【作者】 杨磊；

【导师】 宋来君；

【作者基本信息】 郑州大学 ， 外科学， 2014， 硕士

【摘要】 目的探讨神经外科患者术后下肢深静脉血栓形成（deep venous thrombosis，DVT）的临床特点及危险因素，为临床预防和治疗提供指导。方法选取2012年7月至2013年12月在郑州大学第一附属医院神经外科手术治疗的196例患者作为研究对象，所有入选患者术前已排除DVT，术后3天、7天、14天行床旁彩色多普勒超声检查和血浆D-二聚体测定，随访记录所有病例的临床资料，前瞻性的调查神经外科患者术后下肢DVT的发病率，分析其临床特点。根据术后是否发生DVT分为血栓组和对照组，所有资料录入计算机后进行统计学处理。计量资料采用均数±标准差（x±s）表示，两组间比较采用t检验，p<0.05有统计学意义。选择性别、年龄、高血压、冠心病、糖尿病、吸烟、饮酒、手术时间、长期卧床或瘫痪、肿瘤、术后应用脱水、激素药物作为可能影响神经外科患者术后下肢DVT的因素进行危险因素分析：首先采用卡方检验进行单因素分析，筛选出有统计学意义的影响因素，然后采用二分类多因素Logistic回归分析进行多因素分析，均设定p<0.05有统计学意义，得出神经外科患者术后下肢DVT的危险因素。结果所有病例中，术后发生下肢DVT61例，发生率31.1%。血栓组患者中男31例（50.8%），女30例（49.2%），年龄21-83岁，平均55.38±13.21岁；血栓检出时间在术后1周内40例（65.6%），1周以上21例（34.4%）；无临床症状者37例（60.7%），有症状者24例（39.3%），常见症状依次为患肢肿胀20例（83.3％）、下肢疼痛16例（66.7％）、软组织张力增高11例（45.8%），三种症状均有者7例（29.2％）；血栓位于左下肢38例(62.3％)，右下肢14例(23.0%)，双下肢9例(14.8％)；常见的静脉受累部位依次为小腿肌间静脉52例（85.2%）、腓静脉24例（39.3%）、胫后静脉11例（18.0%）。两组患者术前血浆D-二聚体水平差异无统计学意义；术后血浆D-二聚体水平血栓组大于对照组，差异有统计学意义（p<0.05），并且两组D-二聚体水平均大于正常参考值。危险因素分析中，单因素分析结果显示：年龄、高血压、吸烟、手术时间、长期卧床或瘫痪、肿瘤、术后应用脱水药、术后应用激素等因素在血栓组和对照组之间的差异有统计学意义（p<0.05）；多因素Logistic回归分析得出年龄>50岁、高血压、长期卧床或瘫痪、肿瘤、术后应用脱水药是神经外科患者术后下肢DVT的危险因素。结论1．下肢深静脉血栓形成是神经外科患者术后的常见并发症，发病率为31.1%。多数患者无明显症状，有症状患者中常见症状依次为患肢肿胀、疼痛、软组织张力增高。血栓多于术后1周内形成，分布左侧大于右侧，小腿肌间静脉血栓形成最多见。2．年龄>50岁、高血压、长期卧床或瘫痪、肿瘤、术后应用脱水药是神经外科患者术后下肢深静脉血栓形成的危险因素，长期卧床或瘫痪风险最高。3．彩色多普勒超声具有准确性高、无创、可重复、可床旁检查等优点，是神经外科术后监测患者下肢深静脉血栓形成的首选方法和有效手段。4．针对存在下肢深静脉血栓形成危险因素的神经外科患者，术后应加强预防和监测措施，及早诊断和治疗。更多还原

