急性脊柱损伤患者发生肺栓塞的危险因素分析  

Risk factors for pulmonary embolism in patients with acute spinal cord injury

作　　者：李伊敬 鄢苏鹏 邵艳霞 袁媛 蒋春梅 蒲淑玉 孙溦 LI Yijing;YAN Supeng;SHAO Yanxia;YUAN Yuan;JIANG Chunmei;PU Shuyu;SUN Wei(Department of Emergency Medicine,First Affiliated Hospital,Army Medical University(Third Military Medical University),Chongqing,400038;Department of Medical Engineering and Information,Hospital of Troop 96604,Lanzhou,Gansu Province,730030,China;Department of Clinical Nursing,First Affiliated Hospital,Army Medical University(Third Military Medical University),Chongqing,400038;First Department of General Surgery,Hospital of Troop 96604,Lanzhou,Gansu Province,730030,China)

机构地区：[1]陆军军医大学(第三军医大学)第一附属医院急诊医学科,重庆400038 [2]解放军96604部队医院医学工程与信息科,兰州730030 [3]陆军军医大学(第三军医大学)第一附属医院临床护理学教研室,重庆400038 [4]解放军96604部队医院外一科,兰州730030

出　　处：《陆军军医大学学报》2024年第18期2130-2137,共8页Journal of Army Medical University

基　　金：重庆市自然科学基金面上项目(CSTB2022NSCQ-MSX1400)。

摘　　要：目的分析影响急性脊柱损伤患者肺栓塞发生的危险因素。方法采用病例-对照研究设计方案。收集2018年1月至2023年8月期间陆军军医大学3所附属医院收治的840例急性脊柱损伤患者的基本信息、损伤原因、损伤部位、影像学及实验室检查等相关资料,按照患者是否并发肺栓塞分为2组:发生肺栓塞患者83例;未发生肺栓塞患者757例。对2组患者性别、年龄、住院时间、ICU时间、损伤原因等37个危险因素指标进行单因素分析,再对筛选出的有意义的变量进行多因素Logistic回归分析。结果急性脊柱损伤患者单因素分析提示年龄、住院时间、下肢骨折、肺部挫伤及感染、休克、手术次数等24个危险因素与肺栓塞的发生有关(P<0.05)。多因素二元Logistic回归分析提示,年龄(P=0.000,OR=1.957,95%CI:1.532~2.499)、ICU时间(P=0.000,OR=2.561,95%CI:1.728~3.794)、手术次数(P=0.015,OR=1.814,95%CI:1.124~2.927)、脊柱固定(P=0.004,OR=0.370,95%CI:0.189~0.724)、限制性体位(P=0.000,OR=21.269,95%CI:5.276~85.740)、血小板(P=0.000,OR=1.553,95%CI:1.236~1.951)、D-二聚体(P=0.000,OR=1.600,95%CI:1.376~1.860)、凝血酶原时间(P=0.025,OR=2.756,95%CI:1.138~6.670)是急性脊柱损伤患者肺栓塞的独立危险因素。结论急性脊柱损伤患者肺栓塞组病死率明显高于非肺栓塞组,年龄、ICU时间、手术次数、脊柱固定、限制性体位、血小板、D-二聚体、凝血酶原时间与急性脊柱损伤患者发生肺栓塞密切相关。ObjectiveTo investigate the risk factors for pulmonary embolism(PE)in patients with acute spinal cord injury(ASCI).MethodsA case-control design was adopted in this study.Basic information,injury cause,injury site,imaging and laboratory examination results and other relevant data of 840 ASCI patients admitted to 3 affiliated hospitals of Army Medical University from January 2018 to August 2023 were collected.According to occurrence of PE or not,these patients were divided a PE group(n=83)and a non-PE group(n=757).Univariate analysis was performed on 37 risk factors including gender,age,length of hospital stay,length of intensive care unit(ICU)stay,cause of injury,and so on,and then multivariate logistic regression analysis was applied to analyze these selected significant variables.ResultsUnivariate analysis showed that 24 factors such as age,length of hospital stay,lower limb fracture,pulmonary contusion and infection,shock and number of operations were related to the occurrence of PE in ASCI patients(P<0.05).Binary logistic regression analysis indicated that age(P=0.000,OR=1.957,95%CI:1.532~2.499),length of ICU stay(P=0.000,OR=2.561,95%CI:1.728~3.794),number of operations(P=0.015,OR=1.814,95%CI:1.124~2.927),spinal fixation(P=0.004,OR=0.370,95%CI:0.189~0.724),restrictive position(P=0.000,OR=21.269,95%CI:5.276~85.740),platelet count(P=0.000,OR=1.553,95%CI:1.236~1.951),D-dimer level(P=0.000,OR=1.600,95%CI:1.376~1.860)and prothrombin time(P=0.025,OR=2.756,95%CI:1.138~6.670)were independent risk factors for PE in the patients.ConclusionThe mortality of the ASCI patients with PE is significantly higher than those without.Age,length of ICU stay,number of operations,spinal fixation,restrictive position,platelet count,D-dimer level and prothrombin time are closely associated with PE in ASCI patients.

关 键 词：脊柱损伤 肺栓塞 危险因素 

分 类 号：R181.32[医药卫生—流行病学] R563.5[医药卫生—公共卫生与预防医学] R681.54