大隐静脉高位结扎剥脱术后静脉血栓栓塞形成的危险因素分析  

Risk factors of venous thromboembolism after high ligation and stripping of great saphenous vein

作　　者：乔萌萌 贾伟 Qiao Mengmeng;Jia Wei(Operating Room,Beijing Jishuitan Hospital Affiliated to Capital Medical University,Beijing 100035,China;Department of Vascular Surgery,Beijing Jishuitan Hospital Affiliated to Capital Medical University,Beijing 100035,China)

机构地区：[1]首都医科大学附属北京积水潭医院手术室,北京100035 [2]首都医科大学附属北京积水潭医院血管外科,北京100035

出　　处：《血管与腔内血管外科杂志》2024年第3期282-286,共5页Journal of Vascular and Endovascular Surgery

摘　　要：目的 探讨大隐静脉(GSV)高位结扎剥脱术后静脉血栓栓塞(VTE)形成的危险因素。方法 收集2020年12月至2022年12月于首都医科大学附属北京积水潭医院接受GSV高位结扎剥脱术治疗的138例GSV曲张患者的临床资料,将术后发生VTE的46例患者作为VTE组,并采用倾向性评分匹配法,根据VTE组患者的年龄与性别按1:2的比例选取92例术后未发生VTE的患者作为NVTE组。分析GSV高位结扎剥脱术后发生VTE的危险因素。结果 单因素分析结果显示,VTE组患者术前有下肢静脉炎病史的比例、术后1dD-二聚体(D-D)水平、术后1 d血小板计数(PLT)、术后1d高敏C反应蛋白(hs-CRP)水平均高于NVTE组患者,术中出血量多于NVTE组患者,差异均有统计学意义(P﹤0.05)。多因素分析结果显示,术前有下肢静脉炎病史、术中出血量较高、术后1dD-D水平较高、术后1 d PLT较高及术后1dhs-CRP水平较高均为GSV高位结扎剥脱术后发生VTE的危险因素(P﹤0.05)。受试者工作特征(ROC)曲线分析结果显示,当有术前下肢静脉炎病史、术中出血量≥86.43 ml、术后1dD-D水平≥443.36μg/L、术后1dPLT≥295.63×10~9/L、术后1dhs-CRP水平≥10.62 mg/L时,GSV高位结扎剥脱术后发生VTE的风险较高(P﹤0.05)。结论 大隐静脉高位结扎剥脱术前有下肢静脉炎病史,术中出血量较多,术后D-D、PLT、hs-CRP水平较高的患者术后发生VTE的风险更高,应尽早给予抗凝、抗血小板治疗,以提高手术的安全性。Objective To investigate the risk factors of venous thrombosis after high ligation and stripping of great saphenous vein(GSV).Method The clinical data of 138 patients with varicose GSV who received high ligation and stripping surgery of GSV at Beijing Jishuitan Hospital Affiliated to Capital Medical University from December 2020 to December 2022 were collected.Among them,46 patients with postoperative venous thromboembolism(VTE)were included in the VTE group.According to the age and gender of patients in 1:2 ratio based on the VTE group,92 patients without postoperative VTE were selected as the NVTE group by the propensity matching method.Analyze the risk factors for VTE after high ligation and stripping surgery for GSV.Result The results of univariate analysis showed that the proportion of VTE group patients with a history of lower limb phlebitis before surgery,D-dimer(D-D)levels at 1 day after surgery,platelet count(PLT)at 1 day after surgery,high sensitivity C-reactive protein(hs-CRP)levels at 1 day after surgery were higher than those of NVTE group patients,and the intraoperative blood loss was higher than those of NVTE group patients,and the differences were statistically significant(P<0.05).The results of multivariate analysis showed that a history of lower limb phlebitis before surgery,high intraoperative blood loss,high D-D levels at 1 day after surgery,high PLT at 1 day after surgery,and high hs-CRP levels at 1 day after surgery were all risk factors for VTE after high ligation and stripping of GSV(P<0.05).The receiver operator characteristic(ROC)curve analysis results show that when there is a history of lower limb phlebitis before surgery,intraoperative bleeding volume≥86.43 ml,D-D level≥443.36μg/L at 1 day after surgery,PLT≥295.63×109/L at 1 day after surgery,and hs-CRP≥10.62 mg/L at 1 day after surgery,the risk of VTE after high ligation and stripping of GSV is higher(P<0.05).Conclusion The patients with high ligation and stripping of GSV had a history of phlebitis of lower limb before surg

关 键 词：大隐静脉曲张 高位结扎剥脱术 静脉血栓 静脉血栓栓塞 危险因素 

分 类 号：R543[医药卫生—心血管疾病]