脊柱退变性疾病术后患者发生深静脉血栓危险因素的Meta分析  

Risk factors for deep vein thrombosis in postoperative patients with spinal degenerative diseases:a meta-analysis

作　　者：余金甜 江海娇 孙瑞祥 YU Jin-tian(Yijishan Hospital,First Affiliated Hospital of Wannan Medical College,Wuhu 241001,Anhui,China)

机构地区：[1]皖南医学院第一附属医院(弋矶山医院)重症医学科,安徽芜湖241001

出　　处：《牡丹江医学院学报》2024年第4期112-119,124,共9页Journal of Mudanjiang Medical University

基　　金：皖南医学院中青年科研基金项目(WK2023ZQNS20,WK2023ZQNS21)。

摘　　要：目的系统评价脊柱退变性疾病术后患者深静脉血栓形成的危险因素。方法计算机检索PubMed、Web of Science、The Cochrane Library、知网、万方、维普网数据库,搜集有关脊柱退变性疾病术后患者发生深静脉血栓危险因素的临床研究,检索时限均为建库至2023年7月。由2名研究者独立筛选文献,提取资料并评价纳入研究的偏倚风险后,使用RevMan 5.3软件进行Meta分析。结果共纳入23篇文献,共14020例患者。Meta分析结果显示,年龄[OR=1.16,95%CI(1.09,1.23),P<0.001]、性别[OR=1.10,95%CI(1.01,1.20),P=0.03]、体重指数[OR=1.38,95%CI(1.07,1.78),P=0.01]、肥胖[OR=2.54,95%CI(1.37,4.72),P=0.003]、高血压[OR=1.91,95%CI(1.16,3.16),P=0.01]、手术时间[OR=1.46,95%CI(1.08,1.97),P=0.01]、术中输血[OR=2.43,95%CI(1.45,4.05),P<0.001]、术前≥2项凝血四项检查结果异常[OR=4.81,95%CI(2.92,7.91),P<0.001]、D-2聚体水平[OR=2.67,95%CI(1.74,4.11),P<0.001]、术后卧床时间[OR=3.68,95%CI(2.50,5.42),P<0.001]是脊柱退变性疾病术后患者发生深静脉血栓的危险因素,术后进行下肢主被动训练[OR=0.39,95%CI(0.18,0.86),P=0.02]是脊柱退变性疾病术后患者发生深静脉血栓的保护因素。结论当前证据表明,年龄、性别、体重指数、肥胖、高血压、手术时间、术中输血、术前≥2项凝血四项检查结果异常、D-2聚体水平、术后卧床时间是脊柱退变性疾病术后患者发生深静脉血栓的危险因素,术后进行下肢主被动训练是脊柱退变性疾病术后患者发生深静脉血栓的保护因素。医务人员可针对以上因素采取相关的治疗及护理措施,从而降低深静脉血栓的发生率,改善患者临床预后结局。Objective To systematically evaluate the risk factors of deep vein thrombosis in postoperative patients with spinal degenerative diseases.Methods PubMed,Web of science,The Cochrane Library,CNKI,VIP and WanFang were electronically searched to collect studies about the risk factors of deep vein thrombosis in postoperative patients with spinal degenerative diseases from inception to July 2023.Two reviewers independently screened literature,extracted data and assessed the risk of bias of included studies,meta-analysis was performed by using RevMan 5.3 software.Results A total of 23 articles were included,including 14020 patients.The results of meta-analysis showed that age(OR=1.16,95%CI 1.09 to 1.23,P<0.001),gender(OR=1.09,95%CI 1.00 to 1.19,P=0.04),body mass index(OR=1.20,95%CI 1.00 to 1.44,P=0.04),obesity(OR=2.54,95%CI 1.37 to 4.72,P=0.003),hypertension(OR=1.81,95%CI 1.14 to 2.87,P=0.01),operation time(OR=1.62,95%CI 1.21 to 2.16,P<0.001),intraoperative blood transfusion(OR=2.43,95%CI 1.45 to 4.05,P<0.001),abnormal items of four blood coagulation≥2(OR=4.81,95%CI 2.92 to 7.91,P<0.001),D-dimer level(OR=2.67,95%CI 1.74 to 4.11,P<0.001),postoperative bed time(OR=3.55,95%CI 2.34 to 5.40,P<0.001)were the risk factors for deep vein thrombosis in patients with spinal degenerative diseases,active and passive training of lower limbs after operation(OR=0.39,95%CI 0.18 to 0.86,P=0.02)was a protective factor for postoperative deep vein thrombosis in patients with spinal degenerative diseases.Conclusion Current evidence shows that age,gender,body mass index,obesity,hypertension,operation time,intraoperative blood transfusion,abnormal items of four blood coagulation≥2,D-dimer level,postoperative bed time are the risk factors for deep vein thrombosis in patients with spinal degenerative diseases after surgery.Postoperative active and passive lower limb training is a protective factor for deep vein thrombosis in patients with spinal degenerative diseases after surgery.Medical staff can take relevant treatment and nursing measure

关 键 词：脊柱手术 深静脉血栓 危险因素 META分析 

分 类 号：R687.3[医药卫生—骨科学]