Ⅲ期与Ⅳ期压疮患者入院时并发下肢深静脉血栓形成情况及其危险因素

张伟; 黄红军; 张俊峰; 刘宝辉; 李刚; 石凡超; 牛希华; 杨林

doi:10.3760/cma.j.cn501120-20210419-00134

Ⅲ期与Ⅳ期压疮患者入院时并发下肢深静脉血栓形成情况及其危险因素

doi: 10.3760/cma.j.cn501120-20210419-00134

1.
郑州市第一人民医院介入科，郑州　　450004
2.
郑州市第一人民医院创面修复科，郑州　　450004
3.
郑州市第一人民医院骨科，郑州　　450004

基金项目:

河南省医学科技攻关联合共建项目 LHGJ2019001

详细信息

通讯作者:
张伟，Email：zhangweiivr@sina.com

计量
- 文章访问数: 106
- HTML全文浏览量: 116
- PDF下载量: 0
- 被引次数: 0
出版历程
- 收稿日期: 2021-04-19
- 网络出版日期: 2022-08-12
- 刊出日期: 2022-06-20

Prevalence and risk factors of deep venous thrombosis of lower extremity in patients with stage Ⅲ and Ⅳ pressure ulcers on admission

1.
Department of Interventional Radiology, the First People's Hospital of Zhengzhou, Zhengzhou 450004, China
2.
Department of Wound Repair, the First People's Hospital of Zhengzhou, Zhengzhou 450004, China
3.
Department of Orthopedics, the First People's Hospital of Zhengzhou, Zhengzhou 450004, China

Funds:

Joint Construction Project of Medical Science and Technology in Henan Province LHGJ2019001

