一项关于重大创伤后静脉血栓栓塞的前瞻性研究。

A prospective study of venous thromboembolism after major trauma.

作者信息

Geerts W H, Code K I, Jay R M, Chen E, Szalai J P

机构信息

Department of Medicine, Sunnybrook Health Science Centre, University of Toronto, ON, Canada.

出版信息

N Engl J Med. 1994 Dec 15;331(24):1601-6. doi: 10.1056/NEJM199412153312401.

DOI:10.1056/NEJM199412153312401

PMID:7969340

Abstract

BACKGROUND

Although deep-vein thrombosis and pulmonary embolism are considered common complications after major trauma, their frequency and the associated risk factors have not been carefully quantified.

METHODS

We performed serial impedance plethysmography and lower-extremity contrast venography to detect deep-vein thrombosis in a cohort of 716 patients admitted to a regional trauma unit. Prophylaxis against thromboembolism was not used.

RESULTS

Deep-vein thrombosis in the lower extremities was found in 201 of the 349 patients (58 percent) with adequate venographic studies, and proximal-vein thrombosis was found in 63 (18 percent). Three patients died of massive pulmonary embolism before venography could be performed. Before venography, only three of the patients with deep-vein thrombosis had clinical features suggestive of the condition. Deep-vein thrombosis was found in 65 of the 129 patients with major injuries involving the face, chest, or abdomen (50 percent); in 49 of the 91 patients with major head injuries (53.8 percent); in 41 of the 66 with spinal injuries (62 percent); and in 126 of the 182 with lower-extremity orthopedic injuries (69 percent). Thrombi were detected in 61 of the 100 patients with pelvic fractures (61 percent), in 59 of the 74 with femoral fractures (80 percent), and in 66 of the 86 with tibial fractures (77 percent). A multivariate analysis identified five independent risk factors for deep-vein thrombosis: older age (odds ratio, 1.05 per year of age; 95 percent confidence interval, 1.03 to 1.06), blood transfusion (odds ratio, 1.74; 95 percent confidence interval, 1.03 to 2.93), surgery (odds ratio, 2.30; 95 percent confidence interval, 1.08 to 4.89), fracture of the femur or tibia (odds ratio, 4.82; 95 percent confidence interval, 2.79 to 8.33), and spinal cord injury (odds ratio, 8.59; 95 percent confidence interval, 2.92 to 25.28).

CONCLUSIONS

Venous thromboembolism is a common complication in patients with major trauma, and effective, safe prophylactic regimens are needed.

摘要

背景

尽管深静脉血栓形成和肺栓塞被认为是严重创伤后的常见并发症，但其发生率及相关危险因素尚未得到精确量化。

方法

我们对收治于某地区创伤治疗中心的716例患者进行了系列阻抗体积描记法及下肢静脉造影以检测深静脉血栓形成。未采取预防血栓栓塞的措施。

结果

在349例接受了充分静脉造影检查的患者中，有201例（58%）发现下肢深静脉血栓形成，63例（18%）发现近端静脉血栓形成。3例患者在静脉造影检查前死于大面积肺栓塞。在静脉造影检查前，只有3例深静脉血栓形成患者有提示该病的临床特征。在129例面部、胸部或腹部有严重损伤的患者中，65例（50%）发现深静脉血栓形成；在91例重度颅脑损伤患者中，49例（53.8%）发现深静脉血栓形成；在66例脊髓损伤患者中，41例（62%）发现深静脉血栓形成；在182例下肢骨科损伤患者中，126例（69%）发现深静脉血栓形成。在100例骨盆骨折患者中，61例（61%）检测到血栓；在74例股骨骨折患者中，59例（80%）检测到血栓；在86例胫骨骨折患者中，66例（77%）检测到血栓。多变量分析确定了深静脉血栓形成的5个独立危险因素：年龄较大（比值比，每年1.05；95%置信区间，1.03至1.06）、输血（比值比，1.74；95%置信区间，1.03至2.93）、手术（比值比，2.30；95%置信区间，1.08至4.89）、股骨或胫骨骨折（比值比，4.82；95%置信区间，2.79至8.33）以及脊髓损伤（比值比，8.59；95%置信区间，2.92至25.28）。