ICU深静脉血栓形成高危患者DVT发生的危险因素分析

王自军; 朱丽丽; 孟盈; 王飞; 李华; 游达礼; 胡善友; 王伟; 孙岚

doi:10.13201/j.issn.1009-5918.2020.05.013

ICU深静脉血栓形成高危患者DVT发生的危险因素分析

- 1. 上海健康医学院附属嘉定区中心医院重症监护室(上海, 201800);
- 2. 上海健康医学院附属嘉定区中心医院超声影像科;
- 3. 上海健康医学院附属嘉定区中心医院急诊科;
- 4. 上海市同济医院医学影像科
基金项目:
上海市嘉定区卫计委科研项目基金(No:2017-KY-10)

上海市科委“科技创新行动计划”项目(No:17411952300)

详细信息

通讯作者: 孙岚,E-mail:sunlan7500@163.com

中图分类号: R543.6

收稿日期: 2019-12-15

Analysis of risk factors for DVT in ICU patients with high risk of deep vein thrombosis

- 1. Department of ICU, Jiading District Central Hospital, Shanghai Medical College, Shanghai, 201800, China;
- 2. Department of Ultrasound Imaging, Jiading District Central Hospital, Shanghai Medical College;
- 3. Department of Emergency, Jiading District Central Hospital, Shanghai Medical College;
- 4. Department of Medical Imaging, Tongji Hospital, Shanghai

More Information

Corresponding author: SUN Lan, E-mail: sunlan7500@163.com

Received Date: 15 December 2019

摘要

摘要: 目的:了解ICU危重症患者的DVT发生情况及探讨其发生的危险因素。方法:连续性收集我院2018-07—2019-06期间入住ICU的危重症患者,以Caprini量表为依据,将患者分为高危组(Caprini评分≥10分,n=100)和低危组(Caprini评分<10分,n=89),比较两组患者的一般临床资料及DVT发生的差异,采用多因素Logistic回归找出DVT发生高危患者的危险因素。结果:ICU危重症患者DVT的发生率为5.3%;相对于低危组,高危组患者的年龄、合并脑卒中、脓毒症、深静脉穿刺置管比例均显著增高(P均<0.05),同时,左足背动脉血流流速显著减慢[41.8(30.3,48.5) vs.47(35,57.2),P<0.01];多因素Logistic回归分析发现,左足背动脉流速减慢(OR=1.026,95%CI 1.003~1.049,P=0.025)、合并脑卒中(OR=9.398,95%CI 1.142~77.322,P=0.037)、深静脉置管(OR=2.451,95%CI 1.022~5.876,P=0.044)是高危患者DVT发生的独立危险因素。结论:在ICU的危重症患者中,高危DVT患者的占比较高,合并脑卒中、行深静脉置管及左足背动脉流速减慢增加患者DVT的发生风险。
- 深静脉血栓 /
- 高危 /
- 危险因素 /
- 重症监护 /
- 危重症
Abstract: Objective: To investigate the incidence of DVT in critically ill patients in ICU and explore the risk factors for DVT in these patients. Method: Clinical data were collected continuously from critically ill patients admitted to the ICU of our hospital from July 2018 to June 2019. Based on the Caprini scale score, patients were assigned to the high-risk group(Caprini score ≥10 points, n=100) or low-risk Group(Caprini score<10 points, n=89) to compare the general clinical data and DVT incidence between the two groups. Multivariate Logistic regression analysis was performed to identify the risk factors for high-risk patients with DVT. Result: The incidence of DVT in critically ill patients in ICU was 5.3%. Compared with the low-risk group, age and incidences of complicating stroke, sepsis and deep vein catheterization were significantly increased in the high-risk group(P<0.05). Blood flow velocity in left dorsal pedal artery was significantly decreased in the high-risk group[41.8(30.3, 48.5) vs. 47(35, 57.2), P<0.01]. Multivariate Logistic regression analysis showed that decreased flow velocity in left dorsal pedal artery(OR= 1.026, 95%CI:1.003-1.049, P=0.025), stroke(OR= 9.398, 95%CI:1.142-77.322, P=0.037) and deep vein catheterization(OR=2.451, 95%CI:1.022-5.876, P=0.044) were independent risk factors for DVT in high-risk patients.Conclusion: High-risk DVT patients account for a high proportion of critically ill patients in ICU. Decreased flow velocity in left dorsal pedal artery, stroke and deep vein catheterization increased the risk of DVT.
- deep vein thrombosis /
- high risk /
- risk factor /
- intensive care /
- critically ill

HTML全文

参考文献(24)