More Information

Corresponding author: Zhang Wei, Email: zhangweiivr@sina.com

摘要

摘要:
目的探讨Ⅲ、Ⅳ期压疮患者入院时并发下肢深静脉血栓形成（DVT）的情况及危险因素。
方法采用回顾性病例系列研究方法。将于郑州市第一人民医院创面修复科2015年1月1日—2019年12月31日出院的符合入选标准的241例Ⅲ、Ⅳ期压疮患者纳入研究，其中男134例、女107例，年龄22~93岁，中位年龄68岁；其中Ⅲ期压疮者37例、Ⅳ期压疮者204例。收集患者发生DVT情况。根据入院后48 h内下肢静脉彩色多普勒超声检查是否确诊为DVT，将病例分为DVT组（37例）和非DVT组（204例）；收集并比较2组患者的性别、年龄、压疮持续时间、卧床时间以及合并糖尿病、高血压、冠心病、脑梗死、肺炎、脓毒症/感染性休克、截瘫与入院后24 h内血浆D-二聚体水平和Caprini评分等临床资料。对数据行独立样本t检验、Mann-Whitney U检验、χ²检验及Fisher确切概率法检验。将组间比较差异有统计学意义的指标进行多因素logistic回归分析，筛选影响241例Ⅲ、Ⅳ期压疮患者入院时并发下肢DVT的独立危险因素。
结果 DVT发生率为15.4%（37/241），其中86.5%（32/37）的患者系无症状DVT，46条下肢DVT中仅累及膝下静脉者29条，占63.0%。2组患者性别、压疮持续时间及合并糖尿病、高血压、冠心病、脑梗死、肺炎、脓毒症/感染性休克情况比较，差异均无统计学意义（P>0.05）；2组患者年龄、卧床时间、合并截瘫情况、血浆D-二聚体水平及Caprini评分比较，差异均有统计学意义（t=-3.19，Z=-2.04，χ²=4.44，Z=-3.89，t=-2.14，P<0.05或P<0.01）。多因素logistic回归分析显示，年龄、血浆D-二聚体水平是影响241例Ⅲ、Ⅳ期压疮患者入院时并发下肢DVT的独立危险因素（比值比分别为1.03、1.18，95%置信区间分别为1.00~1.06、1.05~1.33，P<0.05或P<0.01）。
结论 Ⅲ、Ⅳ期压疮患者入院时具有较高的DVT发生率，年龄、血浆D-二聚体水平是发生下肢DVT的独立危险因素，有必要在接诊时重视DVT的针对性筛查及预防宣传教育。
- 压力性溃疡 /
- 静脉血栓形成 /
- 发病率 /
- 危险因素 /
- 年龄 /
- D-二聚体
Abstract:
Objective To investigate the incidence and risk factors of deep venous thrombosis (DVT) of lower extremity in patients with stage Ⅲ and Ⅳ pressure ulcer on admission.
Methods A retrospective case series study was conducted. A total of 241 patients with stage Ⅲ and Ⅳ pressure ulcers who met the inclusion criteria and were discharged from the Department of Wound Repair of the First People's Hospital of Zhengzhou from January 1, 2015 to December 31, 2019 were enrolled in this study, including 134 males and 107 females, aged 22 to 93 years, with a median age of 68 years; 37 patients were with stage Ⅲ pressure ulcers and 204 patients were with stage Ⅳ pressure ulcers. The DVT occurrence of patients was recorded. According to whether DVT of lower extremity veins was diagnosed by color Doppler ultrasound within 48 h after admission or not, the patients were divided into DVT group (n=37) and non-DVT group (n=204). Data of patients in the two groups were collected and compared, including gender, age, duration of pressure ulcer, time in bed, and combination with diabetes, hypertension, coronary heart disease, cerebral infarction, pneumonia, sepsis/septic shock, and paraplegia, and the plasma D-dimer level and Caprini score within 24 h after admission. Data were statistically analyzed with independent sample t test, Mann-Whitney U test, chi-square test, and Fisher's exact probability test. The indicators with statistically significant differences between the two groups were analyzed with multivariate logistic regression analysis to screen the independent risk factors influencing the DVT of lower extremity in 241 patients with stage Ⅲ and Ⅳ pressure ulcers on admission.
Results The incidence of DVT of lower extremity was 15.4% (37/241), of which 86.5% (32/37) were asymptomatic DVT. Among the DVT of 46 lower limbs, only 29 involved the inferior genicular veins, accounting for 63.0%. There were no statistically significant differences in gender, duration of pressure ulcer, combination with diabetes, hypertension, coronary heart disease, cerebral infarction, pneumonia, and sepsis/septic shock of patients between the two groups (P>0.05), while there were statistically significant differences in age, time in bed, combination with paraplegia, the plasma D-dimer level and Caprini score of patients between the two groups(t=-3.19, Z=-2.04, χ²=4.44, Z=-3.89, t=-2.14, respectively, P<0.05 or P<0.01). Multivariate logistic regression analysis showed that age and plasma D-dimer level were independent risk factors influencing the DVT of lower extremity in 241 patients with stage Ⅲ and Ⅳ pressure ulcers on admission (with odds ratios of 1.03 and 1.18, respectively, with 95% confidence intervals of 1.00-1.06 and 1.05-1.33, respectively, P<0.05 or P<0.01).
Conclusions The patients with stage Ⅲ and Ⅳ pressure ulcers have a higher incidence of DVT on admission, with age and plasma D-dimer level being the independent risk factors for DVT of lower extremity. It is necessary to pay attention to the targeted screening of DVT and education of its prevention.
- Pressure ulcer /
- Venous thrombosis /
- Incidence /
- Risk factors /
- Age /
- D-dimer
张伟：酝酿和设计研究、实施研究以及撰写论文；黄红军：酝酿和设计研究、修改论文；张俊峰、刘宝辉：分析/解释数据；李刚、石凡超、杨林：实施研究、采集数据；牛希华：指导研究、修改论文

所有作者均声明不存在利益冲突

·读者·作者·编者·

本刊2022年重点号专栏征稿启事

敬请大家浏览并关注本刊2022年各期重点选题，欢迎您针对有意向的选题内容积极投稿。若稿件通过编委会专家组评审，将有机会被纳入当期重点号专栏刊发。欢迎大家积极参与，感谢您的支持！

