机器人辅助骨科手术后深静脉血栓形成的影响因素及风险预警管理研究  

Influencing factors and risk warning management on DVT formation after robot-assisted orthopedic surgery

作　　者：张玮楠 田奡 彭亚静 贾利利 ZHANG Weinan;TIAN Ao;PENG Yajing;JIA Lili(Department of Anesthesia,Beijing Jishuitan Hospital of Capital Medical University,Beijing 100035,China)

机构地区：[1]首都医科大学附属北京积水潭医院麻醉科,北京100035

出　　处：《机器人外科学杂志(中英文)》2025年第2期229-234,共6页Chinese Journal of Robotic Surgery

基　　金：北京市科委首都临床特色应用研究项目(Z171100001017135)。

摘　　要：目的:分析骨盆骨折患者行天玑?骨科机器人辅助手术后深静脉血栓(DVT)形成影响因素,并探讨其风险预警管理策略。方法:对2023年1月-2023年12月首都医科大学附属北京积水潭医院拟行天玑骨科机器人辅助手术的130例骨盆骨折患者进行研究。根据患者术后2个月内是否出现DVT分为发生组(17例)和未发生组(113例)。比较两组患者相关指标差异,并行Logistic回归单因素和多因素分析,筛选术后DVT形成影响因素,构建相关指标风险预警模型,分析模型对患者术后DVT形成的预测价值,提出针对性管理策略。结果:与未发生组相比,发生组患者手术时间更长,全身麻醉、术前卧床时间≥3 d的比例更高,术前抗凝预防比例更低(P<0.05)。多因素Logistic回归分析提示全身麻醉、术前卧床时间过长、手术时间过长会增加患者术后DVT发生风险(P<0.05)。建立术后DVT形成风险预警列线图模型,该模型评估手术后DVT形成ROC曲线下面积为0.934,特异度为0.867,敏感度为0.941,Cut-off值为0.137,(P<0.05)。经内部验证分析发现,该模型有良好稳定性与正向净收益率。结论:全身麻醉、术前卧床时间过长、手术时间过长会增加骨盆骨折患者行天玑骨科机器人辅助手术后DVT发生风险,构建基于上述因素的风险预警模型预测效能较好,可供临床参考。Objective:To analyze the influencing factors of deep vein thrombosis(DVT)formation in pelvic fracture patients who underwent TiRobot-assisted surgery and explore the risk warning management strategies.Methods:130 pelvic fracture patients who underwent TiRobot-assisted surgery in Beijing Jishuitan Hospital of Capital Medical University from January 2023 to December 2023 were selected and divided into the occurrence group(n=17)and the non-occurrence group(n=113)according to whether the patients had DVT within 2 months after surgery.The difference of relevant indicators between the two groups of patients were compared,univariate and multivariate logistic regression analyses were performed to screen the influencing factors of postoperative DVT formation,then the risk prediction model was conducted to analyze the predictive value of the model for postoperative DVT,and targeted management strategies were proposed.Results:Compared with the non-occurrence group,the occurrence group had a longer operative time,higher proportion of general anesthesia and preoperative bed time≥3 d,and a lower proportion of preoperative anticoagulation prevention(P<0.05).Multivariate logistic regression analysis indicated that general anesthesia,long preoperative bed time,and long operative time would increase the risk of postoperative DVT(P<0.05).A postoperative DVT formation risk prediction nomogram model was established,and the area under the ROC curve for postoperative DVT formation was assessed as 0.934,with the specificity of 0.867,sensitivity of 0.941,and cut-off value of 0.137(P<0.05).The internal validation analysis revealed that the model had good stability and a positive net return.Conclusion:General anesthesia,long preoperative bed time,and long operative time could increase the risk of DVT in pelvic fracture patients after TiRobot-assisted surgery.The risk warning model based on the above factors has good evaluation efficacy and can be used for clinical reference.

关 键 词：骨盆骨折 深静脉血栓 机器人辅助手术 护理干预 

分 类 号：R687.3[医药卫生—骨科学]