老年严重创伤患者并发静脉血栓栓塞的危险因素分析  

Risk factors for secondary venous thromboembolism in elderly patients with severe trauma

作　　者：许永安[1] 丁洪波 金禹辰 季晓珍 沈嘉生 康洋波 胡雨峰 Xu Yongan;Ding Hongbo;Jin Yuchen;Ji Xiaozhen;Shen Jiasheng;Kang Yangbo;Hu Yufeng(Department of Emergency Medicine,the Second Affiliated Hospital&Institute of Emergency Medicine,Zhejiang University School of Medicine/Emergency Medicine Institute of Zhejiang Province/Key Laboratory of the Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province/Zhejiang Province Clinical Research Center for Emergency and Critical Care Medicine,Hangzhou 310009,China)

机构地区：[1]浙江大学医学院附属第二医院急诊医学科/浙江大学急救医学研究所/浙江省严重创伤与烧伤诊治重点实验室/浙江省急危重症临床医学研究中心,杭州310009

出　　处：《创伤外科杂志》2024年第12期931-935,共5页Journal of Traumatic Surgery

基　　金：国家自然科学基金(81571916,81372079,81201478);浙江省科技厅“尖兵领雁+X”研发攻关计划(2024C03186);国家中医药管理局科技司-浙江省中医药管理局共建重大项目(GZY-ZJ-KJ-24030)。

摘　　要：目的探讨老年严重创伤患者并发静脉血栓栓塞(VTE)的危险因素。方法回顾性分析2016年2月—2020年12月浙江大学医学院附属第二医院急诊重症监护室(EICU)收治的的371例老年严重创伤患者的临床资料,包括性别、年龄、BMI、基础疾病、损伤部位、伤情评估、入院时生命体征、入院后首次检验结果、治疗措施、静脉血栓发生情况与临床预后。根据患者是否并发VTE分为VTE组(111例)和非VTE组(260例)。采用单因素和多因素Logistic回归分析老年严重创伤患者并发VTE的危险因素。结果371例老年严重创伤患者中男性254例,女性117例;年龄65~96岁,平均72.4岁。单因素Logistic回归分析发现:VTE组和非VTE组间BMI[(23.12±3.39)kg/m^(2) vs.(22.19±3.26)kg/m^(2)]、头颈部损伤比例(73.0%vs.85.4%)、Caprini评分[11(9,15)分vs.10(8,13)分]、Hb[87.0(81.0,117.0)g/L vs.107.5(88.0,126.0)g/L]、PT[14.8(13.7,16.2)s vs.14.3(13.4,15.5)s]、INR[1.17(1.06,1.30)vs.1.12(1.04,1.24)]、输注红细胞比例(44.1%vs.27.7%)、预防性药物抗凝比例(25.2%vs.40.0%)与急性创伤性凝血病发生率(41.4%vs.30.8%)差异有统计学意义(P<0.05)。多因素Logistic回归分析发现:高BMI(OR=1.092,95%CI:1.007~1.184,P=0.034)、高Caprini评分(OR=1.085,95%CI:1.005~1.171,P=0.038)与低预防性药物抗凝比例(OR=1.959,95%CI:1.053~3.645,P=0.034)是老年严重创伤患者并发VTE的独立危险因素。结论老年严重创伤患者并发VTE与高BMI、高Caprini评分和低预防性药物抗凝比例密切相关。Objective To investigate the risk factors associated with venous thromboembolism(VTE)in elderly patients with severe trauma.Methods A retrospective analysis was conducted on the clinical data of elderly patients with severe trauma admitted to the Emergency Intensive Care Unit(EICU)of the Second Affiliated Hospital,Zhejiang University School of Medicine,from Feb.2016 to Dec.2020.Data collected included gender,age,BMI,underlying diseases,injury infor mation,injury assessments,vital signs on admission,laboratory test Results,treatment measures,incidence of venous thrombosis,and clinical outcomes.Patients were divided into VTE group(111 cases)and non-VTE group(260 cases)based on the occurrence of VTE.Univariate and multivariate logistic regression analyses were used to identify risk factors for VTE in these patients.Results Among the 371 elderly patients with severe trauma,254 were male(68.5%)and 117 were female(31.5%),with the age ranging from 65 to 96 years and 72.4 years on average.Univariate logistic regression analysis revealed significant differences between the VTE and non-VTE groups in BMI(kg/m^(2),23.12±3.39 vs.22.19±3.26),proportion of head and neck injuries(73.0%vs.85.4%),Caprini score[11(9,15)vs.10(8,13)],hemoglobin[g/L,87.0(81.0,117.0)vs.107.5(88.0,126.0)],prothrombin time[s,14.8(13.7,16.2)vs.14.3(13.4,15.5)],INR[1.17(1.06,1.30)vs.1.12(1.04,1.24)],red blood cell transfusion rate(44.1%vs.27.7%),use of prophylactic anticoagulation(25.2%vs.40.0%),and incidence of acute traumatic coagulopathy(41.4%vs.30.8%)(all P<0.05).Multivariate logistic regression analysis identified higheRBMI(OR=1.092,95%CI:1.007-1.184,P=0.034),higher Caprini score(OR=1.085,95%CI:1.005-1.171,P=0.038),and loweRrate of prophylactic anticoagulation(OR=1.959,95%CI:1.053-3.645,P=0.034)as independent risk factors for VTE in elderly patients with severe trauma.Conclusion The development of VTE in elderly patients with severe trauma is closely associated with high BMI,high Caprini scores,and low utilization of prophylactic anticoagulants.

关 键 词：老年创伤 严重创伤 静脉血栓栓塞 危险因素 

分 类 号：R641[医药卫生—外科学]