内科重症监护病房中深静脉血栓的发病情况及危险因素分析

摘要

Objective A cross-sectional study was carried out to observe the prevalence.Incidence and risk factors of deep venous thrombosis(DVT)in patients from intensive care unit(ICU).Methods Patients who were admitted to respiratory intensive care unit(RICU)and emergency intensive care unit (EICU)of Beijing Chaoyang Hospital and Bering Anzhen Hospital were screened in our studv.All patients enrolled underwent compression ultrasonography(CUS)witlain 48 h upon their admission to the ICUs.CUS Was re-performed at 10-14 day,or when 1eaving ICU or at the time patients developed signs and symptoms(pain,heat,redmess,edema)of DVT.Risk factors which were presumed assiated with DVT were recorded.The main identified outcome Was the presence of DVT.The secondary outcome Was pulmonary thromboembolism(FrrE).Results DVT was found in 30 patients of 252 patients within 48h (11.90％).One hundred seventy-two patients were perforrned CUS two times or more.26 patients(15.12％)had DVT.D-dimer,history of operation,kidney failure appeared to be independent risk factors for DVT in ICU patients.13 patients were suspected PTE and 3 patients diagnosed as PTE.Conclusion ICU doctors should pay more attention to DVT,which is relatively common in ICU patients.%目的 横断面调查内科重症监护病房(MICU)患者深静脉血栓形成(DVT)的发生及评价相关危险因素.方法 连续选择2006年8月至2007年1月收住北京朝阳医院和安贞医院呼吸ICU、急诊ICU的患者.在入住ICU 48 h内完成双下肢静脉超声,查出入ICU时已合并DVT的患者;出现DVT症状、转出ICU前或入住ICU 10～14 d时完成第二次下肢静脉超声,查出在ICU住院期间发生DVT的患者,采集可能相关的危险因素.观察患者有无肺血栓栓塞症(PTE)相关症状体征,需要时行相关检查. 结果 48 h内DVT阳性率为11.90%(30/252);在ICU期间DVT阳性率为15.12%(26/172).13例疑诊PTE,3例确诊PTE.logistic回归模型分析D-二聚体升高、近期手术史、肾功能衰竭为DVT的独立危险因素. 结论 ICU人群是DVT的高发人群,ICU医生应对静脉血栓栓塞症问题高度关注.