髋关节置换患者不同阶段深静脉血栓风险调查及影响因素分析

Risk of deep venous thrombosis in patients with hip arthroplasty in different stages and related influencing factors

摘要:

目的：分析髋关节置换的患者不同阶段深静脉血栓（deep venous thrombosis，DVT）风险的变化情况及影响因素。方法：采用方便抽样法，使用一般资料调查表、Autar DVT风险量表、日常生活能力量表（Barthel量表）和Charlson合并症指数分别于入院当天、手术当天、出院当天、出院1个月对重庆市某三级甲等医院209名髋关节置换的患者进行追踪性观察。结果：各阶段DVT风险评估总分为12.31~15.42分，自入院当天开始上升，在手术当天达到最高值后，呈下降趋势，但出院当天DVT的风险高于入院当天。多元线性回归分析显示，入院时最有效的血栓预测指标为日常生活能力（β=-0.460，P＜0.05），疾病类型是入院时DVT风险的独立影响因素（β=0.194，P=0.000）；体质指数（body mass index，BMI）在手术后至出院1个月均为血栓风险的重要指标（β=0.315，β=0.302，β=0.251，均P＜0.05）；年龄、住院次数和Charlson合并症是入院至出院1个月预测DVT的重要指标（β=0.229，β=0.098，β=0.258；β=0.383，β=0.133，β=0.423；β=0.273，β=0.114，β=0.115，β=0.313；β=0.217，β=0.115，β=0.223，均P＜0.05），术后开始下床时间也是DVT的影响因素（β=0.258，β=0.278，均P＜0.05）。结论：髋关节置换患者从入院至出院1个月，DVT风险均处于中高危水平。高龄、肥胖、Charlson合并症、多次住院史、术后开始下床时间晚是DVT的危险因素。应根据不同阶段的危险因素采取针对性预防措施，提示医务人员对于出院时DVT高危患者给予持续关注，重视全面系统的院外血栓预防措施的普及，加强出院后的随访。

Abstract:

Objective：To investigate the changes in the risk of deep venous thrombosis（DVT） in patients undergoing hip arthroplasty in different stages and related influencing factors. Methods：The method of convenience sampling was used. A total of 209 patients who underwent hip arthroplasty in a grade A tertiary hospital in Chongqing，China were enrolled，and a questionnaire of general informa－tion，Autar Scale，Barthel scale，and Charlson comorbidity index were used for observation on the day of admission，the day of surgery，and the day of discharge and at one month after discharge. Results：The total score of DVT risk assessment ranged from 12.31 to 15.42 at different time points；this score started to increase since the day of admission，reached the peak on the day of surgery，and then tended to decrease，but the risk of DVT on the day of discharge was higher than that on the day of admission. The multivariate linear regression analysis showed that activities of daily living was the most effective predictive factor for DVT on admission（β=-0.460，P<0.05） and disease type was an independent influencing factor for DVT on admission（ β=0.194，P=0.000）；body mass index（BMI） was an important risk factor for DVT from after surgery to one month after discharge（ β=0.315，0.302，and 0.251，all P<0.05）；age，times of hospitalization，and Charlson comorbidity index were important predictive factors for DVT from admission to one month after discharge（β=0.229，β=0.098，β=0.258；β= 0.383，β=0.133，β=0.423；β=0.273，β=0.114，β=0.115，β=0.313；β=0.217，β=0.115，β=0.223，all P<0.05），and time to ambulation after surgery was also an influencing factor for DVT（β=0.258 and 0.278，P<0.05）. Conclusion：Patients undergoing hip arthroplasty have intermediate to high risk of DVT from admission to one month after discharge. Old age，obesity，Charlson comorbidity，history of multiple hospital－izations，and a long time to ambulation after surgery are risk fac－tors for DVT. Preventive measures should be taken according to the risk factors in different periods of time，and the medical staff should pay attention to the patients with a high risk of DVT at the time of discharge. Comprehensive preventive measures for DVT should be taken seriously and follow-up after discharge should be strengthened.