摘要
目的分析胸部创伤患者围术期二次剖胸手术对发生血栓事件风险的影响。方法采用回顾性病例对照研究分析2000年1月-2016年12月收治的175例胸部创伤施行剖胸手术患者的临床资料。根据有无二次剖胸手术，将患者分为二次剖胸组（36例）和对照组（139例）。二次剖胸组：男25例，女11例；年龄（65．4±5．5）岁；胸部创伤简明损伤定级（AIS）（3．8±0．6）分。对照组：男98例，女41例；年龄（64．6±5．3）岁；胸部AIS（3．7±0．8）分。比较两组ICU住院时间、胸腔引流量、术后卧床时间、术后1，3，5，7，9，11d内皮素-1（ET-1）、D-二聚体和血小板水平。采用Logistic回归分析法分析二次剖胸手术对发生血栓事件风险的影响。同时比较两组血栓发生率等情况。结果二次剖胸组与对照组相比，ICU住院时间长[（4．2±1．4）d：（1．8±1．0）d]（P〈0．01）、胸腔腔引流量多[（1550±250）ml：（635±184）m1]（P〈0．01）、术后卧床时间长[（5。4±1．6）d：（1．5±0．9）d]（P〈0．01）。二次剖胸组与对照组术后不同时相点ET-1、D-二聚体比较差异均有统计学意义（P〈0．01）。血小板计数在术后第5天后比较差异有统计学意义（P〈0．01）。二次剖胸组出现深静脉血栓12例（33％），其中6例因血栓相关并发症死亡；对照组出现深静脉血栓8例（5．7％），均治愈（P〈0．05）。进一步多因素Logistic分析结果显示，ET-1（OR=7．46，95％CI4．53～11．06，P〈0．05）、D-二聚体（OR=4．28，95％CI2．65～8．37，P〈0．05）、血小板计数（OR=1．13，95％CI0．56～1．98，P〈0．05）是血栓事件的独立危险因素。结论胸部创伤同术期二次剖胸手术增加血栓事件风险。ICU住院时间、胸腔胸腔引流量、卧床时间是血栓事件风险因素，而ET-1、D-二聚体、血小板计数是血栓事件的独立危险因素。
Objective To investigate the effect of perioperative secondary thoracotomy on the risk of thrombosis in patients with thoracic trauma. Methods A retrospective case control study was conducted on the clinical data of 175 patients with thoracic trauma who underwent thoracotomy from January 2000 to December 2016. According to whether the palients underwent secondary thoracotomy, they were divided into secondary thoracotomy group （36 eases） and the control group （ 139 eases）. In the secondary thoracotomy group, there were 25 males and 11 females, with age of （65.4 ± 5.5） years and thoracic abbreviated injury score （AIS） of （3.8 ±0.6） points. In the control group, there were 98 males and 41 females, with the age of （64.6 ±5.3）years and thoracic AIS of （3.7 ±0.8）points. The ICU stay, thoracic drainage, bed rest time, and the incidence of thrombosis in two groups were compared, and the levels of endothelin （ ET-1 ）, D-dimer aggregation and platelet were measured. Logistic regression analysis was used to analyze the impact of secondary thoracotomy on the risk of thrombosis. Results Compared with the control group, patients in the secondary thoracotomy group had longer ICU stay [ （4.2 ± 1.4） d ： （ 1.8 ± 1.0） d ] （ P 〈 0. 01 ）, more thoracic drainage [ （ 1 550 ± 250 ） ml ： （ 635 ± 184 ） ml ] （ P 〈 0. 01 ） , and longer bed rest time [ （ 5.4 ± 1.6 ） days ： （ 1.5 ± 0. 9 ） days ] （ P 〈 0.01 ）. There were significant differences in levels of ET-1 and D-dimer aggregation between two groups （P〈0. 01 ）. There was significant difference in platelet count after 5 days （ P 〈 0. 01 ）. Twelve eases of deep venous thrombosis （33%） occurred in the secondary thoraeotomy group, of which six eases died of thrombus related complications. Eight eases （5.7%） of deep venous thrombosis occurred in the control group, all of which recovered （P 〈 0.05 ）. In multivariate analysis, ET-1 （ OR = 7.46, 95% CI 4.53-11.06, P 〈 0.05 ） ,
作者
陈松林
邓华
易云峰
陈检明
钟京
焦昌结
郭军华
Chen Songlin;Deng Hua;Yi Yunfeng;Chen Jianming;Zhong Jing;Jiao Changjie;Guo Junhua(Department of Cardioth.oracic Surgery,175th Hospital of PLA/Affiliated Southeast Hospital of Xiamen University,Zhangzhou 363000,China)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2018年第8期734-739,共6页
Chinese Journal of Trauma
基金
全军后勤科研项目（CNJ14C007,CWH17J030）
关键词
胸部损伤
围术期
外科手术
血栓
Thoracic injuries
Perioperative period
Surgical procedures
operative
Thrombosis
