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目的 调查烧伤患者深静脉血栓(DVT)发生情况,并探讨其影响因素. 方法 对2009年1月-2014年1月笔者单位收治的符合入选标准的2 506例烧伤患者的病历资料进行回顾性分析.根据住院期间是否发生DVT,将患者分为DVT组26例和非DVT组2 480例.计算DVT发生率,统计DVT诊断时间及类型;比较2组患者性别、年龄、烧伤深度、烧伤总面积、致伤部位、致伤原因、创面感染、静脉液体输入(高渗液、血液)、置管部位、植皮手术、伤后首次植皮手术时机、D-二聚体、伤后卧床时间情况,对数据行x 2检验、Wilcoxon检验.选取2组差异有统计学意义的指标,行多因素logistic逐步回归分析,筛选患者发生DVT的独立危险因素. 结果 (1)DVT发生率为1.04％(26/2 506);DVT诊断时间为伤后16 ～62(40±12)d,伤后20 d以后诊断者占92.3％(24/26);均为下肢DVT,类型包括中央型1例、周围型24例、混合型1例.(2)2组患者在性别、上肢烧伤、躯干烧伤、头面部烧伤、致伤原因、颈内静脉置管、植皮手术及伤后首次植皮手术时机方面比较,差异均无统计学意义(x2值为1.853 ～3.742,Z=3.342,P值均大于0.05);在年龄、烧伤深度、烧伤总面积、下肢烧伤、创面感染、静脉输入高渗液和血液、股静脉和锁骨下静脉置管、D-二聚体、伤后卧床时间方面比较,差异均有统计学意义(x2值为4.569 ～ 11.324,Z值分别为7.357、7.012,P＜0.05或P＜0.01).(3)年龄、烧伤总面积、下肢烧伤、创面感染、D-二聚体为患者发生DVT的独立危险因素(比值比分别为2.904、2.655、3.574、2.786、3.142,95％置信区间分别为1.504～7.652、1.368～6.594、1.958 ～8.511、1.459 ～7.001、1.922 ～8.062,P值均小于0.05). 结论 烧伤患者DVT发生率相对较低,诊断时间多在伤后20 d以后,类型以下肢周围型最为多见;年龄、烧伤总面积、下肢烧伤、创面感染、D-二聚体是可预测烧伤患者并发DVT的独立危险因素.

Objective To investigate the prevalence of deep venous thrombosis (DVT) in burn patients,and to explore its influencing factors.Methods Clinical data of 2 506 burn patients admitted to our ward from January 2009 to January 2014,conforming to the study criteria,were retrospectively analyzed.Patients were divided into DVT group (n =26) and non-DVT group (n =2 480) according to whether or not DVT occurred during hospitalization.The incidence of DVT was calculated.The diagnosis time and type of DVT were recorded.The data of gender,age,depth of burn,total burn area,location of injury,cause of injury,infection of wound,venous transfusion of fluid (hypertonic solution and blood),location of intravenous catheterization,skin grafting,timing of first skin grafting after injury,D-dimer,bedridden duration after injury among patients between two groups were compared with chi-square test and Wilcoxon test.Indexes with statistically significant differences between two groups were selected,and they were processed with multivariate logistic stepwise regression analysis to screen the independent risk factors of DVT.Results (1) The incidence of DVT was 1.04％ (26/2 506).The diagnosis time of DVT was 16-62(40 ± 12)d,and patients diagnosed as having DVT after the 20th day post injury accounted for 92.3％ (24/26).All DVT occurred in lower limbs,with 1 case of central type,24 cases of peripheral type,and 1 case of mixed type.(2) There were no statistically significant differences in gender,location of injury (upper limbs,trunk,head and face),cause of injury,jugular vein catheterization,skin grafting,and timing of first skin grafting after injury among patients between two groups (withx 2 values from 1.853 to 3.742,Z =3.342,P values above 0.05).There were statistically significant differences in age,depth of burn,total burn area,burn in lower limbs,infection of wound,venous transfusion of hypertonic solution and blood,femoral vein and subclavian vein catheterization,D-dimer,and bedridden duration after injury among patients between two groups (with x2 values from 4.569 to 11.324,Zvalues respectively 7.357 and 7.012,P ＜0.05 orP ＜0.01).(3) Age,total burn area,burn in lower limbs,infection of wound,and D-dimer were the independent risk factors of DVT (with odds ratio respectively 2.904,2.655,3.574,2.786,3.142,95％ confidence interval respectively 1.504-7.652,1.368-6.594,1.958-8.511,1.459-7.001,1.922-8.062,P values below 0.05).Conclusions The incidence of DVT in burn patients is relatively low;it is diagnosed after the 20th day post injury in most patients,and the overwhelming majority is the peripheral type.Age,total burn area,burn in lower limbs,infection of wound,and D-dimer are the independent risk factors of DVT in burn patients,with which its occurrence could be predicted.