血红蛋白水平对上肢骨折患者深静脉血栓形成的影响

doi:10.3969/j.issn.1000-8535.2023.02.013

摘要/Abstract

摘要： 目的分析血红蛋白水平对上肢骨折患者深静脉血栓形成(DVT)的影响。方法采用回顾性分析法,对2018年1月—2021年6月期间来我院进行治疗的386例上肢骨折患者展开研究,依据患者是否发生DVT分为DVT组(n=114)和对照组(n=272)。对2组患者的各项一般资料和临床资料进行比较,对有统计学意义的因素进一步行Logistic多因素回归分析,探究上肢骨折患者发生DVT的危险因素,并Pearson分析血红蛋白水平与各危险因素的相关性。结果与对照组相比,DVT组患者为女性、年龄＞60岁、体质量指数(BMI)＞25 kg/m²、冠状动脉粥样硬化性心脏病、糖尿病、合并其他骨折、受伤至超声检查时间≥3 d、受伤至手术时间＞5 d、纤维蛋白降解产物(FDP)≥35 mg/L、凝血酶时间(TT)≥17 s、血红蛋白≤120 g/L、血小板计数/血红蛋白比值≥2.5、血糖≥8 mmol/L、全身麻醉、术后住院时间＜7 d的发生率升高,差异有统计学意义(P＜0.05)。Logistic多因素回归分析显示,年龄＞60岁、BMI＞25 kg/m²、受伤至手术时间＞5 d、血红蛋白≤120 g/L、血小板计数/血红蛋白比值≥2.5、血糖≥8 mmol/L是上肢骨折患者发生DVT的危险因素(P＜0.05)。上肢骨折患者的血红蛋白水平与年龄、BMI、受伤至手术时间、血小板计数/血红蛋白比值、血糖水平呈现负相关(P＜0.05)。结论血红蛋白≤120 g/L是上肢骨折患者发生DVT的危险因素,与DVT的发生存在相关性。

关键词: 上肢骨折, 深静脉血栓, 血红蛋白, 危险因素

Abstract: Objective To analyze the influence of hemoglobin level on deep vein thrombosis (DVT) in patients with upper extremity fractures. Methods A retrospective study of 386 upper extremity fracture patients who came to our hospital for treatment from January 2018 to June 2021 was carried out.According to whether the patients had DVT or not, they were divided into DVT group (n=114) and control group (n=272).The general data and clinical data of the two groups were compared, and the statistically significant factors were further analyzed by Logistic multivariate regression analysis to explore the risk factors of DVT in patients with upper limb fractures, and analyzed the hemoglobin level and the risk factors correlation by Pearson. Results Compared with the control group, the DVT group had increased incidence in female, age >60 years old, body mass index (BMI) >25 kg/m², coronary heart disease, diabetes mellitus, other fractures, injury to ultrasonic time ≥3 days, injury to operation time >5 days, fibrin degradation products (FDP) ≥35 mg/L, thrombin time (TT) ≥ 17 s, hemoglobin ≤120 g / L, platelet count / hemoglobin ratio ≥2.5, blood glucose ≥8 mmol/L, general anesthesia and postoperative hospital stay <7 days, and the difference was significant (P<0.05).Logistic multivariate regression analysis showed that age>60, BMI>25 kg/m², time from injury to operation>5 days, hemoglobin≤120 g/L, platelet count/hemoglobin ratio ≥2.5, blood glucose ≥8 mmol/L were the risk factors of DVT in patients with upper extremity fractures (P<0.05).The hemoglobin level of those patients was negatively correlated with age, BMI, time from injury to operation, platelet count/hemoglobin ratio and blood glucose level (P<0.05). Conclusions Hemoglobin ≤120 g/L was a risk factor for DVT in patients with upper extremity fractures, and it was related to the occurrence of DVT.

Key words: upper extremity fractures, deep vein thrombosis, hemoglobin, risk factors

刘奋飞, 刘东平, 李建明. 血红蛋白水平对上肢骨折患者深静脉血栓形成的影响[J]. 广州医药, 2023, 54(2): 64-69.

