Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Yuzhong District, Chongqing, 400000, China.
J Orthop Surg Res. 2020 Dec 10;15(1):597. doi: 10.1186/s13018-020-02131-5.
Clinical characteristics, anticoagulant protocols, and risk factors of deep vein thrombosis (DVT) in patients with femoral and pelvic fractures were analyzed throughout the perioperative period to provide references for early identification and optimization of risk factors.
This was a retrospective study. A total of 569 patients undergoing surgery of femoral and pelvic fractures from May 2018 to December 2019 were included. The clinical data including general conditions, trauma, surgery, anticoagulant protocols, and laboratory indexes were collected. According to the results of deep vein Doppler ultrasonography of the lower extremities, the patients were divided into non-DVT group and DVT group. Univariate analysis and multivariate logistic regression analysis were used to identify the independent risk factors of preoperative and postoperative DVT.
The incidence of DVT was 40.25% and preoperative DVT was 26.71%, which was higher than the incidence of postoperative DVT of 17.22%. Most of them were thrombus on the affected side (60.26%) and distal thrombus (81.66%). The average time of DVT formation was 6.55 ± 0.47 days after trauma and 6.67 ± 0.48 days after surgery. Chronic obstructive pulmonary disease (COPD), anemia, hypoproteinemia, non-anticoagulation before surgery, delayed anticoagulation after trauma and admission, high-energy trauma, multiple injuries, drinking history, and advanced age were independent risk factors for perioperative DVT. The increased level of fibrinogen degradation products was an independent risk factor for preoperative DVT. These risk factors were identified to be independently associated with postoperative DVT, including intraoperative blood transfusion, postoperative blood transfusion, pulmonary infection, preoperative non-anticoagulation, postoperative delayed anticoagulation, preoperative waiting time > 7 days, operative time > 2 h, c-reactive protein, fibrinogen level, platelet count 1 day after surgery, c-reactive protein, fibrinogen, and hemoglobin levels 3 days after surgery, comminuted fracture.
At present, anticoagulation and other DVT prevention and treatment programs have not changed the current situation that the incidence of DVT is still high. Through the analysis of the risk factors of DVT throughout the perioperative period, optimizing the perioperative blood transfusion, preoperative lung disease, hypoproteinemia, anemia, inflammation, etc., and surgery as soon as possible after trauma may further reduce its incidence.
分析股骨和骨盆骨折患者围手术期深静脉血栓形成（DVT）的临床特征、抗凝方案和危险因素，为早期识别和优化危险因素提供参考。
这是一项回顾性研究。纳入 2018 年 5 月至 2019 年 12 月期间接受股骨和骨盆骨折手术的 569 例患者。收集一般情况、创伤、手术、抗凝方案和实验室指标等临床资料。根据下肢深静脉多普勒超声结果，将患者分为非 DVT 组和 DVT 组。采用单因素分析和多因素 logistic 回归分析，识别术前和术后 DVT 的独立危险因素。
DVT 的发生率为 40.25%，其中术前 DVT 发生率为 26.71%，高于术后 DVT 发生率 17.22%。大多数为患侧血栓（60.26%）和远端血栓（81.66%）。DVT 形成的平均时间为创伤后 6.55±0.47 天，手术后 6.67±0.48 天。慢性阻塞性肺疾病（COPD）、贫血、低蛋白血症、术前未抗凝、创伤后和入院后抗凝延迟、高能创伤、多发伤、饮酒史和高龄是围手术期 DVT 的独立危险因素。纤维蛋白原降解产物水平升高是术前 DVT 的独立危险因素。这些危险因素被确定与术后 DVT 独立相关，包括术中输血、术后输血、肺部感染、术前未抗凝、术后抗凝延迟、术前等待时间＞7 天、手术时间＞2 小时、C 反应蛋白、纤维蛋白原水平、术后 1 天血小板计数、C 反应蛋白、纤维蛋白原和血红蛋白水平术后 3 天、粉碎性骨折。
目前，抗凝等 DVT 防治方案并未改变 DVT 发生率仍居高不下的现状。通过分析围手术期 DVT 的危险因素，优化围手术期输血、术前肺部疾病、低蛋白血症、贫血、炎症等，并在创伤后尽快手术，可能进一步降低其发生率。
