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

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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

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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

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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

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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）
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2022年8期	烧伤营养	组稿专家：韩春茂（已组稿完成）
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2022年12期	烧伤康复	组稿专家：谢卫国

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