征稿要求：原创性论著，字数5 000字左右（需附中英文摘要及关键词），至少于当期专栏出刊前4个月投稿。

投稿途径：登录本刊官网www.zhsszz.org→点击左侧“在线投稿”注册投稿即可，投稿时请务必在题目中注明投第几期重点选题。

HTML全文

下载: 全尺寸图片幻灯片

表1 2组Ⅲ期与Ⅳ期压疮患者临床资料比较

组别	例数	性别［例（%）］		年龄（岁， $\bar{x} \pm s$ ）	压疮持续时间［个月，M（Q₁，Q₃）］	卧床时间［个月，M（Q₁，Q₃）］	合并糖尿病［例（%）］		合并高血压［例（%）］		合并冠心病［例（%）］
组别	例数	男	女	年龄（岁， $\bar{x} \pm s$ ）	压疮持续时间［个月，M（Q₁，Q₃）］	卧床时间［个月，M（Q₁，Q₃）］	有	无	有	无	有	无
非DVT组	204	113（55.4）	91（44.6）	66±16	4.0（1.5，12.0）	41（12，120）	54（26.5）	150（73.5）	69（33.8）	135（66.2）	28（13.7）	176（86.3）
DVT组	37	21（56.8）	16（43.2）	74±13	2.5（1.5，5.5）	17（4，90）	13（35.1）	24（64.9）	18（48.6）	19（51.4）	6（16.2）	31（83.8）
统计量值		χ²=0.02		t=-3.19	Z=-1.92	Z=-2.04	χ²=1.17		χ²=2.98		χ²=0.16
P值		>0.999		0.002	0.055	0.042	0.319		0.096		0.618
注：DVT为深静脉血栓形成；“—”表示无此统计量值

下载: 导出CSV

表2 多因素logistic回归分析241例Ⅲ期与Ⅳ期压疮患者入院时并发下肢DVT的独立危险因素

危险因素	偏回归系数	标准误	比值比	95%置信区间	P值
年龄（岁）	0.03	0.02	1.03	1.00~1.06	0.045
卧床时间（个月）	0.00	0.00	1.00	0.99~1.00	0.291
合并截瘫情况	0.11	0.50	1.12	0.42~3.00	0.826
血浆D-二聚体水平（mg/L）	0.17	0.05	1.18	1.05~1.33	0.004
Caprini评分（分）	0.18	0.13	1.19	0.92~1.54	0.175
注：DVT为深静脉血栓形成

下载: 导出CSV

2022年1期	烧伤缺血缺氧性损害与休克的防治	组稿专家：申传安（已组稿完成）
2022年2期	烧伤后炎症与免疫	组稿专家：孙炳伟、贺伟峰（已组稿完成）
2022年3期	烧伤感染、脓毒症	组稿专家：姚咏明、袁志强（已组稿完成）
2022年4期	扩张术与瘢痕修复	组稿专家：马显杰（已组稿完成）
2022年5期	烧伤后脏器功能损害	组稿专家：郇京宁（已组稿完成）
2022年6期	特殊原因创面（冻伤、自身免疫病创面等）	组稿专家：于家傲（已组稿完成）
2022年7期	生长因子调控创面修复	组稿专家：肖健（已组稿完成）
2022年8期	烧伤营养	组稿专家：韩春茂（已组稿完成）
2022年9期	瘢痕的光电治疗	组稿专家：章一新
2022年10期	生物材料在创面修复中的应用	组稿专家：罗高兴
2022年11期	创面修复中的细胞与干细胞治疗	组稿专家：史春梦
2022年12期	烧伤康复	组稿专家：谢卫国

下载: 导出CSV

参考文献(36)