[1]	内科住院患者静脉血栓栓塞症预防中国专家建议写作组,中华医学会呼吸病学分会,中华医学会老年医学分会,等.内科住院患者静脉血栓栓塞症预防中国专家建议(2015)[J].中华结核和呼吸杂志,2015,38(7):484-491.
[2]	Bembenek JP,Dennis M,Czlonkowska A.A survey to establish current methods of venous thromboembolism prophylaxis in stroke patients practiced by Polish neurologists[J].Arch Med Sci,2014,10(3):470-476.
[3]	许俊旭,王振贤,王聪,等.海口市两家医院2010-2017年肺血栓栓塞症流行病学及危险因素分析[J].中国热带医学,2018,18(2):166-169.
[4]	Righini M,Le Gal G,Bounameaux H.Venous throrllboembolism diagnosis:unresolved issues[J].Thromb Haemost,2015,113(6):1184-1192.
[5]	高亮,陈宋育.美国神经重症学会预防神经重症患者静脉血栓栓塞指南的解读[J].中华神经创伤外科电子杂志,2016,2(5):261-270.
[6]	Pannucci CJ,Obi A,Alvarez R,et al.Inadequate venous thromboembolism risk stratification predicts venous thromboembolic events in surgical intensive care unit patients[J].J Am Coll Surg,2014,218(5):898-904.
[7]	孙明利,冯亚平,黄俊,等.住院患者深静脉血栓形成的临床特征[J].中华内科杂志.2017,56(12):914-918.
[8]	中华医学会重症医学分会.ICU患者深静脉血栓形成预防指南(2009)[J].中华内科杂志,2009,48(9):788-792.
[9]	张晓勤,何丹,黎嘉嘉,等.Caprini血栓风险评估量表评估重症住院患者静脉血栓栓塞风险的有效性研究[J].四川大学学报(医学版),2015,46(5):732-735.
[10]	Liu Y,Gao Y,Wei L,et al.Peripherally inserted central catheter thrombosis incidence and risk factors in cancer patients:a doublecenter prospective investigation[J].Ther Clin Risk Manag,2015,11:153-160.
[11]	万嘉,杨镛,李珊珊,等.D-二聚体、肠脂肪酸结合蛋白在急性肠系膜上静脉血栓形成患者中的临床意义[J].中国全科医学,2019,22(24):2933-2936.
[12]	Krauss ES,Segal A,Cronin M A,et al.Implementation and Validation of the 2013 Caprini Score for Risk Stratification of Arthroplasty Patients in the Prevention of Venous Thrombosis[J].Clin Appl Thromb Hemost,2019,25:1-9.
[13]	Xu JX,Dong J,Ren H,et al.Incidence and risk assessment of venous thromboembolism in cancer patients admitted to intensive care unit for postoperative care[J].J BUON,2018,23(1):248.
[14]	Van Haren RM,Valle EJ,Thorson CM,et al.Hypercoagulability and other risk factors in trauma intensive care unit patients with venous thromboembolism[J].J Trauma Acute Care Surg,2014,76(2):443-449.
[15]	刘娟,刘冰.改良优质护理措施对ICU长期卧床患者深静脉血栓形成率及凝血指标、血液流变学指标的影响[J].血栓与止血学,2019,25(5):862-863.
[16]	Ribeiro RC,Abib SC,Aguiar AS,et al.Long-term complications in totally implantable venous access devices:randomized study comparing subclavian and internal jugular vein puncture[J].Pediatr Blood Cancer,2012,58(2):274-277.
[17]	Parienti JJ,Mongardon N,Mégarbane B,et al.Intravascular Complications of Central Venous Catheterization by Insertion Site[J].N Engl J Med,2015,373(13):1220-1229.
[18]	Bell J,Goyal M,Long S,et al.Anatomic Site-Specific Complication Rates for Central Venous Catheter Insertions[J].J Intensive Care Med,2018 Sep 19:885066618795126.[Epub ahead of print]
[19]	赵宁,张加乐,江婷,等.ICU患者外周静脉置入中心静脉导管相关上肢深静脉血栓形成的危险因素[J].中华危重病急救医学,2017,29(2):167-171.
[20]	Nm Bhat M,Venkataraman R,Ramakrishnan N,et al.Value of Routine Sonographic Screening of Internal Jugular Vein to Detect Catheter Related Thrombosis in Intensive Care Unit[J].Indian J Crit Care Med,2019,23(7):326-328.
[21]	Steen EH,Lasa JJ,Nguyen TC,et al.Central Venous Catheter-Related Deep Vein Thrombosis in the Pediatric Cardiac Intensive Care Unit[J].J Surg Res,2019,241:149-159.
[22]	张伟伟,方云.血液肿瘤患者PICC导管相关性血栓形成的危险因素分析[J].临床血液学杂志,2018,31(3):197-200.
[23]	White JM,Comerota AJ.Venous Compression Syndromes[J].Vasc Endovascular Surg,2017,51(3):155-168.
[24]	Fasanya AA,Lacapra G.May-Thurner Syndrome With Pulmonary Embolism as the First Presentation Rather Than Deep Vein Thrombosis[J].Cureus,2016,8(2):e509.