Occurrence of deep venous thrombosis in adult burn patients and its risk factors
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摘要:
目的 探讨成年烧伤患者深静脉血栓(DVT)发生情况及危险因素。 方法 2015年1月1日—2016年8月31日，郑州市第一人民医院烧伤科收治符合入选标准的成年烧伤患者1 219例，其中男811例、女408例，年龄18～102岁，以病例对照研究的方法对其临床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12例和非DVT组1 207例。统计DVT发生率及DVT确诊时间、累及四肢与类型；比较2组患者性别、年龄、烧伤总面积、D－二聚体，以及是否有下肢烧伤、Ⅲ度烧伤、股静脉留置中心静脉导管(CVC)、吸入性损伤、脓毒症/感染性休克、外科手术、输注浓缩红细胞情况，对数据行
χ 2检验。选取2组比较差异有统计学意义的指标，行多因素二分类logistic回归分析，筛选成年烧伤患者发生DVT的独立危险因素。 结果 (1)成年烧伤患者DVT发生率为0.98%(12/1 219)；DVT确诊时间为伤后24～138 d，中位数为61.5 d；DVT累及右侧下肢2例、左侧下肢8例、双侧下肢2例，分型包括混合型6例、周围型6例。(2)2组患者在性别、年龄、Ⅲ度烧伤方面比较，差异无统计学意义(
χ 2＝1.524、0.021、3.115，
P >0.05)；在烧伤总面积、下肢烧伤、吸入性损伤、脓毒症/感染性休克、D－二聚体、股静脉留置CVC、外科手术和输注浓缩红细胞方面比较，差异有统计学意义(
χ 2＝17.975、6.206、3.987、8.875、5.447、15.124、10.735、14.031，
P <0.05或
P <0.01)。(3)烧伤总面积、D－二聚体和股静脉留置CVC是本组成年烧伤患者发生DVT的独立危险因素(比值比＝10.927、4.762、9.394，95%置信区间＝3.078～38.789、1.197～18.934、2.631～33.540，
P <0.05或
P <0.01)。 结论 成年烧伤患者DVT发生率较低，DVT确诊时间为烧伤3周后，分型为混合型和周围型，烧伤总面积、股静脉留置CVC和D－二聚体是可预测成年烧伤患者并发DVT的独立危险因素。
Abstract:Objective To investigate the occurrence and risk factors of deep venous thrombosis (DVT) in adult burn patients. Methods The clinical data of 1 219 adult burn patients admitted to the Department of Burns of Zhengzhou First People′s Hospital from January 1, 2015 to August 31, 2016, conforming to the study criteria, were analyzed retrospectively by the method of case-control study, including 811 males and 408 females, aged 18-102 years. According to whether DVT occurred during hospitalization or not, the patients were divided into group DVT (
n =12) and non-DVT group (
n =1 207). The incidence of DVT, the diagnosis time of DVT, affected limbs, and DVT classification were counted and recorded. The gender, age, total burn area, D-dimer, lower limb burn, full-thickness burn, femoral vein indwelling central venous catheter (CVC) , inhalation injury, sepsis/infection shock, surgical operation, and infusion of concentrated red blood cells of patients between the two groups were compared with chi-square test, and then the indicators with statistically significant differences between the two groups were processed by multivariate binary logistic regression analysis to screen the independent risk factors of DVT in the adult burn patients. Results (1) The incidence of DVT of adult burn patients was 0.98% (12/1 219), and DVT was diagnosed 24-138 days after injury, with a median of 61.5 days. DVT occurred in the right lower limb of 2 patients, left lower limb of 8 patients, and bilateral lower limbs of 2 patients, and DVT classification included 6 cases of mixed type and 6 cases of peripheral type. (2) There were no statistically significant differences in gender, age, and full-thickness burn of patients between the two groups (
χ 2=1.524, 0.021, 3.115,
P >0.05). There were statistically significant differences in total burn area, lower limb burn, inhalation injury, sepsis/infection shock, D-dimer, femoral vein indwelling CVC, surgical operation, and infusion of concentrated red blood cells among patients between the two groups (
χ 2=17.975, 6.206, 3.987, 8.875, 5.447, 15.124, 10.735, 14.031,
P <0.05 or
P <0.01). (3) Total burn area, D-dimer, and femoral vein indwelling CVC were independent risk factors for DVT in adult burn patients (odds ratio=10.927, 4.762, 9.394, 95% confidence interval=3.078-38.789, 1.197-18.934, 2.631-33.540,
P <0.05 or
P <0.01). Conclusions The incidence of DVT in adult burn patients is relatively low, and the diagnosis time of DVT is 3 weeks after burn, with DVT classification of mixed type and peripheral type. The total burn area, femoral vein indwelling CVC, and D-dimer are independent risk factors for predicting DVT in adult burn patients.
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Key words:
- Burns /
- Venous thrombosis /
- Risk factors
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