Risk Factors of Deep Vein Thrombosis after Soft Tissue Trauma of Lower Extremities
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摘要:
目的 回顾性分析下肢软组织创伤患者并发深静脉血栓(DVT)的易患风险因素,为防治DVT提供参考。 方法 收集 2020年1月至2021年12月间单中心收治的下肢软组织创伤患者的一般临床资料、创伤情况、实验室检查资料、影像学检查资料、临床管理情况、并发症等因素进行统计分析,分析下肢软组织创伤并发DVT的易患风险因素。 结果 363例下肢软组织创伤患者中DVT发生率为8.8%,DVT累及髂静脉1例,股静脉1例,腘静脉3例,胫后静脉3例,腓静脉3例,肌间静脉31例。DVT组和非DVT组患者在年龄、性别、吸烟、饮酒、心脏病、创伤类型、创伤严重程度、血红蛋白、纤维蛋白降解产物(FDP)、D-二聚体、入院等待时间、未预防性抗凝、创伤后局部感染、软组织缺损方面差异有统计学意义(P < 0.05)。经多因素logistics回归分析后显示年龄、吸烟、创伤后局部感染、入院等待时间、未预防性抗凝、创伤严重程度、D-二聚体升高(> 0.5 μg/mL)是下肢软组织创伤后并发DVT的独立危险因素(P < 0.05)。 结论 下肢软组织创伤并发DVT主要累及下肢肌间静脉,年龄、吸烟史、创伤后局部感染、入院等待时间、未预防性抗凝、创伤严重程度、D-二聚体升高(> 0.5 μg/mL)与DVT的发生密切相关。 Abstract:Objective To retrospectively analyze the risk factors of deep vein thrombosis (DVT) in patients with soft tissue trauma of the lower extremities, and to provide reference for the prevention and treatment of DVT. Methods The general clinical data, trauma status, laboratory tests data, imaging data, clinical management information, complications, and other factors of patients with lower limb soft tissue trauma admitted to a single center from January 2020 to December 2021 were collected and statistically analyzed. The risk factors of lower limb soft tissue trauma complicated with DVT were analyzed. Results The incidence of deep vein thrombosis (DVT) in 363 patients with lower limb soft tissue trauma was 8.8%. DVT involved the iliac vein in 1 case, the femoral vein in 1 case, the popliteal vein in 3 cases, the posterior tibial vein in 3 cases, the peroneal vein in 3 cases, and the muscular veins in 31 cases. There were significant differences between the DVT group and the non-DVT group in terms of age, gender, smoking, alcohol consumption, heart disease, type and severity of trauma, hemoglobin, fibrin degradation products (FDP), D-dimer, waiting time for admission, lack of prophylactic anticoagulation, post-traumatic local infection, and soft tissue defects (P < 0.05). Multivariate logistic regression analysis showed that age, smoking, post-traumatic local infection, waiting time for admission, lack of prophylactic anticoagulation, severity of trauma, and elevated D-dimer ( > 0.5 μg/mL) were independent risk factors for DVT after lower limb soft tissue trauma (P < 0.05). Conclusion DVT following soft tissue trauma of the lower limb mainly involves the intermuscular veins. Age, smoking history, local infection after trauma, waiting time for admission, unprotected anticoagulation, severity of trauma, and elevated D-dimer ( > 0.5 μg/mL) is closely related to the occurrence of DVT. -
Key words:
- Lower limb soft tissue trauma /
- Deep vein thrombosis /