【Abstract】 ObjectiveTo investigate clinical features and risk factors for lower-extremity DVT inpostoperative neurosurgical patients in order to provide guidance for clinicalprevention and treatment.MethodsFrom Jan2012to Dec2013,196patients who had neurosurgical operations inthe Department of Neurosurgery of the First Affiliated Hospital of ZhengzhouUniversity, were selected as the research subjects. All patients had no DVT beforesurgery. Bedside color dopple ultrasonography and measurements of D-dimer levelswere performed on the3rd,7th, and14th days after surgery. Follow-up clinical datawere recorded for the investigation of incidence of lower-extremity DVT inpostoperative neurosurgical patients and analysis of related clinical features. Allpatients were divided into thrombus group and control group according to theexistence of postoperative DVT. Statistical analysis were performed after all theinformation was entering into the computer. Measurement data were presented asmean±standard deviation（x±s）and t-test was used for the comparison between twogroups, p <0.05was considered statistically significant. The possible risk factors forDVT in postoperative neurosurgical patients, including sex, age, hypertension,coronary heart disease,diabetes, smoking, alcohol consumption, operationtime,bedridden or paralysis, tumor, postoperative dehydration,glucocorticoid,wereused for the analysis of risk factors.First,single factor analysis was used to selectstatistically significant factors(the method of chi-square test was used); thenmultivariate analysis was used to determine risk factors for lower-extremity DVT inpostoperative neurosurgical patients(binary logistic regression analysis wasused)p<0.05was set for statistically significant in two methods. ResultsLower-extremity DVT occurred in61patients and the incidence was31.1%.Inthe thrombus group,31cases(50.8%) were male and30cases(49.2%) were female,with a mean age of55.38±13.21years old ranging21-83years old; in40cases(65.6%),thrombus were detected less than1week after surgery,and in21case(34.4%), the time was more than1week after sugery;37cases(60.7%) had noclinical symptoms and24cases(39.3%)showed clinical symptoms. The commonsymptoms were limb swelling, lower extremity pain and increased soft tissue tension,which occurred in20cases (83.3%),16cases(66.7%) and11cases(45.8%), and all ofthese symptoms occurred in7cases(29.2%);38cases(62.3%) were left lowerextremity thrombosis,14cases(23.0%) were right lower extremity thrombosis, and9cases(14.8%) were both lower extremity thrombosis；the common sites of venousinvolvement were calf muscle vein, peroneal vein and posterior tibial vein, whichoccurred in52cases (85.2%),24cases(39.3%) and11cases(18.0%).The difference ofpreoperative plasma D-dimer levels between two groups was notstatisticallysignificant; postoperative plasma D-dimer levels in thrombus group were higher thanin the control group(p<0.05)，and plasma D-dimer levels of two groups were allhigher than the normal reference values. In the analysis of risk factors, the singlefactor analysis showed statistically significant difference of factors including age,hypertension, smoking, operation time,bedridden or paralysis, tumor, postoperativedehydration and glucocorticoid between two groups (p<0.05); binary Logisticregression analysis showed age>50years old, hypertension, bedridden or paralysis,tumor, postoperative dehydration were risk factors for lower-extremity deep venousthrombosis in postoperative neurosurgical patients.Conclusions1．Lower-extremity deep venous thrombosis was a common complication ofpostoperative neurosurgical patients, and the incidence was31.1%.Most patients hadno obvious symptoms; the common symptoms included limb swelling, lowerextremity pain and increased soft tissue tension. Most DVT occurred less than1week after surgery, and thrombosis in the left lower extremity was more often observedthan on the right side; the most common site of venous involvement was calf musclevein.2． Age>50years old, hypertension, bedridden or paralysis,postoperativedehydration and tumor were risk factors for DVT in neurosurgical patients, bedriddenor paralysis was the highest risk factor.3．Color doppler ultrasound had many advantages, such as high accuracy,non-invasive, repeatable and convenient for bedside examination, so it was thepreferred and effective method for monitoring of deep vein thrombosis inpostoperative neurosurgical patients.4．For neurosurgical patients who had risk factors, the prevention and monitoringmeasures should be strengthened for early diagnosis and treatment.更多还原