[1]	中华医学会外科学分会血管外科学组. 深静脉血栓形成的诊断和治疗指南(第三版)[J].中华普通外科杂志,2017,32(9):807-812. DOI: 10.3760/cma.j.issn.1007-631X.2017.09.032.
[2]	“卧床患者常见并发症规范化护理干预模式的构建”项目组,中华护理学会行政管理专业委员会. 卧床患者常见并发症护理专家共识[J].中国护理管理,2018,18(6):740-747. DOI: 10.3969/j.issn.1672-1756.2018.06.006.
[3]	WuX, LiZ, CaoJ, et al. The association between major complications of immobility during hospitalization and quality of life among bedridden patients: a 3 month prospective multi-center study[J]. PLoS One, 2018,13(10):e0205729. DOI: 10.1371/journal.pone.0205729.
[4]	JiaoX, CuiC, NgSK, et al. The modified bilobed flap for reconstructing sacral decubitus ulcers[J/OL]. Burns Trauma, 2020,8:tkaa012[2022-03-23]. https://pubmed.ncbi.nlm.nih.gov/33335930/.DOI: 10.1093/burnst/tkaa012.
[5]	European Pressure Ulcer Advisory PanelNational Pressure Injury Advisory PanelPan Pacific Pressure Injury AlliancePrevention and treatment of pressure ulcers/injuries: clinical practice guideline2019-11-262020-04-19http://www.internationalguideline.com/ European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, Pan Pacific Pressure Injury Alliance. Prevention and treatment of pressure ulcers/injuries: clinical practice guideline[EB/OL]. (2019-11-26)[2020-04-19]. http://www.internationalguideline.com/.
[6]	付小兵. 进一步重视体表慢性难愈合创面发生机制与防治研究[J].中华创伤杂志,2004,20(8):449-451. DOI: 10.3760/j:issn:1001-8050.2004.08.001.
[7]	CapriniJA. Thrombosis risk assessment as a guide to quality patient care[J]. Dis Mon, 2005, 51(2/3): 70-78. DOI: 10.1016/j.disamonth.2005.02.003.
[8]	ManiR, MargolisDJ, ShuklaV, et al. Optimizing technology use for chronic lower- extremity wound healing: a consensus document[J]. Int J Low Extrem Wounds, 2016, 15(2):102-119. DOI: 10.1177/1534734616646261.
[9]	WeiR, ChenHL, ZhaML, et al. Diabetes and pressure ulcer risk in hip fracture patients: a meta-analysis[J]. J Wound Care, 2017,26(9):519-527. DOI: 10.12968/jowc.2017.26.9.519.
[10]	贾晓明. 压疮的流行病学特点及诊断与治疗进展[J/CD].中华损伤与修复杂志:电子版,2018,13(1):4-7. DOI: 10.3877/cma.j.issn.1673-9450.2018.01.002.
[11]	HauckKD, WangSL, VincentC, et al. Healthy life-years lost and excess bed-days due to 6 patient safety incidents: empirical evidence from English hospitals[J]. Med Care, 2017, 55(2):125-130. DOI: 10.1097/MLR.0000000000000631.
[12]	SellierE, LabarereJ, SevestreMA, et al. Risk factors for deep vein thrombosis in older patients: a multicenter study with systematic compression ultrasonography in postacute care facilities in France[J]. J Am Geriatr Soc, 2008,56(2):224-230. DOI: 10.1111/j.1532-5415.2007.01545.x.
[13]	JenkinsDA, MohamedS, TaylorJK, et al. Potential prognostic factors for delayed healing of common, non-traumatic skin ulcers: a scoping review[J]. Int Wound J, 2019,16(3):800-812. DOI: 10.1111/iwj.13100.
[14]	张伟, 张俊峰, 王觅, 等. 体表慢性难愈合创面患者下肢深静脉血栓形成的发生情况及影响因素[J].中华医学杂志,2020,100(4):291-294. DOI: 10.3760/cma.j.issn.0376-2491.2020.04.010.
[15]	DennisM, SandercockP, ReidJ, et al. The effect of graduated compression stockings on long-term outcomes after stroke: the CLOTS trials 1 and 2[J]. Stroke, 2013, 44(4): 1075-1079. DOI: 10.1161/STROKEAHA.111.680298.
[16]	ZhangY, YangY, ChenW, et al. Prevalence and associations of VTE in patients with newly diagnosed lung cancer[J]. Chest, 2014,146(3):650-658. DOI: 10.1378/chest.13-2379.
[17]	QuH, LiZ, ZhaiZ, et al. Predicting of venous thromboembolism for patients undergoing gynecological surgery[J]. Medicine(Baltimore), 2015, 94(39): e1653. DOI: 10.1097/MD.0000000000001653.
