长时间卧床住院患者下肢深静脉血栓形成的相关因素病例对照研究

摘要

Objective To investigate risk factors of lower extremity deep venous thrombosis (DVT) for the inpatients with long stay in bed and to detect preventive measures.Methods Case control studies were performed.The patients (83 cases) from the First Hospital of Qinhuangdao City (June 2007 to June 2009) who have been absolutely in bed rest for more than one week and diagnosed as DVT were enrolled as case group, while those (111 cases) who absolutely in bed rest over one week but not diagnosed as DVT were involved as control group.Related data were collected and the correlation between each factor and DVT was analyzed.Results The gender composition, BMI, hospital stay and absolute bed rest days between the two groups showed no statistically significant difference (P > 0.05).The age of the case group was significantly younger than the control group and the smoking rate of the case group was significantly higher than the control group (P <0.05).The operation history, trauma history and CVD history between the two groups showed statistically significant differences (P < 0.05), while other disease history showed no statistically significant difference between the two groups (P >0.05).The application rate of anti-platelet agents, anti-coagulant drugs and medicines for promoting blood circulation and removing blood stasis in the case group was significantly lower than those of the control group (P < 0.01).The detection rate of hyperfibrinogenemia in the case group was significantly higher than in the control group (P =0.000).The multi-factor logistic regression analysis showed that hyperfibrinogenemia was an independent risk factor for DVT [ OR = 12.700, 95%CI (1.946, 82.894), P =0.008 ], while anti-platelet agents [ OR = 0.031, 95% CI (0.004, 0.247), P = 0.001 ], anti-coagulant drugs [ OR = 0.059, 95% CI (0.005, 0.690), P =0.024 ] and medicines for promoting blood circulation and removing blood stasis [ OR =0.005 , 95% CI (0.001,rn0.046), P = 0.000 ] were protective factors.Conclusion Hyperfibrinogenemia is an independent risk factor for DVT among long bed rest patients, so fibrinolytic treatment should be paid more attention to.Antiplatelet and anticoagulant therapy and medicines for promoting blood circulation and removing blood stasis can reduce the incidence of DVT in hospitalized patients.%目的 探讨长时间卧床住院患者下肢深静脉血栓形成(DVT)的相关因素.方法 采用病例对照研究.选取2007年6月-2009年6月住院绝对卧床时间1周以上确诊为下肢DVT的患者83例作为病例组,同期住院绝对卧床1周以上但未发生下肢DVT的患者111例作为对照组.收集相关临床资料,分析各因素与下肢DVT的关系.结果 两组患者的性别构成、体质指数、住院天数、绝对卧床天数比较,差异均无统计学意义(P＞0.05);但病例组患者的年龄低于对照组、吸烟率高于对照组,差异均有统计学意义(P＜0.05).两组患者的手术史、创伤史、心血管疾病史比较,差异均有统计学意义(P＜0.05);而两组患者的其他疾病史比较,差异均无统计学意义(P＞0.05).病例组患者的抗血小板药物、抗凝药物及活血化瘀药物的使用率低于对照组,差异均有统计学意义(P＜0.01).病例组高纤维蛋白原血症检出率高于对照组,差异有统计学意义(P=0.000).多因素Logistic回归分析结果显示,高纤维蛋白原血症[OR=12.700,95%CI(1.946,82.894),P=0.008]是住院患者下肢DVT的独立危险因素;而抗血小板药物[OR=0.031,95%CI(0.004,0.247),P=0.001]、抗凝药物[OR=0.059,95%CI(0.005,0.690),P=0.024]、活血化瘀药物[OR=0.005,95%CI(0.001,0.046),P=0.000]是其保护因素.结论 高纤维蛋白原血症是住院长时间卧床患者下肢DVT的独立危险因素,长期卧床患者应注意降纤治疗.抗血小板药物、抗凝药物、活血化瘀药物的应用可减少住院患者下肢DVT的发生.