加速康复下肢关节置换深静脉血栓形成的相关因素

Factors associated with deep vein thrombosis in lower extremity joint replacement following accelerated rehabilitation

摘要:

[目的]探讨加速康复下下肢关节置换术后深静脉血栓（deep vein thrombosis, DVT）形成的相关因素。[方法]2021 年 12 月—2022 年 12 月于本院行下肢关节置换的 330 例患者纳入本研究，观察术后 DVT 的发生情况，采用单因素和多因素二元逻辑回归分析探索 DVT 形成的相关因素。[结果]330 例患者中，术后 46 例患者被诊断为下肢深静脉血栓，血栓总体发生率为 13.9%。血栓组患者年龄 [(71.9±7.2) 岁 vs (64.4±14.2) 岁, P＜0.001]、女性占比 [男/女, (7/39) vs (84/200), P=0.046]、脑梗史占比 [是/否, (12/34) vs (32/252), P=0.006] 及病因为 OA 患者占比 [CD/ON/OA/RA/FX, (5/2/35/0/4) vs (42/50/157/10/25), P=0.048]、术前 CRP [(9.3±8.2) mg/L vs (3.5±3.2) mg/L, P＜0.001]、术后第 1 d CRP [(21.4±18.5) mg/L vs (14.7±12.8) mg/L, P=0.004] 显著高于非血栓组，但术中失血量 [(322.2±225.4) ml vs (432.9 298.6) ml, P=0.005] 显著少于非血栓组，术式为 UKA、TKA、AFHR 的患者占比 [UKA/TKA/AFHR/THA, (13/22/2/9) vs (67/82/10/125), P=0.013] 显著高于非血栓组。多因素二元逻辑回归结果显示：饮酒史（OR= 5.041, P=0.046）、术前 CRP（OR=1.173, P=0.031）、年龄（OR=1.078, P＜0.001）是下肢关节置换术后发生 DVT 的独立危险因素。 [结论]在加速康复理念指导下下肢关节置换术后，除外肌间静脉血栓，下肢其余类型深静脉血栓发生率较低。饮酒史、术前 CRP、年龄是下肢关节置换术术后 DVT 发生的独立危险因素。

Abstract:

[Objective] To investigate the related factors for the formation of deep vein thrombosis (DVT) after lower limb joint replacement following accelerated rehabilitation. [Methods] A total of 330 patients who underwent lower limb joint replacement following accelerated rehabilitation in our hospital from December 2021 to December 2022 were included in this study to observe whether postoperative DVT occurred. The univariate comparison and multifactor binary logistic regression analysis was used to explore the factors related to DVT formation. [Results] Among the 330 patients, 46 patients were diagnosed with lower extremity deep vein thrombosis after operation, with the overall incidence of 13.9%. The DVT group proved significantly greater than the non-DVT group in terms of age [(71.9±7.2) years vs (64.4±14.2) years, P＜0.001], the proportion of females [male/female, (7/39) vs (84/200), P=0.046], the proportion of previous cerebral infarction [yes/no, (12/34) vs (32/252), P=0.006] and proportion of disease as OA [CD/ON/OA/RA/FX, (5/2/35/0/4) vs (42/50/157/10/25), P=0.048], preoperative CRP [(9.3±8.2) mg/L vs (3.5±3.2) mg/L, P＜0.001], CRP a day postoperatively [(21.4±18.5) mg/L vs (14.7±12.8) mg/L, P=0.004]. However, the former had significantly less intraoperative blood loss than the latter [(322.2±225.4) ml vs (432.9±298.6) ml, P=0.005]. The DVT group had significantly higher ratio of UKA, TKA, and AFHR than the non-DVT group [UKA/TKA/AFHR/THA, (13/22/2/9) vs (67/82/10/ 125), P=0.013]. As results of multivariate logistic regression, the alcohol consumption history (OR=5.041, P=0.046), preoperative CRP (OR= 1.173, P=0.031), and age (OR=1.078, P＜0.001) were the independent risk factor for DVT after lower limb joint replacement. [Conclusion] After lower limb joint replacement following accelerated rehabilitation, the incidence of other types of deep vein thrombosis of lower limb is low except for intermuscular vein thrombosis. Alcohol consumption history, preoperative CRP and age are independent risk factors for DVT after lower limb joint replacement.