摘要
目的分析危重症患者下肢深静脉血栓形成(DVT)的危险因素.方法采用横断面描述性研究方法,连续选择2019年6月至2020年4月青岛市3所三级综合医院重症医学科收治的300例患者,其中下肢DVT患者35例(DVT组),非DVT患者265例(非DVT组).观察患者一般资料、实验室检查结果及维持生命体征稳定的检查和治疗措施.根据下肢DVT发生情况,采用单因素分析寻找危重症患者下肢DVT发生的影响因素;将单因素分析中具有统计学意义的影响因素纳入二元多因素Logistic回归分析,从而确定下肢DVT发生的独立危险因素.绘制受试者工作特征曲线(ROC),评价D-二聚体和急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)对危重症患者下肢DVT发生的预测价值.结果危重症患者下肢DVT发生率为11.67%(35/300).单因素分析显示,两组间APACHEⅡ评分、血小板计数(PLT)、纤维蛋白原(FIB)、D-二聚体水平及使用脱水药物、血管升压素、连续性肾脏替代治疗(CRRT)、机械通气(MV)、糖尿病(DM)患者比例差异均有统计学意义(均P<0.05).多因素分析显示,APACHEⅡ评分升高〔优势比(OR)=1.13,95%可信区间(95%CI)为1.02~1.25,P=0.019〕、DM(OR=3.95,95%CI为1.15~13.57,P=0.029)、MV(OR=19.04,95%CI为3.96~91.63,P=0.000)、使用血管升压素(OR=9.85,95%CI为3.00~32.31,P=0.001)和D-二聚体升高(OR=1.08,95%CI为1.02~1.13,P=0.005)是危重症患者发生下肢DVT的独立危险因素.ROC曲线分析显示,D-二聚体和APACHEⅡ评分对危重症患者下肢DVT的发生均有预测能力,ROC曲线下面积(AUC)分别为0.64±0.05和0.70±0.04.D-二聚体最佳截断值为3.62 mg/L时,敏感度为80.00%,特异度为46.42%;APACHEⅡ评分最佳截断值为16.00分时,敏感度为80.00%,特异度为61.89%.结论对于有DM史、APACHEⅡ评分>16分、D-二聚体>3.62 mg/L以及使用血管升压素和MV治疗的危重症患者,要警惕下肢DVT的发生.
Objective To analyze the risk factors of lower extremity deep venous thrombosis(DVT)in critically ill patients.Methods A cross-sectional descriptive research method was adopted.From June 2019 to April 2020,300 patients admitted into intensive care unit(ICU)of three tertiary general hospitals were sequentially selected in Qingdao City,including 35 patients with DVT in lower extremity(DVT group)and 265 non DVT patients(non DVT group).The patients'general data,laboratory examination results and the measures of examination and treatment applied to maintain the stability of vital signs of these critically ill patients were observed and recorded.According to the occurrence situation of lower extremity DVT,univariate analysis was used to look for the factors that might impact the occurrence of lower extremity DVT in these patients.The factors with statistical significance in univariate analysis were incorporated into the dual multivariate Logistic regressive analysis to determine the independent risk factors for occurrence of lower extremity DVT.A receiver operating characteristic curve(ROC)was drawn to evaluate the predictive value of D-dimer and acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score on the occurrence of lower extremity DVT in these patients.Results The incidence of lower extremity DVT was 11.67%(35/300).Univariate analysis showed that the differences in patients'APACHE Ⅱ score,platelet count(PLT),fibrinogen(FIB),D-dimer levels and the uses of dehydrating drugs,vasopressin,continuous renal replacement therapy(CRRT),mechanical ventilation(MV)and the proportion of patients with diabetes(DM)between the two groups were statistically significant(all P<0.05).Multivariate analysis showed that APACHE Ⅱ score increased[odds ratio(OR)=1.13,95%confidence interval(95%CI)was 1.02-1.25,P=0.019],DM(OR=3.95,95%CI was 1.15-13.57,P=0.029),MV(OR=19.04,95%CI was 3.96-91.63,P=0.000),use of vasopressin(OR=9.85,95%CI was 3.00-32.31,P=0.001)and D-dimer increasing(OR=1.08,95%CI was 1.02-1.13,P=0.005)were indep
作者
陈颖
秦贤
王敬东
王清峰
曲彦
Chen Ying;Qin Xian;Wang Jingdong;Wang Qingfeng;Qu Yan(School of Nursing,Qingdao Universitys Qingdao 266000,Shandong,China;Qingdao Municipal Hospital Affiliated to Qingdao University,Qingdao 26600,Shandong,China;Qingdao Central Hospital,Qingdao 266000,Shandong,China;Qingdao Eighth People’s Hospital,Qingdao 266000,Shandong,China)
出处
《中国中西医结合急救杂志》
CAS
CSCD
北大核心
2021年第2期189-193,共5页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
基金
山东省青岛市医疗卫生A类重点专科(2017-9)。
关键词
下肢深静脉血栓
重症医学科
危险因素
机械通气
Lower extremity deep venous thrombosis
Intensive care unit
Risk factor
Mechanical ventilation