LIU Fenfei, LIU Dongping, LI Jianming. Influence of hemoglobin level on deep vein thrombosis in patients with upper extremity fracture[J]. Guangzhou Medical Journal, 2023, 54(2): 64-69.

参考文献

[1] SKEIK N, SMITH J E, JENSEN J D, et al.Literature review of distal deep vein thrombosis[J].J Vasc Surg Venous Lymphat Disord,2021,9(4):1062-1070.
[2] KHAN O, MARMARO A, COHEN D A.A review of upper extremity deep vein thrombosis[J].Postgrad Med,2021,133(sup1):3-10.
[3] KIM K A, CHOI S Y, KIM R.Endovascular treatment for lower extremity deep vein thrombosis: an overview[J].Korean J Radiol,2021,22(6):931-943.
[4] OBI A T, BARNES G D, NAPOLITANO L M, et al.Venous thrombosis epidemiology, pathophysiology, and anticoagulant therapies and trials in severe acute respiratory syndrome coronavirus 2 infection[J].J Vasc Surg Venous Lymphat Disord,2021,9(1):23-35.
[5] 刘鸿,冯莹莹,邢莉民.自身免疫性溶血性贫血并发静脉血栓栓塞症的研究现状[J].国际输血及血液学杂志,2020,43(4):313-317.
[6] 李佳蔚,李燊,周文涛,等.聚合人脐带血红蛋白氧载体对部分凝血指标影响的体外初步研究[J].中国输血杂志,2021,34(4):339-342.
[7] ROGNONI C, LUGLI M, MALETI O, et al.Clinical guidelines versus current clinical practice for the management of deep vein thrombosis[J].J Vasc Surg Venous Lymphat Disord,2021,9(5):1334-1344.
[8] KAHN S R, JULIAN J A, KEARON C, et al.Quality of life after pharmacomechanical catheter-directed thrombolysis for proximal deep venous thrombosis[J].J Vasc Surg Venous Lymphat Disord,2020,8(1):8-23.
[9] LISETTE F D, DRONKERS C E A, GAUTAM G, et al.Magnetic resonance imaging for diagnosis of recurrent ipsilateral deep vein thrombosis[J].Blood,2020,135(16):1377-1385.
[10] 禹焰,于源,李帅.老年髋部骨折病人术后下肢抬高方式与下肢深静脉血栓的相关性研究[J].实用老年医学,2021,35(6):642-644.
[11] 朱冬梅,张家雄,刘贻尚,等.两样本孟德尔随机化法分析儿童期肥胖与成人深静脉血栓形成的因果关联[J].中国血管外科杂志(电子版),2021,13(3):245-248,255.
[12] 敬慧丹,李洪超,艾山木,等.非急诊老年创伤重症患者受伤至手术的间隔时间与预后的关系[J].解放军医药杂志,2019,31(7):64-67.
[13] 傅一牧,李冬冬,荆尧,等.血小板计数与血红蛋白比值和血糖变化对合并颅脑创伤的多发伤患者下肢深静脉血栓形成的预测价值[J].上海医学,2017,40(11):660-663.
[14] 张明亮,李爱玲,王玉涛.2型糖尿病患者发生小腿肌间静脉血栓的危险因素分析[J].国际内分泌代谢杂志,2021,41(5):450-454.
[15] 张明亮,李爱玲,王玉涛.2型糖尿病患者发生小腿肌间静脉血栓的危险因素分析[J].中国中西医结合外科杂志,2021,27(4):576-580.
[16] 钟锐,吴小东,王红,等.西藏地区不同血红蛋白含量的男性藏族人群血浆凝血功能分析[J].中国输血杂志,2021,34(6):581-584.
[17] 李树灏,张堃,宋哲,等.血红蛋白量与下肢骨折下肢深静脉血栓形成发生率的关系分析[J].中华创伤骨科杂志,2021,23(10):864-870.
[18] 陈仁盛,彭超.高原地区下肢骨折术后发生深静脉血栓与血红蛋白相关性的分析[J].西藏医学,2020,41(6):57-59.