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摘要: 目的 探讨影响泌尿外科手术患者术后下肢深静脉血栓(DVT)发生的危险因素。方法 回顾性分析2019年3月—2021年5月山西白求恩医院收治的1025例泌尿外科手术患者的临床资料，其中男765例，女260例；年龄18~94岁，平均(56.3±15.8)岁。收集患者信息包括年龄、性别、体重指数(BMI)、既往病史(高血压、糖尿病、脑梗死、冠心病)、手术体位、麻醉方式、手术出血量、麻醉时间、Caprini风险评估模型(RAM)、D-二聚体(术前及术后第1天)、病理诊断(良、恶性)，采用单因素和多因素回归分析泌尿外科手术患者术后DVT的危险因素。结果 1025例患者中，有55例(5.4%)患者发生了DVT。单因素分析结果显示，年龄(P< 0.001)、BMI(P=0.021)、麻醉方式(P=0.026)、手术体位(P=0.042)、恶性肿瘤(P< 0.001)、吸烟史(P< 0.001)、术前D-二聚体(P=0.002)、术后第1天D-二聚体(P< 0.001)、Caprini RAM(P< 0.001)、出血量(P< 0.015)、麻醉时间(P< 0.001)、术后住院时间(P< 0.001)，与泌尿外科术后DVT发生密切相关。多因素分析结果显示，术后第1天D-二聚体(OR=1.001，95%CI：1.001~1.001；P< 0.001)和Caprini RAM(OR=1.612，95%CI：1.32~1.97；P< 0.001)是泌尿外科术后DVT发生的强因素。ROC分析表明，术后第1天D-二聚体ROC曲线下面积为0.913(95%CI：0.880~0.946；P< 0.001)，最佳截断值为1100 ng/mL，阈值敏感性为81.8%，特异性为85.1%，约登指数为0.669。结论 术后第1天D-二聚体、Caprini RAM是泌尿外科患者术后DVT发生的独立危险因素。
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关键词:
- 泌尿外科 /
- D-二聚体 /
- Caprini风险评估模型 /
- 下肢深静脉血栓 /
- 危险因素
Abstract: Objective To find out whether urological operation might increase the risk of deep vein thrombosis (DVT) in the lower extremities.Methods From March 2019 to May 2021, 1025 urological patients were retrospectively analysed, including 765 males and 260 females. The mean age was (56.3±15.8) (range, 18-94) years. Patients' specific factors include patients' age, gender, BMI, underlying diseases, operative position, anesthetic techniques, hemorrhage volume, narcotic time, Caprini risk assessment model(RAM), preoperative and the first postoperative day D-2 polymers, pathologic result. Univariate and logistic multiple regression were used to analyze the risk variables of postoperative DVT in urological operation.Results DVT was observed in 5.4% of patients. Univariate analysis showed that age (P< 0.001), BMI (P< 0.01), anesthetic techniques (P< 0.01), malignancy (P< 0.001), history of cigarette smoking (P< 0.001), preoperative and the first postoperative day D-2 polymers (P< 0.001), Caprini RAM (P< 0.001), hemorrhage volume (P< 0.001) and narcotic time (P< 0.001) were significantly associated with the probability of DVT. D-2 polymers on the first postoperative day (P< 0.001) and Caprini RAM (P< 0.001) were important indicators of DVT following urological operation according to multivariate regression.Conclusion D-2 polymers on the first postoperative day and Caprini RAM are independent risk factors for postoperative DVT in urology patients. -
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表 1 一般临床资料
