老年患者消化道内镜围术期血栓及出血相关危险因素的研究

摘要

Objective To study the risk factors for thromboembolism and bleeding in elderly patients during gastrointestinal endoscopic perioperation.Methods A total of 3458 ≥60 years old patients admitted to our hospital for gastrointestinal endoscopy were included in this study.Their general condition and clinical data (including cardiovascular disease and its risk factors,use of drugs and its advertise events) were retrospectively analyzed.Correlation of age,blood pressure,BMI,medical history,use of drugs,laboratory testing parameters with thromboembolism and bleeding during gastrointestinal endoscopic perioperation was analyzed by multivariate logistic regression analysis.Results Multivariate logistic regression analysis showed that CHD,hypertension and AF were the independent risk factors for thromboembolism and bleeding,past history of major bleeding and AF were the independent risk factors for bleeding,D-dimer and CRP were the independent risk factors for both thromboembolism and bleeding during gastrointestinal endoscopic perioperation (OR=5.58,95％CI:1.81-17.23,P=0.003;OR=3.51,95％CI:1.28-9.62,P=0.015;OR=1.58,95％CI:1.01-5.88,P=0.021;OR=10.15,95％CI:1.37-75.36,P=0.024;OR=3.82,95％CI:1.36-10.72,P=0.011).Conclusion CHD,hypertension and AF are the independent risk factors for thromboembolism,past history of major bleeding and AF are the independent risk factors for bleeding,D-dimer and CRP are the independent risk factors for both thromboembolism and bleeding during gastrointestinal endoscopic perioperation.%目的 探讨老年患者消化道内镜围术期血栓和出血等不良事件的相关危险因素.方法 回顾性分析在解放军总医院住院接受择期消化道内镜检查的年龄≥60岁患者共3458例.记录患者一般临床情况、心血管疾病及危险因素、用药和不良事件等临床资料.应用多因素回归分析评价患者年龄、血压、体质量指数、临床病史、用药、实验室检查指标与消化道内镜围术期血栓栓塞及出血事件的相关性.结果 冠心病(OR=5.58,95％CI:1.81～17.23,P=0.003)、高血压(OR=3.51,95％CI:1.28～9.62,P=0.015)和心房颤动(OR=1.58,95％CI:1.01～5.88,P=0.021)是消化道内镜围术期血栓栓塞事件的危险因素.既往大出血病史(OR=10.15,95％CI:1.37～75.36,P=0.024)和心房颤动(OR=3.82,95％CI:1.36～10.72,P=0.011)是消化道内镜围术期出血事件的危险因素.D-二聚体和C反应蛋白既是消化道内镜围术期血栓栓塞事件独立危险因素,同时也是出血事件的独立危险因素.结论 冠心病、高血压和心房颤动均是老年人群消化道内镜围术期发生血栓栓塞事件的独立危险因素,既往大出血病史为消化道内镜围术期发生出血事件的强的独立危险因素.D-二聚体和C反应蛋白既是消化道内镜围术期血栓栓塞事件的独立危险因素,同时也是出血事件的独立危险因素.