创伤骨折患者术中导致DVT风险增高的危险因素分析

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摘要目的探讨在手术过程中创伤骨折患者深静脉血栓风险增高的危险因素。方法观察记录2018年4月至2019年5月进入中国人民解放军联勤保障部队第940医院麻醉手术室实施手术的创伤骨折患者106例，其中男68例，女38例；年龄18～83岁，平均(43.11±17.97)岁。对深静脉血栓高风险组与低风险组患者的性别、年龄、吸烟史、慢性疾病、骨折部位、术前红细胞计数、血小板计数、胆固醇、甘油三脂、高密度脂蛋白、低密度脂蛋白，术中麻醉方式、手术时间、输入红细胞量、输入血浆量、血液回收量、止血带使用时间、止血带压力、手术体位、内植物类型、出血量、补液量、抗生素使用、手术切口类型，先采用单因素分析，再将单因素分析结果中P＜0.05的指标纳入多因素Logistic回归模型进行分析。结果单因素分析显示：骨折部位、术前红细胞计数、术中麻醉方式、出血量、补液量的差异具有统计学意义(P＜0.05)；多因素分析显示：患者下肢骨折(P＝0.044，OR=6.552，95% CI为1.051～40.857)、术前红细胞计数偏高(P＝0.006，OR=14.259，95% CI为2.118～96.018)、椎管内麻醉(P＝0.010，OR=7.292，95% CI为1.612～32.989)、全身麻醉(P＝0.006，OR=8.034，95% CI为1.799～35.875)进入回归模型。结论创伤骨折患者下肢骨折、术前红细胞计数偏高、术中采取椎管内麻醉或全身麻醉是导致深静脉血栓风险增高的危险因素。

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	王亚馨 1
	肖亚娟 2
	李雪 1
	许磊 1*

关键词 ：创伤骨折患者, 麻醉手术室, 深静脉血栓, 危险因素

Abstract：Objective To explore the risk factors for increased risk of deep venous thrombosis in patients with traumatic orthopedic fracture during operation.Methods We observed and record the case data of sex，age，smoking history，chronic disease，fracture site，preoperative red blood cell count，preoperative platelet count，preoperative cholesterol，preoperative triglyceride，preoperative high density lipoprotein，preoperative low density lipoprotein，intraoperative anesthesia，operation time，input red blood cell volume，input plasma volume，blood recovery volume，tourniquet use time，tourniquet pressure，surgical posture，implantation type，bleeding volume，the quantity of rehydration，the use of antibiotics and the type of surgical incision in traumatic fractures who entered the anesthesia and operating room of 940th Hospital of PLA from April 2018 to May 2019.The data were analyzed by single factor analysis and those whose P＜0.05 in the single factor analysis would be evaluated by multivariate logistic regression analysis.Results single factor analysis showed that preoperative red blood cell count，fracture site，intraoperative anesthesia，bleeding volume，the quantity of rehydration statistically significant (P＜0.05).Multivariate logistic regression analysis showed that fracture of lower limb (P＝0.044，OR=6.552，95% CI：1.051～40.857)，red blood cell count is on the high side (P＝0.006，OR=14.259，95% CI：2.118～96.018)，intravertebral anesthesia (P＝0.010，OR=7.292，95% CI：1.612～32.989)，general anesthesia (P＝0.006，OR=8.034，95% CI：1.799～35.875) were the main independent risk factor leading to increased risk of DVT.Conclusion In patients with traumatic orthopedic fracture，the red blood cell count is on the high side before operation，intravertebral anesthesia or general anesthesia are the risk factor of increased risk of deep venous thrombosis.

Key words： traumatic fracture patients anesthesia and operating room deep venous thrombosis risk factor

通讯作者: 许磊

作者简介: 王亚馨(1991－ )，女，护师，中国人民解放军联勤保障部队第940医院麻醉手术室，730000。

引用本文:

王亚馨 1，肖亚娟 2，李雪 1，许磊 1*. 创伤骨折患者术中导致DVT风险增高的危险因素分析[J]. 实用骨科杂志, 2020, 26(3): 219-222.
Wang Yaxin 1，Xiao Yajuan 2，Li Xue 1，et al. Analysis the Risk Factors for Increased Risk of Deep Venous Thrombosis Risk Increase in Traumatic Fracture Patients During Operation. sygkzz, 2020, 26(3): 219-222.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2020/V26/I3/219

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