全髋关节置换术后深静脉血栓形成的危险因素分析

目的 提高对全髋关节置换术后下肢深静脉血栓(DVT)形成临床特点的认识,并探讨其易发生的危险因素.方法 2000年1月至2012年6月间对在苏州吴中人民医院骨科行人工全髋关节置换治疗并有完整资料的145例患者行DVT形成相关风险因素分析,其中男性51例,女性94例,年龄23～83岁,平均(59.8±13.0)岁.所有患者均在术前、术后第7天分别行双下肢彩色多普勒超声检查,明确是否有下肢深静脉血栓形成.详细调查和记录患者的年龄、性别、体重指数(BMI)、血型、是否吸烟、是否饮酒、麻醉类型、术中出血量、输血量、是否使用骨水泥、手术人路、单侧或双侧置换、术后镇痛方式、术前诊断以及有无合并糖尿病、高血压病等,同时记录发生DVT的部位、类型以及有无深静脉血栓形成的临床症状.按BMI分为正常组(BMI≤25kg/m2)和肥胖组(BMI＞ 25 kg/m2).将DVT发生与否作为因变量,把以上可疑因素作为自变量,先进行单因素分析,得出有显著差异性的因素,再进行多因素非条件logistic分析,筛选出DVT发生的主要影响因素.结果 (1)本组病例共发生DVT 45例,发生率31％.单纯近端DVT为7例(15.6％),远端DVT 33例(73.3％),全静脉DVT 5例(11.1％),均未发生肺栓塞(PTF).无DVT临床症状的25例(55.5％),有DVT临床症状的20例(44.5％)； (2)临床因素与术后DVT形成的关系:单因素x 2检验显示:高龄、女性、双侧关节同时置换、全身麻醉、使用骨水泥等与DVT形成显著相关(P＜0.05)；将临床各因素进行Logistic多变量回归分析,最终进入Logistic回归模型的相关因素有4个,其中危险因素3个,分别是性别,肥胖及骨水泥的使用,其术后发生DVT的风险倍数分别增加到10.012,3.086,8.834;保护因素1个,为术前患者血型是O型,术后发生DVT的可能性减少到0.191倍.结论 全髋关节置换患者术后发生DVT常存在危险因素,最常见的危险因素有高龄、女性、双侧关节同时置换、全身麻醉、使用骨水泥等.认识DVT的各种危险因素及临床征象,及早给予相应的辅助检查及术前预防性的治疗,是防止PTE的发生和降低DVT的发生率的关键.

Clinical Risk Factors of Deep Venous Thrombosis after Total Hip Replacement

Objective To improve the cognition in clinical characteristics of deep venous thrombosis(DVT)after total hip replacement,and explore the related risk factors.Methods A prospective analysis of clinical cases in 145 patients(including 51 male and 94 femal patients)of hip replacement treated in our hospital from January 2010 to February 2012 was conducted to analyze the risk factors related to the formation of DVT.All patients were given color Doppler echocardiography examination to find the formation of DVT before and 7 days after total hip replacement.We recorded the age,gender,BMI,blood type,smoking or not,drinking or not,aneasthesia methods,bleeding volume during operation,transfusion volume,using bone cement or not,operative approach,unilateral or bilateral hip replacement,postoperative analgesia methods,preoperative diagnosis,complications such as diabetes or hypertension,and also recorded the location,type and clinical symptoms of DVT.According to BMI,patients were divided into two groups: normal group(BMI≤25 kg/m2)and obesity group(BMI>25 kg/m2).The incidence of DVT was used as the dependent variable,and the suspected risk factors were used as independent variables,the single factor correlation analysis was conducted to find out the significantly related factors.Then multiple factor logistic correlation analysis was conducted to find out the major risk factors of DVT.The statistical analysis was carried out using SPSS 11.0.We used a threshold of P<0.05 for statistical significance.Results(1)Of the 145 cases,45 cases were diagnosed as DVT(31.1%).The incidence of proximal DVT was 15.6%(7 cases)and distal DVT 73.3%(33 cases),total DVT 11.1%(5 cases).There were more asymptomatic DVT(55.5%,25/45)than symptomatic ones(44.5%),and no case of PTE was found.25 patients(55.5%) with DVT had no clinical symptoms and 20 patients(44.5%)had clinical symptoms of DVT.(2)The correlation between clinical factors and the formation of DVT after operation: Single factor χ2 test showed that advanced age,femal,bilateral hip replacement,general aneasthesia and using bone cement were significantly correlated with the formation of DVT(P < 0.05).Multiple factor Logistic regression analysis demonstrated a definite association of rsik factors including female,obesity(representative by BMI),and bone cement usage with DVT with odds ratio of 10.012,(3)086 and 8.834.The O blood type was a protective factor,with odds ratio of 0.191.Other clinical factors had no statistically significant association with DVT.Conclusions Most patients with total hip replacement had risk factors of DVT,the most common risk factors were: advanced age,female,bilateral hip replacement,general anaesthesia,bone cement useage,etc.Understanding the risk factors and clinical signs of DVT and taking some precautionary measures is the key point to decrease the incidence of DVT and PTE.