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深静脉血栓形成的分析:一项前瞻性观察研究。

Analysis of Deep Vein Thrombosis: A Prospective Observational Study.

作者信息

Ali Iqbal M, Reddy M Vijay Sai, Shetty Varun

机构信息

General Surgery, Dr D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND.

出版信息

Cureus. 2024 Aug 28;16(8):e68014. doi: 10.7759/cureus.68014. eCollection 2024 Aug.

Abstract

Objective This prospective observational study aimed to investigate the prevalence, acquired risk factors, and treatment outcomes of deep vein thrombosis (DVT) at a tertiary care center in India. Materials and methods Conducted from 2022 to 2024, the study included 100 patients diagnosed with lower extremity DVT. The study subjects included patients visiting the general surgery, vascular surgery, surgical gastroenterology, general medicine, emergency medicine, and obstetrics and gynecology departments with symptoms suggestive of DVT. The primary objectives were to evaluate the effectiveness of conventional anticoagulation and thrombolytic therapy as well as to assess the various acquired risk factors for DVT. Patients underwent comprehensive clinical and biochemical evaluations, including venous Doppler ultrasound, and were treated based on their clinical presentations. The study's primary end outcome was early recanalization rates on day 14 post-initiation of treatment and occurrence of post-thrombotic syndrome (PTS). Secondary outcome measures included duration of hospital stay, time taken to return to work and early complications. Results The highest incidence of DVT was in individuals in their forties, with a mean age of 44.84+/-11.71 years and a female preponderance of 58% (n=58). Key acquired risk factors identified included hypertension (25%; n=25), diabetes mellitus (20%; n=20), obesity (16%; n=16), and smoking (34%; n=34). Obesity (16%; n=16), a history of DVT (25%; n=25), trauma/immobilization (9%; n=9), pregnancy (10%; n=10), smoking (34%; n=34), and cancer (20%; n=20) were also identified as important acquired risk factors contributing to the occurrence of DVT. Amongst the study participants, 28% (n=28) had femoro-popliteal segment involvement, 36% (n=36) had calf vein thrombosis, and the remaining 36% (n=36) showed femoro-iliac segment thrombosis. Conventional anticoagulation was administered to 69% (n=69) of patients, while 31% (n=31) received thrombolytic therapy. Both treatments showed similar recanalization rates, but thrombolytic therapy was associated with a longer hospital stay (8.61+/-1.65 days; p=0.024; p<0.05) and return to work period (14.65+/-2.31 days; p=0.012; p<0.05). Post-thrombotic syndrome was less common in the thrombolytic therapy group (3%; n=3). Three patients died in the study, with the cause being pulmonary embolism. The descriptive statistics were computed to delineate the study sample. After completion of data collection, data analysis was achieved using SPSS for Windows, Version 16 (Released 2007; SPSS Inc., Chicago, United States), and the correlations sought after were achieved using the chi-square test of significance. Conclusion The study underscores the importance of recognizing and managing acquired risk factors for DVT, thereby facilitating early diagnosis and ultimately reducing morbidity and mortality. Understanding these factors and employing effective treatment strategies are crucial for better management and prevention of DVT, enhancing patient outcomes.

摘要

目的 本前瞻性观察性研究旨在调查印度一家三级医疗中心深静脉血栓形成(DVT)的患病率、获得性危险因素及治疗结果。

材料与方法 该研究于2022年至2024年进行,纳入了100例被诊断为下肢DVT的患者。研究对象包括前往普通外科、血管外科、外科胃肠病学、普通内科、急诊医学以及妇产科就诊且有DVT症状的患者。主要目的是评估传统抗凝和溶栓治疗的有效性以及评估DVT的各种获得性危险因素。患者接受了全面的临床和生化评估,包括静脉多普勒超声检查,并根据临床表现进行治疗。该研究的主要终点结局是治疗开始后第14天的早期再通率以及血栓形成后综合征(PTS)的发生情况。次要结局指标包括住院时间、恢复工作所需时间以及早期并发症。

结果 DVT发病率最高的是四十多岁的人群,平均年龄为44.84±11.71岁,女性占比58%(n = 58)。确定的主要获得性危险因素包括高血压(25%;n = 25)、糖尿病(20%;n = 20)、肥胖(16%;n = 16)和吸烟(34%;n = 34)。肥胖(16%;n = 16)、DVT病史(25%;n = 25)、创伤/制动(9%;n = 9)、妊娠(10%;n = 10)、吸烟(34%;n = 34)和癌症(20%;n = 20)也被确定为导致DVT发生的重要获得性危险因素。在研究参与者中,28%(n = 28)累及股腘段,36%(n = 36)有小腿静脉血栓形成,其余36%(n = 36)表现为股髂段血栓形成。69%(n = 69)的患者接受了传统抗凝治疗,而31%(n = 31)接受了溶栓治疗。两种治疗方法的再通率相似,但溶栓治疗与更长的住院时间(8.61±1.65天;p = 0.024;p<0.05)和恢复工作时间(14.65±2.31天;p = 0.012;p<0.05)相关。溶栓治疗组中血栓形成后综合征较少见(3%;n = 3)。研究中有3例患者死亡,死因是肺栓塞。计算描述性统计数据以描述研究样本。数据收集完成后,使用Windows版SPSS 16(2007年发布;SPSS公司,美国芝加哥)进行数据分析,并使用卡方显著性检验寻求相关性。

结论 该研究强调了识别和管理DVT获得性危险因素的重要性,从而促进早期诊断并最终降低发病率和死亡率。了解这些因素并采用有效的治疗策略对于更好地管理和预防DVT、改善患者结局至关重要。

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