上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2019, Vol. 39 ›› Issue (3): 278-.doi: 10.3969/j.issn.1674-8115.2019.03.010

• 论著·临床研究 • 上一篇    下一篇

多发伤患者急性下肢深静脉血栓形成的危险因素分析

傅一牧 1，荆尧 2，李冬冬 1，封启明 1，田恒力 2   

  1. 1. 上海交通大学附属第六人民医院急诊科，上海 200233；2. 上海交通大学附属第六人民医院神经外科，上海 200233
  • 出版日期:2019-03-28 发布日期:2019-04-28
  • 通讯作者: 田恒力，电子信箱：tianhlsh@126.com。
  • 作者简介:傅一牧（1986—），男，主治医师，硕士生；电子信箱： fym2205@163.com。
  • 基金资助:
    国家自然科学基金（81471245，81671207）

Risk factors analysis for acute lower deep venous thrombosis in multiple injury patients

FU Yi-mu1, JING Yao2, LI Dong-dong1, FENG Qi-ming1, TIAN Heng-li2   

  1. 1. Department of Emergency Medicine, The Sixth People′s Hospital, Shanghai Jiao Tong University, Shanghai 200233, China; 2. Department of Neurosurgery, The Sixth People′s Hospital, Shanghai Jiao Tong University, Shanghai 200233, China
  • Online:2019-03-28 Published:2019-04-28
  • Supported by:
    National Nature Science Foundation of China, 81471245, 81671207

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摘要： 目的 ·研究多发伤患者急性下肢深静脉血栓（ acute lower deep venous thrombosis，ALDVT）的发生率并对影响其形成的危险因素进行分析。方法 ·选取 2017年 1月—6月上海交通大学附属第六人民医院急诊创伤中心的 175例多发伤患者为研究对象，收集其临床资料。依据超声检查结果将其分为 ALDVT组和无 ALDVT组，并计算 ALDVT的发生率。采用单因素分析和多因素 Logistic回归分析对可能影响患者 ALDVT发生的人口学特征、生命体征及血液学指标进行相关性探究。结果 ·在 175例多发伤患者中，56例（32%）患者出现 ALDVT。单因素分析显示， 2组中高创伤严重程度评分（ injury severity score，ISS）（ ≥25分）、高血糖 ( ≥ 10 mmol/L）、合并上肢骨折、合并下肢骨折、合并脊柱损伤、合并骨盆骨折以及合并胸腹部损伤的多发伤患者数量间差异均具有统计学意义（均 P<0.05）；在凝血指标中，与无 ALDVT组相比， ALDVT组患者的 D-二聚体和纤维蛋白（原）降解产物的水平均有所增加，且差异具有统计学意义（均 P0.001）。多因素 Logistic回归分析显示，血糖水平≥ 10 mmol/L（P0.009）、ISS ≥ 25分（P0.024）、合并脊柱损伤（ P0.048）和合并骨盆骨折（ P0.029）均是 ALDVT的独立危险因素。结论 ·多发伤患者 ALDVT的发生率较高。血糖水平、ISS、多发伤合并脊柱损伤和多发伤合并骨盆骨折均对 ALDVT的诊断具有重要预测意义。

关键词: 多发伤, 急性下肢深静脉血栓, 危险因素

Abstract:

Objective · To explore the incidence and analyze the risk factors of acute lower deep venous thrombosis (ALDVT) in multiple injury patients. Methods · A total of 175 multiple injury patients in trauma emergency center of The Sixth People′s Hospital, Shanghai Jiao Tong University, Jan. to Jun. in 2017 were chosen, and their clinical data were collected. The ALDVT group and the non-ALDVT group were differentiated according to the results of ultrasound, and the incidence of ALDVT was calculated. Univariate analysis and multivariate Logistic regression analysis were used to investigate the correlations between the occurrance of ALDVT and the factors, including demographic characteristics, vital signs and hematological parameters. Results · Fifty-six patients (32%) developed ALDVT in 175 multiple injury patients. Univariate analysis showed that there were statistically significant differences in the numbers of multiple injury patients with upper limb fracture, lower limb fracture, spinal injury, pelvic fracture, chest and abdomen injury, higher injury severity score (ISS) (≥ 25 scores), or higher glucose ( ≥ 10 mmol/L) between two groups (all P<0.05). In the coagulation parameters, compared with the non-ALDVT group, the levels of D-dimer and fibrinogen degradation products in the ALDVT group were significantly elevated (both P0.001). Multivariate Logistic regression analysis showed that the level of glucose ( ≥ 10 mmol/L) (P0.009), ISS ( ≥ 25 scores) (P0.024), multiple injury with spinal injury (P0.048), and multiple injury with pelvic fracture (P0.029) were the independent risk factors of the ALDVT patients. Conclusion · There is a high occurrence of ALDVT in multiple injury patients. The level of glucose, ISS, multiple injury with spinal injury, and multiple injury with pelvic fracture have important predictive significance for the diagnosis of ALDVT.

Key words: multiple injury, acute lower deep venous thrombosis (ALDVT), risk factor

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