肢骨折 深静脉血栓 危险因素 回顾性队列研究 

分 类 号：R687.3[医药卫生—骨科学]