Email Alerts
RSS
Volume 38 Issue 6
Jun.  2022
Turn off MathJax
Article Contents
Article Navigation >  CHINESE JOURNAL OF BURNS AND WOUNDS  > 2022  >  38(6): 549-554
Zhang W,Huang HJ,Zhang JF,et al.Prevalence and risk factors of deep venous thrombosis of lower extremity in patients with stage Ⅲ and Ⅳ pressure ulcers on admission[J].Chin J Burns Wounds,2022,38(6):549-554.DOI: 10.3760/cma.j.cn501120-20210419-00134.
Citation: Zhang W,Huang HJ,Zhang JF,et al.Prevalence and risk factors of deep venous thrombosis of lower extremity in patients with stage Ⅲ and Ⅳ pressure ulcers on admission[J].Chin J Burns Wounds,2022,38(6):549-554.DOI: 10.3760/cma.j.cn501120-20210419-00134.
shu

Prevalence and risk factors of deep venous thrombosis of lower extremity in patients with stage Ⅲ and Ⅳ pressure ulcers on admission

doi: 10.3760/cma.j.cn501120-20210419-00134
  • 1.

    Department of Interventional Radiology, the First People's Hospital of Zhengzhou, Zhengzhou 450004, China

  • 2.

    Department of Wound Repair, the First People's Hospital of Zhengzhou, Zhengzhou 450004, China

  • 3.

    Department of Orthopedics, the First People's Hospital of Zhengzhou, Zhengzhou 450004, China

Funds:

Joint Construction Project of Medical Science and Technology in Henan Province LHGJ2019001

More Information
    Abstract
  •   Objective  To investigate the incidence and risk factors of deep venous thrombosis (DVT) of lower extremity in patients with stage Ⅲ and Ⅳ pressure ulcer on admission.  Methods  A retrospective case series study was conducted. A total of 241 patients with stage Ⅲ and Ⅳ pressure ulcers who met the inclusion criteria and were discharged from the Department of Wound Repair of the First People's Hospital of Zhengzhou from January 1, 2015 to December 31, 2019 were enrolled in this study, including 134 males and 107 females, aged 22 to 93 years, with a median age of 68 years; 37 patients were with stage Ⅲ pressure ulcers and 204 patients were with stage Ⅳ pressure ulcers. The DVT occurrence of patients was recorded. According to whether DVT of lower extremity veins was diagnosed by color Doppler ultrasound within 48 h after admission or not, the patients were divided into DVT group (n=37) and non-DVT group (n=204). Data of patients in the two groups were collected and compared, including gender, age, duration of pressure ulcer, time in bed, and combination with diabetes, hypertension, coronary heart disease, cerebral infarction, pneumonia, sepsis/septic shock, and paraplegia, and the plasma D-dimer level and Caprini score within 24 h after admission. Data were statistically analyzed with independent sample t test, Mann-Whitney U test, chi-square test, and Fisher's exact probability test. The indicators with statistically significant differences between the two groups were analyzed with multivariate logistic regression analysis to screen the independent risk factors influencing the DVT of lower extremity in 241 patients with stage Ⅲ and Ⅳ pressure ulcers on admission.  Results  The incidence of DVT of lower extremity was 15.4% (37/241), of which 86.5% (32/37) were asymptomatic DVT. Among the DVT of 46 lower limbs, only 29 involved the inferior genicular veins, accounting for 63.0%. There were no statistically significant differences in gender, duration of pressure ulcer, combination with diabetes, hypertension, coronary heart disease, cerebral infarction, pneumonia, and sepsis/septic shock of patients between the two groups (P>0.05), while there were statistically significant differences in age, time in bed, combination with paraplegia, the plasma D-dimer level and Caprini score of patients between the two groups(t=-3.19, Z=-2.04, χ2=4.44, Z=-3.89, t=-2.14, respectively, P<0.05 or P<0.01). Multivariate logistic regression analysis showed that age and plasma D-dimer level were independent risk factors influencing the DVT of lower extremity in 241 patients with stage Ⅲ and Ⅳ pressure ulcers on admission (with odds ratios of 1.03 and 1.18, respectively, with 95% confidence intervals of 1.00-1.06 and 1.05-1.33, respectively, P<0.05 or P<0.01).  Conclusions  The patients with stage Ⅲ and Ⅳ pressure ulcers have a higher incidence of DVT on admission, with age and plasma D-dimer level being the independent risk factors for DVT of lower extremity. It is necessary to pay attention to the targeted screening of DVT and education of its prevention.