- Risk factors
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表 1 一般临床资料比较(n = 363)[n(%)]
Table 1. Comparison of general clinical data (n = 363)[n(%)]
项目 n 血栓 χ2/Z/f P 年龄 18~44岁 171 5(8.77) 28.354
< 0.001*45~59岁 134 12(8.96) ≥60岁 58 15(25.86) 性别 男 239 13(5.44) 9.921 0.002* 女 124 19(15.32) 体重指数(kg/m2) < 18.5 28 2(7.14) −0.908 0.364 18.5~23.9 164 17(10.37) 24~27.9 131 12(9.16) ≥28 40 1(2.50) 个人史 吸烟 242 28(11.57) 5.865 0.015* 饮酒 149 6(4.03) 7.210 0.007* 慢性疾病 高血压 39 7(17.95) 3.351 0.064 糖尿病 7 2(28.57) 1.413 0.120 高血脂 4 1(25.00) — 0.310 心脏病 5 3(60.00) — 0.006* 恶性肿瘤 2 0(0) — 1.000 痛风 8 1(12.50) 0.000 0.526 *P < 0.05。 表 2 创伤情况的比较(n = 363)[n(%)]
Table 2. Comparison of trauma conditions (n = 363)[n(%)]
创伤情况 n 血栓 χ2/Z/f P 创伤因素 摔(跌)伤 85 12(14.12) — 0.181 锐器伤 47 3(6.38) 交通伤 71 7(9.86) 机器伤 55 1(1.82) 重物砸伤 14 2(14.29) 扭伤 42 2(4.76) 异物刺伤 17 1(5.88) 其它 32 4(12.5) 创伤类型 开放性 201 14(6.97) 1.918 0.016* 闭合性 162 18(11.11) 创伤部位 臀部 7 0(0) — 0.536 股部 39 5(12.82) 膝关节 120 12(10) 小腿 78 9(11.54) 足踝 74 4(5.41) 下肢多处创伤 45 2(4.44) 创伤肢体 左侧 175 20(11.43) 3.152 0.207 右侧 161 11(6.83) 双侧 27 1(3.70) 创伤组织 肌肉/肌腱 150 8(5.33) 3.856 0.050 关节韧带 113 11(9.73) 0.172 0.678 血管/神经 67 5(7.46) 0.187 0.665 皮肤组织 202 15(7.43) 1.094 0.296 AIS损伤分度(6度) 轻度 129 5(3.88) −4.148
< 0.001*中度 130 7(5.38) 重度(不危及生命) 91 15(78.95) 重度(危及生命) 13 5(38.46) 危重(可成活) 0 0(0) 无法救治 0 0(0) *P < 0.05。 表 3 临床管理情况的比较(n = 363)[n(%)]
Table 3. Comparison of clinical management (n = 363)[n(%)]
相关因素 n 血栓 χ2 P 未预防性抗凝 273 31(11.36) 7.608 0.006* 入院等待时间 ≥3 d 134 18(13.43) 5.634 0.018* < 3 d 229 14(6.11) 脱水剂应用 179 13(7.26) 1.059 0.303 患肢制动 157 13(8.28) 0.099 0.754 *P < 0.05。 表 4 局部损害因素比较(n = 363)[n(%)]
Table 4. Comparison of local damage(n = 363)[n(%)]
并发症因素 n 血栓 χ2 P 软组织缺损 24 6(25.00) 8.374 0.004* 创伤后局部感染 67 12(17.91) 8.455 0.004* *P < 0.05。 表 5 部分实验室检查指标因素比较(n = 363)
Table 5. Comparison of laboratory tests (n = 363)
检查项目 DVT 非DVT t/Z P 血红蛋白(g/L) 128(115,139) 144(130,155) −3.878 < 0.001* 血小板(×109/L) 226.43±81.04 218.35±57.99 −0.551 0.585 血浆D-二聚体测定 (μg/mL) 1.39(0.65,2.51) 0.60(0.37,0.87) −4.537 < 0.001* 纤维蛋白降解产物(μg/mL) 4.53(2.19,14.57) 1.81(1.13,4.53) −4.762 < 0.001* C-反应蛋白(mg/L) 5.36(1.71,22.04) 3.50(1.00,10.00) −1.960 0.050 *P < 0.05。 表 6 Logistic多因素回归分析
Table 6. Logistic multivariate regression analysis
独立危险因素 β S.E. Wald P EXP(B) 95%CI 年龄 0.084 0.021 15.649 0.000 1.088 1.043-1.134 入院等待时间 0.656 0.319 4.212 0.040 1.926 1.030-3.603 创伤后局部感染 2.313 0.718 10.371 0.001 10.109 2.473-41.322 未预防性抗凝 2.714 0.678 16.048 0.000 15.092 4.000-56.944 D-二聚体 0.846 0.277 9.311 0.002 2.330 1.353-4.012 吸烟 −2.226 0.776 8.230 0.004 0.108 0.024-0.494 创伤严重程度 1.338 0.374 12.787 0.000 3.812 1.831-7.936 -
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