ICU患者发生静脉血栓栓塞的影响因素分析
Influencing factors of venous thromboembolism in hospitalized patients of intensive care unit
目的 调查分析ICU患者发生静脉血栓栓塞(VTE)的影响因素,为相关临床决策提供参考.方法 采用病例对照研究,连续收集2011年11月至2016年11月昆山市三级医院ICU住院患者中确诊的224例VTE患者作为病例组,从ICU同期入院的非VTE患者中随机选择224例作为对照组,回顾性收集患者一般资料、实验室检查等相关临床资料以及VTE防治情况,采用Logistic回归模型分析ICU患者发生VTE的影响因素.结果 单因素分析显示,性别、年龄、高血压、吸烟史、D-二聚体、Caprini评分和VTE的防治措施与VTE的发生具有一定相关性,多因素分析中除高血压外,其余上述因素均为ICU患者发生VTE的独立预测因素:女性(OR=1.68,95%CI1.09~2.61,P=0.02)、年龄增加(OR=1.03,95%CI1.01~1.04,P<0.01)、吸烟史(OR=6.82,95%CI1.70~27.46,P=0.007)、D-二聚体(OR=0.94,95%CI0.92~0.96,P<0.01)、Caprini评分(OR=1.80,95%CI1.33~2.44,P<0.01)和VTE防治措施(OR=0.34,95%CI0.15~0.79,P=0.01).结论 对于女性、年龄较大、有吸烟史、D-二聚体检验值较高的ICU患者应加强VTE的筛查,对于Caprini评分高者应高度重视,并采取相应的防治措施,以减少VTE的形成及其带来的损害.
更多Objective To analyze the influencing factors of venous thromboembolism (VTE) in intensive care units, and provide evidence for corresponding clinical decisions. Methods A case-control study was carried out:224 VTE patients admitted to the ICUs of tertiary hospitals in Kunshan from Nov. 2011 to Nov. 2016 were included in the case group, and 224 non-VTE patients admitted during the same period were randomly selected as the control. The patients' medical history, laboratory tests, prophylaxis and treatment of VTE, and other relevant data were retrieved. Logistic aggression analysis was utilized to identify the influencing factors of VTE in hospitalized critically ill patients. Results The univariate analysis showed that gender, age, hypertension, smoking, D-dimer, Caprini scaling, prophylaxis and treatment of VTE were associated with VTE. The multivariate analysis indicated that except hypertension, the other varieties were independent influencing factors of VTE in hospitalized critically ill patients:female ( OR=1.68, 95%CI:1.09-2.61, P=0.02), higher age(OR=1.03, 95%CI:1.01-1.04, P<0.01), smoking(OR=6.82, 95%CI:1.70-27.46, P=0.007), smoking(OR=6.82, 95%CI:1.70-27.46, P=0.007), D-dimer(OR=0.94, 95%CI:0.92-0.96, P<0.01), higher Caprini scaling(OR=1.80, 95%CI:1.33-2.44, P<0.01), prophylaxis and treatment of VTE(OR=0.34, 95%CI:0.15-0.79, P=0.01). Conclusions Those ICU patients who are female, elder, with smoking history, have higher test value of D-dimer should be screened and assessed for VTE, and those with higher Caprini scaling should be given closer attention, and receive corresponding prophylaxis and treatment to reduce the formation of VTE and its damage.
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