【摘要】 目的:探讨术后患者入住ICU对VTE发生的影响及相关危险因素的分析。方法:回顾性分析2015年1月1日至2015年12月31日广州市第一人民医院8558例手术患者,根据是否存在VTE分为VTE组(72例)和对照组(250例),单因素分析两组患者特征的差别,对可能有意义的因素行logistic回归分析。结果:(1)单因素分析结果显示术后入住ICU患者的D二聚体数值、手术时间、手术次数(≥2次)、卧床>72 h、肿瘤病理分期、中心静脉置管、糖尿病、冠心病、抗凝治疗的P值均小于0.05,有统计学意义。(2)logistic回归分析显示:卧床>72 h的OR值为6.96,95%CI:2.858-16.955,P=0.000;肿瘤病理分期的OR值为7.127,95%CI:1.96-25.911,P=0.003;抗凝治疗的OR值为0.397,95%CI:0.197-0.801,P=0.01。(3)Kaplan-Meier(K-M)法显示入住ICU>24 h的患者术后VTE 90天发生率明显高于入住ICU时间<24 h的患者(P=0.000)。结论:卧床>72 h是术后VTE发生的独立危险因素;肿瘤的病理分期是肿瘤患者术后VTE发生的独立危险因素;入住ICU时间>24 h是术后VTE发生的高危因素;抗凝治疗是术后VTE发生的保护性因素。更多还原

【Abstract】 Objective: To investigate the effect of postoperative ICU admission on occurrence of venous thromboembolism( VTE) and related risk factors. Methods: A review of 8558 surgical patients in Guangzhou First Municipal People’s Hospital between January 1 of 2015 to December 31 of 2015 identified 322 subjects,which were divided into the VTE group( n = 72) and the control group( n = 250) according to the occurrence of VTE. Univariate analysis was performed on the characteristics of the two groups. Potential variables were further analyzed by Logistic regression. Results:( 1) Univariate analysis showed that in these postoperative ICU patients,the D-dimer level,operative time,number of operations( ≥2),bed rest > 72 h,pathological staging of the tumor,central venous catheterization,diabetes,coronary heart disease,and anticoagulant therapy were related to VTE( P<0.05).( 2) Logistic regression analysis showed that bed rest > 72 h( OR = 6. 96,95% CI: 2. 858-16.955,P = 0. 000),pathological staging of the tumor( OR = 7. 127,95% CI: 1. 96-25. 911,P = 0. 003) and anticoagulant therapy( OR = 0. 397,95% CI: 0. 197-0. 801,P = 0. 01) were significant factors in VTE.( 3)Kaplan-Meier( K-M) survival analysis showed that patients with ICU stay > 24 h had higher 90-day incidence rate of postoperative VTE compared with those who stayed in ICU for less than 24 h( P = 0.000). Conclusion:Bed rest>72 h is an independent risk factor for postoperative VTE. The pathological staging of the tumor is an independent risk factor for postoperative VTE in cancer patients. ICU stay > 24 h is a high risk factor for postoperative VTE. Anticoagulant therapy is protective against postoperative VTE.更多还原