Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Department of Nursing, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Dis Markers. 2020 Jun 4;2020:5820749. doi: 10.1155/2020/5820749. eCollection 2020.
It is acknowledged that patients undergoing neurosurgery with neurological illness are at higher risk of lower extremity deep vein thrombosis (DVT). As an underlying life-threatening complication, the incidence and risk factors for high-risk patients with lower extremity deep vein thrombosis are still controversial in relative high-risk patients after neurosurgery.
A total of 204 patients who underwent neurosurgery and were considered as a high-risk group of DVT according to times of stay in bed more than 3 days were enrolled in this study. We evaluated the lower extremity DVT by using Color Doppler Ultrasound System (CDUS). Clinical parameters of patients at the time of admission and postoperation were recorded and prepared for further analysis. Early predictive factors for postoperative lower extremity DVT were established. Diagnostic performance of predictive factors was evaluated by using receiver operating characteristic (ROC) curve analysis.
The overall incidence rate of DVT in 204 enrolled patients was 30.9%. Multivariate logistic regression indicated that hypertension (OR 3.159, 95% CI 1.465-6.816; = 0.003), higher postoperative D-dimer (OR 1.225, 95% CI 1.016-1.477; = 0.034), female (OR 0.174, 95% CI 0.054-0.568; = 0.004), and lower GCS score (OR 0.809, 95% CI 0.679-0.965; = 0.013) were independently associated with incidence of DVT in patients after neurosurgery. The logistic regression function (LR model) of these four independent risk factors had a better performance on diagnostic value of DVT in patients after neurosurgery.
The combined factor was constructed by hypertension, postoperative D-dimer, gender, and GCS score, and it might be a more handy and reliable marker to stratify patients at risk of DVT after neurosurgery.
众所周知，接受神经外科手术治疗神经疾病的患者下肢深静脉血栓（DVT）的风险更高。作为一种潜在的危及生命的并发症，在神经外科手术后相对高危患者中，下肢深静脉血栓高危患者的发病率和危险因素仍存在争议。
本研究共纳入 204 例因卧床时间超过 3 天而被认为是 DVT 高危人群的神经外科手术患者。我们使用彩色多普勒超声系统（CDUS）评估下肢 DVT。记录患者入院时和术后的临床参数，并准备进行进一步分析。建立术后下肢 DVT 的早期预测因素。使用受试者工作特征（ROC）曲线分析评估预测因素的诊断性能。
204 例入组患者中 DVT 的总发生率为 30.9%。多因素 logistic 回归分析表明，高血压（OR 3.159，95%CI 1.465-6.816； = 0.003）、较高的术后 D-二聚体（OR 1.225，95%CI 1.016-1.477； = 0.034）、女性（OR 0.174，95%CI 0.054-0.568； = 0.004）和较低的 GCS 评分（OR 0.809，95%CI 0.679-0.965； = 0.013）与神经外科手术后患者 DVT 的发生率独立相关。这四个独立危险因素的 logistic 回归函数（LR 模型）在神经外科手术后患者 DVT 的诊断价值上表现更好。
构建了由高血压、术后 D-二聚体、性别和 GCS 评分组成的联合因素，可能是一种更简便、可靠的神经外科手术后 DVT 风险分层标志物。