     

    • FullText(HTML)
  • loading
    • References(36)
  • [1]
    中华医学会外科学分会血管外科学组. 深静脉血栓形成的诊断和治疗指南(第三版)[J].中华普通外科杂志,2017,32(9):807-812. DOI: 10.3760/cma.j.issn.1007-631X.2017.09.032.
    [2]
    “卧床患者常见并发症规范化护理干预模式的构建”项目组,中华护理学会行政管理专业委员会. 卧床患者常见并发症护理专家共识[J].中国护理管理,2018,18(6):740-747. DOI: 10.3969/j.issn.1672-1756.2018.06.006.
    [3]
    WuX, LiZ, CaoJ, et al. The association between major complications of immobility during hospitalization and quality of life among bedridden patients: a 3 month prospective multi-center study[J]. PLoS One, 2018,13(10):e0205729. DOI: 10.1371/journal.pone.0205729.
    [4]
    JiaoX, CuiC, NgSK, et al. The modified bilobed flap for reconstructing sacral decubitus ulcers[J/OL]. Burns Trauma, 2020,8:tkaa012[2022-03-23]. https://pubmed.ncbi.nlm.nih.gov/33335930/.DOI: 10.1093/burnst/tkaa012.
    [5]
    European Pressure Ulcer Advisory PanelNational Pressure Injury Advisory PanelPan Pacific Pressure Injury AlliancePrevention and treatment of pressure ulcers/injuries: clinical practice guideline2019-11-262020-04-19http://www.internationalguideline.com/

