肝素钠对腰椎手术患者术后早期恢复质量的影响及术后下肢深静脉血栓的预测模型构建  

Influence of heparin sodium on early recovery after lumbar surgery and the construction of prediction model for postoperative deep vein thrombosis

作　　者：赵清 翟丽君 吴明花 范如丽 Zhao Qing;Zhai Lijun;Wu Minghua;Fan Ruli(Department of Osteoarthropathy Surgery,The First Affiliated Hospital of Naval Medical University,Shanghai 200433,China)

机构地区：[1]海军军医大学第一附属医院骨关节病外科,上海200433 [2]海军军医大学第一附属医院血液内科,上海200433 [3]海军军医大学第一附属医院全科医学科,上海200433

出　　处：《海军医学杂志》2025年第1期57-62,共6页Journal of Navy Medicine

摘　　要：目的 探究肝素钠对腰椎手术患者术后早期恢复质量的影响,以及影响患者术后发生下肢深静脉血栓(DVT)的危险因素,基于危险因素构建腰椎手术患者术后DVT的预测模型。方法 选取2020年1月至2023年1月276例在海军军医大学第一附属医院行腰椎手术治疗的患者为研究对象,均行肝素钠治疗。比较治疗前后活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)以及术前及术后腰椎功能指标。术后住院期间对患者行超声检查,观察双下肢是否发生DVT,根据此结果分为DVT组和非DVT组。收集所有受试者临床资料、实验室指标等,腰椎手术患者发生DVT的危险因素分析采用logistic回归分析法。基于logistic回归分析构建患者术后DVT风险预测模型,并对构建的预测模型进行验证和预测效能评估。结果 术后患者APTT、PT长于术前(P<0.05)。术后3个月Oswestry功能障碍指数(ODI)评分低于术前(t=30.661,P<0.05)。276例患者中有41例发生术后DVT,DVT发生率为14.86%(41/276)。DVT组术中输血、卧床时间≥5 d、全身麻醉占比,以及术中出血量、体重指数(BMI)、D-二聚体水平高于非DVT组(P<0.05)。Logistic回归分析结果显示术中出血量、BMI、D-二聚体水平异常及术中输血、卧床时间≥5 d均是影响腰椎手术患者发生DVT的危险因素(P<0.05)。logi(tP)=9.762+1.425×术中出血量+1.212×BMI+0.856×术中输血+1.105×卧床时间+1.671×D-二聚体。Hosmer-Lemeshow拟合优度检验结果显示,该模型具有较高的拟合优度(χ^(2)=4.025,P=0.473)。构建的预测模型预测腰椎手术患者术后发生DVT的灵敏度、特异度、AUC分别为91.80%、70.40%、0.836(95%CI:0.698~0.948)。结论 肝素钠可改善腰椎手术患者血液循环和腰椎功能,延长凝血时间。术中出血量、BMI、D-二聚体水平异常、术中输血、卧床时间≥5 d均是影响腰椎手术患者发生DVT的危险因素,基于上述危险因素构建的预测模型对患�Objective To explore the influence of heparin sodium on early recovery after lumbar surgery and the risk factors of deep vein thrombosis(DVT)of lower extremities,and build a prediction model for DVT after lumbar surgery based on the risk factors.Methods A total of 276 patients who underwent lumbar surgery and were treated with heparin sodium in The First Affiliated Hospital of Naval Medical University from January 2020 to January 2023 were selected as research objects.Activated partial thromboplastin time(APTT),prothrombin time(PT)and functional indexes of lumbar spine were recorded before and after treatment.DVT of lower extremities was detected by ultrasound during postoperative hospitalization,and then the patients were divided into DVT group and non-DVT group.The clinical data and laboratory indicators of all patients were collected.The risk factors of DVT after lumbar surgery were analyzed by logistic regression analysis.A postoperative DVT risk prediction model based on Logistic regression analysis was constructed and validated.Results APTT and PT after operation were higher than those before operation(P<0.05).The score of Oswestry Disability Index(ODI)3 months after surgery was lower than that before surgery(t=30.661,P<0.05).The incidence of DVT was 14.86%(41/276).Blood transfusion,bed rest≥5 d,proportion of general anesthesia,intraoperative blood loss,body mass index(BMI)and D-dimer level in the DVT group were higher than those in the non-DVT group(P<0.05).Logistic regression analysis showed that intraoperative blood loss,BMI,abnormal D-dimer level,intraoperative blood transfusion,and bed rest≥5 d were all risk factors for DVT after lumbar surgery(P<0.05).logit(P)=9.762+1.425×intraoperative blood loss+1.212×BMI+0.856×intraoperative blood transfusion+1.105×bed rest+1.671×D-dimer.Hosmer-Lemeshow test showed that the model had a high goodness of fit(χ^(2)=4.025,P=0.473).The sensitivity,specificity and area under curve(AUC)of the constructed prediction model for postoperative DVT were 91.80%,70.40%a

关 键 词：肝素钠 腰椎手术 下肢深静脉血栓 预测模型 

分 类 号：R619[医药卫生—外科学]