【摘要】 目的 筛选全麻术后转入麻醉重症监护室(AICU)的患者新发下肢深静脉血栓(DVT)的危险因素。方法 回顾性收集2022年5—8月择期行全麻下手术后带气管插管转入AICU的患者192例，男105例，女87例，年龄18～85岁，BMI 18～31 kg/m~2,ASAⅡ或Ⅲ级。收集患者基线资料、麻醉手术资料及实验室检查资料。根据入AICU 6 h内的超声结果是否有新发DVT将患者分为两组：DVT组和非DVT组。采用多因素Logistic回归分析筛选AICU中患者术后6 h内新发DVT的危险因素及其95%可信区间(CI)。结果 全麻术后在AICU新发DVT的患者有64例(33.3%),均为小腿肌间静脉血栓(CMVT)。多因素Logistic回归分析结果显示，术前心律失常(OR=2.236,95%CI 1.011～4.943,P=0.047)、术前血小板计数高(OR=1.006,95%CI 1.002～1.010,P=0.007)、术前D-二聚体浓度高(OR=1.203,95%CI 1.046～1.383,P=0.010)、术中低血压(OR=1.010,95%CI 1.002～1.019,P=0.020)和术中应用去甲肾上腺素(OR=3.796,95%CI 1.697～8.492,P=0.001)是全麻术后AICU中患者新发DVT的危险因素；阿司匹林规律服用史(OR=0.176,95%CI 0.060～0.518,P=0.002)是其保护因素。结论 术前心律失常、术前血小板计数高、术前D-二聚体浓度高、术中低血压及术中应用去甲肾上腺素是全麻手术后AICU患者6 h内新发DVT的危险因素。更多还原

【Abstract】 Objective To identify the risk factors for newly developed lower extremity deep vein thrombosis(DVT) in patients transferred to the anesthesia intensive care unit(AICU) after general anesthesia. Methods A total of 192 patients who were transferred to AICU with tracheal intubation after elective general anesthesia from May 2022 to August 2022, 105 males and 87 females, aged 18-85 years, BMI 18-31 kg/m~2, ASA physical status Ⅱ or Ⅲ, were retrospectively collected. The patients’ baseline data, anesthesia surgery data and preoperative and postoperative laboratory examination data were obtained. The patients were divided into two groups according to the results of ultrasound within 6 hours after admission to the AICU: DVT group and non-DVT group. Multivariate logistic regression analysis was used to analyze the risk factors and 95% confidence interval(CI) of DVT in AICU patients within 6 hours after surgery. ResultsNew DVT occurred in 64 patients(33.3%) in AICU after general anesthesia were calf intermuscular venous thrombosis(CMVT). Multivariate logistic regression analysis showed that preoperative arrhythmia(OR = 2.236, 95% CI 1.011-4.943, P = 0.047), high preoperative platelet count(OR = 1.006, 95% CI 1.002-1.010, P = 0.007), high preoperative D-dimer concentration(OR=1.203, 95% CI 1.046-1.383, P = 0.010), intraoperative hypotension(OR = 1.010, 95% CI 1.002-1.019, P = 0.020), and intraoperative norepinephrine application(OR = 3.796, 95% CI 1.697-8.492, P = 0.001) were risk factors for new DVT formation in AICU patients after general anesthesia. History of regular intake of aspirin(OR = 0.176, 95% CI 0.060-0.518, P = 0.002) was protective factor. ConclusionPreoperative arrhythmia, high preoperative platelet count, high preoperative D-dimer concentration, intraoperative hypotension, and administration of intraoperative norepinephrine are risk factors for new DVT within 6 hours after general anesthesia in AICU patients.更多还原