    European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, Pan Pacific Pressure Injury Alliance. Prevention and treatment of pressure ulcers/injuries: clinical practice guideline[EB/OL]. (2019-11-26)[2020-04-19]. http://www.internationalguideline.com/.
    [6]
    付小兵. 进一步重视体表慢性难愈合创面发生机制与防治研究[J].中华创伤杂志,2004,20(8):449-451. DOI: 10.3760/j:issn:1001-8050.2004.08.001.
    [7]
    CapriniJA. Thrombosis risk assessment as a guide to quality patient care[J]. Dis Mon, 2005, 51(2/3): 70-78. DOI: 10.1016/j.disamonth.2005.02.003.
    [8]
    ManiR, MargolisDJ, ShuklaV, et al. Optimizing technology use for chronic lower- extremity wound healing: a consensus document[J]. Int J Low Extrem Wounds, 2016, 15(2):102-119. DOI: 10.1177/1534734616646261.
    [9]
    WeiR, ChenHL, ZhaML, et al. Diabetes and pressure ulcer risk in hip fracture patients: a meta-analysis[J]. J Wound Care, 2017,26(9):519-527. DOI: 10.12968/jowc.2017.26.9.519.
    [10]
    贾晓明. 压疮的流行病学特点及诊断与治疗进展[J/CD].中华损伤与修复杂志:电子版,2018,13(1):4-7. DOI: 10.3877/cma.j.issn.1673-9450.2018.01.002.
    [11]
    HauckKD, WangSL, VincentC, et al. Healthy life-years lost and excess bed-days due to 6 patient safety incidents: empirical evidence from English hospitals[J]. Med Care, 2017, 55(2):125-130. DOI: 10.1097/MLR.0000000000000631.
    [12]
    SellierE, LabarereJ, SevestreMA, et al. Risk factors for deep vein thrombosis in older patients: a multicenter study with systematic compression ultrasonography in postacute care facilities in France[J]. J Am Geriatr Soc, 2008,56(2):224-230. DOI: 10.1111/j.1532-5415.2007.01545.x.
    [13]
    JenkinsDA, MohamedS, TaylorJK, et al. Potential prognostic factors for delayed healing of common, non-traumatic skin ulcers: a scoping review[J]. Int Wound J, 2019,16(3):800-812. DOI: 10.1111/iwj.13100.
    [14]
    张伟, 张俊峰, 王觅, 等. 体表慢性难愈合创面患者下肢深静脉血栓形成的发生情况及影响因素[J].中华医学杂志,2020,100(4):291-294. DOI: 10.3760/cma.j.issn.0376-2491.2020.04.010.
    [15]
    DennisM, SandercockP, ReidJ, et al. The effect of graduated compression stockings on long-term outcomes after stroke: the CLOTS trials 1 and 2[J]. Stroke, 2013, 44(4): 1075-1079. DOI: 10.1161/STROKEAHA.111.680298.
    [16]
    ZhangY, YangY, ChenW, et al. Prevalence and associations of VTE in patients with newly diagnosed lung cancer[J]. Chest, 2014,146(3):650-658. DOI: 10.1378/chest.13-2379.
    [17]
    QuH, LiZ, ZhaiZ, et al. Predicting of venous thromboembolism for patients undergoing gynecological surgery[J]. Medicine(Baltimore), 2015, 94(39): e1653. DOI: 10.1097/MD.0000000000001653.
    [18]
    van der WielenH, PostMWM, LayV, et al. Hospital-acquired pressure ulcers in spinal cord injured patients: time to occur, time until closure and risk factors[J]. Spinal Cord, 2016, 54(9): 726-731. DOI: 10.1038/sc.2015.239.
    [19]
    LeeYJ, KimJY, DongCB, et al. Developing risk-adjusted quality indicators for pressure ulcers in long-term care hospitals in the Republic of Korea[J]. Int Wound J, 2019, 16(Suppl 1): S43-50. DOI: 10.1111/iwj.13024.
    [20]
    孙明利, 冯亚平, 黄俊, 等. 住院患者深静脉血栓形成的临床特征[J].中华内科杂志,2017,56(12):914-918. DOI: 10.3760/cma.j.issn.0578-1426.2017.12.005.
    [21]
    王辰. 肺血栓栓塞症诊治与预防指南[J]. 中华医学杂志, 2018, 98(14): 1060-1087. DOI: 10.3760/cma.j.issn.0376-2491.2018.14.007.
    [22]
    孙亚萌, 张建政, 刘智. 老年骨折患者下肢深静脉血栓形成的危险因素及动态D-二聚体对其预测价值的分析[J]. 中国骨与关节杂志, 2020, 9(6): 419-424. DOI: 10.3969/j.issn.2095-252X.2020.06.005.
    [23]
    王勇, 张洪亮, 罗勤, 等. 出院前血浆D-二聚体水平对急性肺血栓栓塞症患者复发静脉血栓栓塞风险的预测价值[J]. 中国循环杂志, 2019, 34(10): 984-989. DOI: 10.3969/j.issn.1000-3614.2019.10.009.
    [24]
    张伟, 刘宝辉, 夏成德, 等. D-二聚体对成年烧伤患者下肢深静脉血栓形成的预测价值[J]. 中华烧伤与创面修复杂志, 2022, 38(4):335-340. DOI: 10.3760/cma.j.cn501120-20201021-00444.
    [25]
    Weill-EngererS, MeaumeS, LahlouA, et al. Risk factors for deep vein thrombosis in inpatients aged 65 and older: a case-control multicenter study[J]. J Am Geriatr Soc, 2004,52(8):1299-1304. DOI: 10.1111/j.1532-5415.2004.52359.x.
    [26]
    PottierP, HardouinJB, LejeuneS, et al. Immobilization and the risk of venous thromboembolism. A meta-analysis on epidemiological studies[J]. Thromb Res, 2009, 124(4): 468-476. DOI: 10.1016/j.thromres.2009.05.006.
    [27]
    GattME, PaltielO, BursztynM. Is prolonged immobilization a risk factor for symptomatic venous thromboembolism in elderly bedridden patients? Results of a historical-cohort study[J]. Thromb Haemost, 2004,91(3):538-543. DOI: 10.1160/TH03-07-0481.
    [28]
    张婉, 史振宇, 符伟国, 等. 住院高危患者下肢深静脉血栓形成的患病率调查[J]. 中华医学杂志, 2009, 89(45):3176-3180. DOI: 10.3760/cma.j.issn.0376-2491.2009.45.004.
    [29]
    BahlV, HuHM, HenkePK, et al. A validation study of a retrospective venous thromboembolism risk scoring method[J]. Ann Surg, 2010, 251(2):344-350. DOI: 10.1097/SLA.0b013e3181b7fca6.
    [30]
    LiQ, BaT, WangLF, et al. Stratification of venous thromboembolism risk in burn patients by Caprini score[J]. Burns, 2019, 45(1):140-145. DOI: 10.1016/j.burns.2018.08.006.
    [31]
    陈央, 周海霞, 胡月红, 等. 老年和非老年肺栓塞的危险因素及Caprini血栓风险评估量表的预测价值[J]. 中华医学杂志, 2017, 97(10):755-760. DOI: 10.3760/cma.j.issn.0376-2491.2017.10.008.
    [32]
    胡智洪, 游国亮, 何敏, 等. Caprini风险评估模型在神经外科卧床患者深静脉血栓栓塞筛选中的应用[J]. 国际神经病学神经外科学杂志, 2018, 45(3):221-224. DOI: 10.16636/j.cnki.jinn.2018.03.002.
    [33]
    OgerE, BressolletteL, NonentM, et al. High prevalence of asymptomatic deep vein thrombosis on admission in a medical unit among elderly patients[J]. Thromb Haemost, 2002,88(4):592-597.
    [34]
    CannonKA, BadieeJ, WallaceJD, et al. The prevalence of chronic deep venous thrombosis in trauma: implications for hospitals and patients[J]. J Trauma Acute Care Surg, 2018, 84(1):170-174. DOI: 10.1097/TA.0000000000001694.
    [35]
    TracyLM, CameronPA, SingerY, et al. Venous thromboembolism prophylaxis practice and its association with outcomes in Australia and New Zealand burns patients[J/OL]. Burns Trauma, 2021,9:tkaa044[2022-02-23].https://pubmed.ncbi.nlm.nih.gov/33654696/. DOI: 10.1093/burnst/tkaa044.
    [36]
    KumagaiG, WadaK, KudoH, et al. D-dimer monitoring combined with ultrasonography improves screening for asymptomatic venous thromboembolism in acute spinal cord injury[J]. J Spinal Cord Med, 2020, 43(3):353-357. DOI: 10.1080/10790268.2018.1518765.
    • Relative Articles
    • Supplements(0)
    • Cited By
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Figures(1)  / Tables(3)

    Get Citation
    PDF
    XML

    Article Metrics

    Article views (252) PDF downloads(31) Cited by()
    Proportional views
    Related

    Copyright © Chinese Journal of Burns京ICP备07035254号-14

    E-mail：shaoshangzazhi@163.com

    Website：https://zhsszz.xml-journal.net/

    Supported by: Beijing Renhe Information Technology Co. Ltd    

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return