Zhang W, Zhang J F, Wang M, Xia C D, Wang L J, Liu B H, Di H P, Xue J D, Lou J H
Department of Interventional Radiology, Zhengzhou First People's Hospital, Zhengzhou 450004, China.
Department of Burns, Zhengzhou First People's Hospital, Zhengzhou 450004, China.
Zhonghua Shao Shang Za Zhi. 2020 Jan 20;36(1):54-57. doi: 10.3760/cma.j.issn.1009-2587.2020.01.010.
To investigate the occurrence and risk factors of deep venous thrombosis (DVT) in adult burn patients. The clinical data of 1 219 adult burn patients admitted to the Department of Burns of Zhengzhou First People's Hospital from January 1, 2015 to August 31, 2016, conforming to the study criteria, were analyzed retrospectively by the method of case-control study, including 811 males and 408 females, aged 18-102 years. According to whether DVT occurred during hospitalization or not, the patients were divided into group DVT (=12) and non-DVT group (=1 207). The incidence of DVT, the diagnosis time of DVT, affected limbs, and DVT classification were counted and recorded. The gender, age, total burn area, D-dimer, lower limb burn, full-thickness burn, femoral vein indwelling central venous catheter (CVC) , inhalation injury, sepsis/infection shock, surgical operation, and infusion of concentrated red blood cells of patients between the two groups were compared with chi-square test, and then the indicators with statistically significant differences between the two groups were processed by multivariate binary logistic regression analysis to screen the independent risk factors of DVT in the adult burn patients. (1) The incidence of DVT of adult burn patients was 0.98% (12/1 219), and DVT was diagnosed 24-138 days after injury, with a median of 61.5 days. DVT occurred in the right lower limb of 2 patients, left lower limb of 8 patients, and bilateral lower limbs of 2 patients, and DVT classification included 6 cases of mixed type and 6 cases of peripheral type. (2) There were no statistically significant differences in gender, age, and full-thickness burn of patients between the two groups ( (2)=1.524, 0.021, 3.115, >0.05). There were statistically significant differences in total burn area, lower limb burn, inhalation injury, sepsis/infection shock, D-dimer, femoral vein indwelling CVC, surgical operation, and infusion of concentrated red blood cells among patients between the two groups ((2)=17.975, 6.206, 3.987, 8.875, 5.447, 15.124, 10.735, 14.031, <0.05 or <0.01). (3) Total burn area, D-dimer, and femoral vein indwelling CVC were independent risk factors for DVT in adult burn patients (odds ratio=10.927, 4.762, 9.394, 95% confidence interval=3.078-38.789, 1.197-18.934, 2.631-33.540, <0.05 or <0.01). The incidence of DVT in adult burn patients is relatively low, and the diagnosis time of DVT is 3 weeks after burn, with DVT classification of mixed type and peripheral type. The total burn area, femoral vein indwelling CVC, and D-dimer are independent risk factors for predicting DVT in adult burn patients.
探讨成年烧伤患者深静脉血栓形成(DVT)的发生情况及危险因素。采用病例对照研究方法,回顾性分析2015年1月1日至2016年8月31日符合研究标准的郑州第一人民医院烧伤科收治的1219例成年烧伤患者的临床资料,其中男性811例,女性408例,年龄18~102岁。根据住院期间是否发生DVT,将患者分为DVT组(n = 12)和非DVT组(n = 1207)。统计并记录DVT的发生率、DVT诊断时间、受累肢体及DVT分型。两组患者的性别、年龄、烧伤总面积、D-二聚体、下肢烧伤、Ⅲ度烧伤、股静脉留置中心静脉导管(CVC)、吸入性损伤、脓毒症/感染性休克、手术操作及输注浓缩红细胞情况进行χ²检验比较,将两组间差异有统计学意义的指标进行多因素二元logistic回归分析,筛选成年烧伤患者DVT的独立危险因素。(1)成年烧伤患者DVT发生率为0.98%(12/1219),伤后24~138 d诊断为DVT,中位诊断时间为61.5 d。DVT发生于右下肢2例,左下肢8例,双下肢2例;DVT分型:混合型6例,周围型6例。(2)两组患者的性别、年龄及Ⅲ度烧伤情况差异无统计学意义(χ² = 1.524、0.021、3.115,P>0.05)。两组患者的烧伤总面积、下肢烧伤、吸入性损伤、脓毒症/感染性休克、D-二聚体、股静脉留置CVC、手术操作及输注浓缩红细胞情况差异有统计学意义(χ² = 17.975、6.206、3.987、8.875、5.447、15.124、10.735、14.031,P<0.05或P<0.01)。(3)烧伤总面积、D-二聚体及股静脉留置CVC是成年烧伤患者发生DVT的独立危险因素(比值比 = 10.927、4.762、9.394,95%可信区间 = 3.078~38.789、1.197~18.934、2.631~33.540,P<0.05或P<0.01)。成年烧伤患者DVT发生率较低,伤后3周诊断DVT,DVT分型为混合型和周围型。烧伤总面积、股静脉留置CVC及D-二聚体是预测成年烧伤患者发生DVT的独立危险因素。