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老年髋部骨折围手术期深静脉血栓形成的危险因素分析
Risk factors of deep vein thrombosis during perioperative time in geriatric patients with hip fractures
投稿时间:2021-12-31  修订日期:2022-04-21
DOI:
中文关键词:  老年  髋部骨折  深静脉血栓  危险因素
英文关键词:Geriatric patients  Hip fracture  Deep vein thrombosis  Risk factors
基金项目:上海市浦东新区卫生系统学科建设项目(PWZy2020-04)
作者单位E-mail
白云鹏 上海市浦东新区人民医院 polity2008@aliyun.com 
邱永敏 上海市浦东新区人民医院  
丁菊红 上海市浦东新区人民医院  
沈燕国 上海市浦东新区人民医院  
王健* 上海市浦东新区人民医院 wjwj0328@163.com 
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中文摘要:
      目的 探讨影响老年髋部骨折患者围手术期下肢深静脉血栓(DVT)形成的相关危险因素。方法 回顾性分析2016年1月至2018年12月上海市浦东新区人民医院收治的363例60岁及以上老年髋部骨折患者的临床资料。其中,男118例,女245例;年龄60 ~ 97岁,平均(73.9±8.6)岁;股骨转子间骨折134例,股骨颈骨折229例;髋关节置换184例,内固定179例。采用多普勒彩超诊断下肢深静脉血栓。采集病例资料包括一般资料(性别、年龄、体重指数(BMI)、既往病史、吸烟史、损伤类型、受伤至手术时间),实验室检查(血浆D-二聚体浓度),手术相关资料(手术时间、术中出血、术中输血、手术方式)。对数据进行统计学分析。结果 363例中56例检测出DVT,总体发病率15.4%。一般资料对比显示年龄≥80岁、BMI≥25 kg/m2、有吸烟史、有心脑血管疾病史、高能量损伤、受伤至手术时间>2 d时DVT发病率较高(P<0.05);D-二聚体≥5 μg/mL时DVT发病率较高(P<0.05);手术相关资料对比显示手术时间>2 h、术中出血>200 mL,术中输血、人工关节置换的患者DVT发病率较高(P<0.05)。多因素Logistic回归分析显示:年龄≥80岁、吸烟史、手术时间>2 h、人工关节置换及D-二聚体≥5 μg/mL是影响老年髋部骨折围手术期DVT形成的独立危险因素。结论 老年髋部骨折围手术期DVT发病率较高,围手术期应根据相关危险因素对患者采取早期积极的预防措施,降低DVT的发生率。
英文摘要:
      Objective To investigate the risk factors associated with deep vein thrombosis in geriatric patients with hip fracture during perioperative period.Methods Retrospectively analyzed the clinical data of 363 elderly patients with hip fracture aged 60 years and over who were treated in Pudong New District People's Hospital from January 2016 to December 2018. There were 118 males and 245 females, ranged from 60 to 97 years old, with an average age of (73.9±8.6) years. There were 134 femoral intertrochanteric fractures and 229 femoral neck fractures, in which 184 were treated by hip replacement and 179 were treated by internal fixation. Color Doppler ultrasound was used to diagnose deep vein thrombosis of lower limbs. Clinical data were collected including general information (gender, age, BMI, comorbidity, smoking history, injury type, and time from injury to surgery), laboratory examination (plasma D-dimer level), and operation-related information (operation time, blood loss, blood transfusion, and surgical method). All data were statistically analyzed.Results DVT was detected in 56 of 363 cases, with an overall incidence of 15.4%. The comparison of general data showed that the incidence of DVT was higher when age≥80 years, BMI≥25 kg/m2, smoking history, history of cardiovascular disease, high energy injury, injury to operation time>2 d (P<0.05). The incidence of DVT was significantly higher when D-dimer≥5 μg/mL (P<0.05). The comparison of operation-related data showed that the incidence of DVT was significantly higher when operation time>2 h, intraoperative blood loss >200 mL, blood transfusion, and artificial joint replacement (P<0.05). Multivariate logistic regression analysis showed that age (≥80 years), smoking history, operation time (>2 h), and artificial joint replacement and D-dimer (≥5 μg/mL) were independent risk factors for DVT after hip fracture surgery in the geriatric patients.Conclusion The incidence of DVT after hip fracture surgery in the geriatric patients is high, and early preventive measures should be taken to reduce the incidence of DVT after surgery according to the risk factors during the perioperative period.
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