ICU机械通气患者下肢深静脉血栓发生现状及危险因素分析  

Analysis of the current status and risk factors of lower extremity deep vein thrombosis in ICU patients with mechanical ventilation

作　　者：张晶晶 李泽晨 张卫红 楚鹏杰 陈聪 ZHANG Jing-jing;LI Ze-chen;ZHANG Wei-hong;CHU Peng-jie;CHEN Cong

机构地区：[1]华北理工大学,河北唐山063000 [2]河北北方学院,河北张家口075000 [3]华北理工大学附属医院,河北唐山063000

出　　处：《中国疗养医学》2025年第4期99-103,共5页Chinese Journal of Convalescent Medicine

摘　　要：目的 调查ICU机械通气患者下肢深静脉血栓(LEDVT)发生现状,并分析危险因素。方法 采用便利抽样法抽取2023年8月至2024年2月在华北理工大学附属医院综合ICU接受机械通气的患者350例作为研究对象,自行设计ICU机械通气患者LEDVT风险因素量表进行调查,采用单因素分析、Logistic回归分析筛选ICU机械通气患者LEDVT发生风险的危险因素。结果 ICU机械通气患者LEDVT发生率为22%。单因素分析结果显示,年龄≥70岁、中心静脉置管史、输血、使用镇静药、机械通气时间≥3 d、加用呼气终末正压(PEEP)、D-二聚体≥450μg/L、血浆纤维蛋白原、行床旁血滤治疗与ICU机械通气患者LEDVT形成有关,差异有统计学意义(P<0.05)。多因素结果显示,年龄≥70岁(OR=2.619,95%CI为1.372,5.001,P=0.004)、机械通气时间≥3 d(OR=11.255,95%CI为3.206,39.514,P<0.001)、加用PEEP(OR=3.227,95%CI为1.488,7.001,P=0.010)、D-二聚体≥450μg/L(OR=2.925,95%CI为1.299,6.589,P=0.01)、血浆纤维蛋白原(OR=2.676,95%CI为1.347,5.315,P=0.005)、输血史(OR=1.960,95%CI为1.056,3.639,P=0.033)是ICU机械通气患者LEDVT的独立危险因素。结论 对于入住ICU行机械通气的患者应进行早期LEDVT的筛查,年龄≥70岁、机械通气时间≥3 d、加用PEEP、D-二聚体≥450μg/L、输血、血浆纤维蛋白原是ICU机械通气患者筛查LEDVT的重点人群。Objective To investigate the current situation of lower extremity deep vein thrombosis(LEDVT)in patients with mechanical ventilation in the intensive care unit(ICU),and to analyze the risk factors.Methods A total of 350 patients who received mechanical ventilation in the general ICU of the Affiliated Hospital of North China University of Science and Technology from August 2023 to February 2024 were selected by convenience sampling method.A self-designed scale for assessing risk factors of LEDVT in ICU patients with mechanical ventilation was used to survey participants.The univariate analysis and Logistic regression analysis were used to screen the risk factors for LEDVT in ICU patients with mechanical ventilation.Results The incidence of LEDVT in ICU patients with mechanical ventilation was 22%.Univariate analysis showed that age≥70 years,history of central venous catheterization,blood transfusion,use of sedatives,duration of mechanical ventilation≥3 days,addition of positive end-expiratory pressure(PEEP),D-dimer≥450μg/L,plasma fibrinogen,and bedside hemofiltration were significantly associated with LEDVT in ICU patients with mechanical ventilation(P<0.05).The results of multivariate results showed that the age≥70 years(OR=2.619,95%CI:1.372,5.001,P=0.004),the duration of mechanical ventilation≥3 days(OR=11.255,95%CI:3.206,39.514,P<0.001),the addition of PEEP(OR=3.227,95%CI:1.488,7.001,P=0.010),and D-dimer≥450µg/L(OR=2.925,95%CI:1.299,6.589,P=0.01),plasma fibrinogen(OR=2.676,95%CI:1.347,5.315,P=0.005),and blood transfusion history(OR=1.960,95%CI:1.056,3.639,P=0.033)were independent risk factors for LEDVT in ICU patients with mechanical ventilation.Conclusion Early screening for LEDVT should be carried out for ICU patients with mechanical ventilation.Age≥70 years,mechanical ventilation time≥3 days,addition of PEEP,D-dimer≥450μg/L,blood transfusion,and plasma fibrinogen are the key groups for screening of LEDVT in ICU patients with mechanical ventilation.

关 键 词：ICU机械通气 插管 危重症患者 深静脉血栓 危险因素 

分 类 号：R543.6[医药卫生—心血管疾病]