例(%)，X±S 变量 总队列(n=1025) 术后DVT P 阳性(n=55) 阴性(n=970) 年龄/岁 56.3±15.8 65.3±10.0 55.8±15.9 < 0.001 性别 0.145 男 765(63.5) 40(5.2) 725(94.8) 女 260(36.5) 15(3.4) 245(96.6) BMI 24.8±3.7 25.9±3.3 24.7±3.8 0.021 麻醉方式 0.026 非全身麻醉 613(59.8) 25(4.1) 588(95.9) 全身麻醉 412(40.2) 30(7.3) 382(92.7) 手术体位 0.042 截石位 612(59.7) 24(3.9) 588(96.1) 平卧位 129(12.6) 9(7.0) 120(93.0) 侧卧位 284(27.7) 22(7.7) 262(92.3) 恶性肿瘤 < 0.001 否 269(26.2) 27(10.0) 242(90.0) 是 756(73.8) 28(3.7) 728(96.3) 吸烟史 < 0.001 有 352(34.3) 35(9.9) 317(90.1) 无 673(65.7) 20(3.0) 653(97.0) 高血压史 0.950 有 302(29.5) 16(5.3) 286(94.7) 无 723(70.5) 39(5.4) 684(94.6) 糖尿病史 0.607 有 115(11.2) 5(4.3) 110(95.7) 无 910(88.8) 50(5.5) 860(94.5) 冠心病史 0.922 有 53(5.2) 3(5.7) 50(94.3) 无 972(94.8) 52(5.3) 920(94.7) 脑梗史 0.867 有 51(5.0) 3(5.9) 48(94.1) 无 974(95.0) 52(5.3) 922(94.7) 术前D-二聚体/(ng·mL-1) 284.1±398.2 552.9±629.7 268.8±375.7 0.002 术后第1天D-二聚体/(ng·mL-1) 840.9±1122.8 3209.2±2573.5 706.6±791.7 < 0.001 Caprini RAM/分 4.7±1.9 6.4±1.7 4.6±1.8 < 0.001 出血量/mL 40.0±188.2 218.4±555.6 29.9±135.3 0.015 麻醉时间/min 98.8±68.4 165.6±110.1 95.0±63.2 < 0.001 术后住院时间/d 6.9±3.0 11.9±3.6 6.6±2.7 < 0.001 
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表 2 各因素与DVT形成的相关性
变量 单因素 多因素 OR 95%CI P OR 95%CI P 年龄/岁 1.048 1.026~1.071 < 0.001 性别 男 1 - 女 1.11 0.602~2.044 0.738 BMI 1.082 1.012~1.157 0.021 1.098 1.01~1.195 0.029 麻醉方式 非全身麻醉 1 - 全身麻醉 1.847 1.070~3.189 0.028 手术体位 截石位 1 - 平卧位 1.837 0.833~4.052 0.132 侧卧位 2.057 1.133~3.736 0.018 恶性肿瘤 否 1 - 是 2.901 1.676~5.019 < 0.001 吸烟史 有 1 - 1 - 无 3.605 2.048~6.346 < 0.001 2.801 1.419~5.529 0.003 高血压史 有 1 - 无 0.981 0.540~1.784 0.950 糖尿病史 有 1 - 无 0.782 0.305~2.002 0.608 冠心病史 有 1 - 无 1.062 0.320~3.518 0.922 脑梗史 有 1 - 无 1.108 0.334~3.677 0.867 术前D-二聚体/(ng·mL-1) 1.001 1.000~1.001 < 0.001 术后第1天D-二聚体/(ng·mL-1) 1.001 1.001~1.001 < 0.001 1.001 1.001~1.001 < 0.001 Caprini RAM 1.796 1.509~2.138 < 0.001 1.612 1.320~1.970 < 0.001 出血量/mL 1.002 1.001~1.003 < 0.001 麻醉时间/min 1.010 1.007~1.013 < 0.001
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| 引用本文: |
王超, 孙世伟, 杨光华, 等. 泌尿外科下肢深静脉血栓形成的危险因素分析[J]. 临床泌尿外科杂志, 2022, 37(8): 595-600. doi: 10.13201/j.issn.1001-1420.2022.08.006
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| Citation: |
WANG Chao, SUN Shiwei, YANG Guanghua, et al. Risk factors for lower extremity deep vein thrombosis in urology[J]. J Clin Urol, 2022, 37(8): 595-600. doi: 10.13201/j.issn.1001-1420.2022.08.006
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