[18]	van der WielenH, PostMWM, LayV, et al. Hospital-acquired pressure ulcers in spinal cord injured patients: time to occur, time until closure and risk factors[J]. Spinal Cord, 2016, 54(9): 726-731. DOI: 10.1038/sc.2015.239.
[19]	LeeYJ, KimJY, DongCB, et al. Developing risk-adjusted quality indicators for pressure ulcers in long-term care hospitals in the Republic of Korea[J]. Int Wound J, 2019, 16(Suppl 1): S43-50. DOI: 10.1111/iwj.13024.
[20]	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. DOI: 10.3760/cma.j.issn.0578-1426.2017.12.005.
[21]	王辰. 肺血栓栓塞症诊治与预防指南[J]. 中华医学杂志, 2018, 98(14): 1060-1087. DOI: 10.3760/cma.j.issn.0376-2491.2018.14.007.
[22]	孙亚萌, 张建政, 刘智. 老年骨折患者下肢深静脉血栓形成的危险因素及动态D-二聚体对其预测价值的分析[J]. 中国骨与关节杂志, 2020, 9(6): 419-424. DOI: 10.3969/j.issn.2095-252X.2020.06.005.
[23]	王勇, 张洪亮, 罗勤, 等. 出院前血浆D-二聚体水平对急性肺血栓栓塞症患者复发静脉血栓栓塞风险的预测价值[J]. 中国循环杂志, 2019, 34(10): 984-989. DOI: 10.3969/j.issn.1000-3614.2019.10.009.
[24]	张伟, 刘宝辉, 夏成德, 等. D-二聚体对成年烧伤患者下肢深静脉血栓形成的预测价值[J]. 中华烧伤与创面修复杂志, 2022, 38(4):335-340. DOI: 10.3760/cma.j.cn501120-20201021-00444.
[25]	Weill-EngererS, MeaumeS, LahlouA, et al. Risk factors for deep vein thrombosis in inpatients aged 65 and older: a case-control multicenter study[J]. J Am Geriatr Soc, 2004,52(8):1299-1304. DOI: 10.1111/j.1532-5415.2004.52359.x.
[26]	PottierP, HardouinJB, LejeuneS, et al. Immobilization and the risk of venous thromboembolism. A meta-analysis on epidemiological studies[J]. Thromb Res, 2009, 124(4): 468-476. DOI: 10.1016/j.thromres.2009.05.006.
[27]	GattME, PaltielO, BursztynM. Is prolonged immobilization a risk factor for symptomatic venous thromboembolism in elderly bedridden patients? Results of a historical-cohort study[J]. Thromb Haemost, 2004,91(3):538-543. DOI: 10.1160/TH03-07-0481.
[28]	张婉, 史振宇, 符伟国, 等. 住院高危患者下肢深静脉血栓形成的患病率调查[J]. 中华医学杂志, 2009, 89(45):3176-3180. DOI: 10.3760/cma.j.issn.0376-2491.2009.45.004.
[29]	BahlV, HuHM, HenkePK, et al. A validation study of a retrospective venous thromboembolism risk scoring method[J]. Ann Surg, 2010, 251(2):344-350. DOI: 10.1097/SLA.0b013e3181b7fca6.
[30]	LiQ, BaT, WangLF, et al. Stratification of venous thromboembolism risk in burn patients by Caprini score[J]. Burns, 2019, 45(1):140-145. DOI: 10.1016/j.burns.2018.08.006.
[31]	陈央, 周海霞, 胡月红, 等. 老年和非老年肺栓塞的危险因素及Caprini血栓风险评估量表的预测价值[J]. 中华医学杂志, 2017, 97(10):755-760. DOI: 10.3760/cma.j.issn.0376-2491.2017.10.008.
[32]	胡智洪, 游国亮, 何敏, 等. Caprini风险评估模型在神经外科卧床患者深静脉血栓栓塞筛选中的应用[J]. 国际神经病学神经外科学杂志, 2018, 45(3):221-224. DOI: 10.16636/j.cnki.jinn.2018.03.002.
[33]	OgerE, BressolletteL, NonentM, et al. High prevalence of asymptomatic deep vein thrombosis on admission in a medical unit among elderly patients[J]. Thromb Haemost, 2002,88(4):592-597.
[34]	CannonKA, BadieeJ, WallaceJD, et al. The prevalence of chronic deep venous thrombosis in trauma: implications for hospitals and patients[J]. J Trauma Acute Care Surg, 2018, 84(1):170-174. DOI: 10.1097/TA.0000000000001694.
[35]	TracyLM, CameronPA, SingerY, et al. Venous thromboembolism prophylaxis practice and its association with outcomes in Australia and New Zealand burns patients[J/OL]. Burns Trauma, 2021,9:tkaa044[2022-02-23].https://pubmed.ncbi.nlm.nih.gov/33654696/. DOI: 10.1093/burnst/tkaa044.
[36]	KumagaiG, WadaK, KudoH, et al. D-dimer monitoring combined with ultrasonography improves screening for asymptomatic venous thromboembolism in acute spinal cord injury[J]. J Spinal Cord Med, 2020, 43(3):353-357. DOI: 10.1080/10790268.2018.1518765.