危重症中心静脉穿刺置管患者深静脉血栓形成的影响因素分析  

Analysis of Influencing Factors for Deep Vein Thrombosis Formation in Patients with Central Venous Catheterization in the Intensive Care Unit

作　　者：高坡 吕智全 屈世全 李泉 张为明 周伟伟 刘静 黄晨钊 李云 GAO Po;L Zhi-quan;LI Yun(Emergency Intensive Care Unit,The Fuyang Affiliated Hospital of Anhui Medical University,Fuyang Anhui 236000,China)

机构地区：[1]安徽医科大学附属阜阳医院急诊重症监护室,安徽阜阳236000 [2]安徽医科大学附属阜阳医院急诊内科 [3]安徽医科大学附属阜阳医院消化内科

出　　处：《湖北科技学院学报(医学版)》2025年第1期48-52,共5页Journal of Hubei University of Science and Technology(Medical Sciences)

摘　　要：目的探究危重症中心静脉穿刺置管患者深静脉血栓形成情况及其影响因素分析。方法选取本院急诊重症监护室(EICU)收治的115例行中心静脉穿刺置管术患者为研究对象,根据穿刺置管后是否发生深静脉血栓(DVT),将患者分为血栓组与非血栓组,对两组临床资料,进行多因素分析,探究中心静脉穿刺置管患者DVT发生的影响因素,使用受试者特征曲线(ROC曲线)探究影响因素在预测深静脉血栓形成方面的敏感性和特异性。结果115例危重症中心静脉穿刺置管患者中24例发生DVT,单纯肌间静脉血栓、下肢多条深静脉血栓及附壁血栓是DVT中占比前三的血栓类型,急性呼吸系统感染、恶性肿瘤及急性消化系统出血性疾病是DVT中占比前三的疾病。两组患者在是否感染、是否恶性肿瘤、高脂血症、血栓史、置管留置时长、血小板(PLT)、凝血酶原时间(PT)、和D-二聚体(D-dimer)方面比较差异有统计学意义(P均<0.05),纳入多因素分析后,高脂血症、血栓史、置管留置时长及D-dimer是影响中心静脉穿刺置管患者发生DVT的独立危险因素,ROC曲线分析结果显示,置管留置时长和D-dimer在预测DVT的发生比较有差异(P<0.05),置管留置时长的ROC曲线下面积最大,AUC为0.765,最佳截断值为2.5d,预测DVT的敏感性和特异性为85.7%和57.1%。结论危重症中心静脉穿刺置管患者DVT发生率较高,临床中应予以重视,高脂血症、血栓史、置管留置时长及D-dimer是影响DVT发生的独立危险因素,其中置管留置时长对预测DVT形成价值最大。Objective To explore the incidence of deep vein thrombosis(DVT)and its influencing factors in critically ill patients with central venous catheterization.Methods A retrospective analysis was performed,encompassing 115 patients who underwent central venous catheterization procedures in our hospital's Emergency Intensive Care Unit(EICU).Patients were categorized into a thrombosis group and a non-thrombosis group based on the occurrence of DVT after catheterization.A comparative analysis of clinical profiles was conducted,and factors with significant statistical disparities were subjected to multivariate analysis to identify determinants influencing DVT development.The sensitivity and specificity of these factors in predicting DVT were assessed using the receiver operating characteristic(ROC)curve.Results Among 115 patients 24 developed DVT,and the top three types of thrombosis in DVT were simple intermuscular vein thrombosis,multiple deep vein thromboses in the lower limbs,and mural thrombi.The top three diseases associated with DVT were acute respiratory infections,malignancies,and acute digestive hemorrhagic diseases.Significant statistical differences were observed between the two groups in terms of infection,malignancy,hyperlipidemia,history of thrombosis,duration of catheter retention,platelet count(PLT),prothrombin time(PT),and D-dimer levels(all P<0.05).Multivariate analysis revealed that hyperlipidemia,thrombosis history,catheter retention duration,and D-dimer levels were independent risk factors for DVT in catheterized patients.ROC curve analysis indicated that both catheter retention duration and D-dimer levels are significant predictors of DVT,with the former showing the highest area under the curve(AUC=0.765)and an optimal cutoff point of 2.5 days,offering the sensitivity and specificity of 85.7%and 57.1%,respectively,for DVT prediction.Conclusion The incidence of DVT in critically ill patients with central venous catheterization is high,and it should be taken seriously in clinical practice.Hyperlipidem

关 键 词：重症监护病房 中心静脉导管 静脉血栓形成 急诊室 Logistic回归分析模型 

分 类 号：R543[医药卫生—心血管疾病]