高龄卧床患者血液高凝状态相关因素分析及其对下肢深静脉血栓形成的预后影响研究

Abstract

目的 探讨血栓弹力图(thromboelastogram,TEG) 在预测长期卧床高龄患者下肢深静脉血栓形成的临床应用价值,并进一步分析这类患者血液高凝状态的危险因素. 方法 选取2013年2月至2014年2月我院老年科住院患者70例,年龄70~90岁之间,因老年痴呆、脑卒中、骨折后卧床>1年的患者.以TEG测定的凝血综合指数(Clotting composite index,CI)分组,CI≤3的定为对照组,CI>3的定为高凝组.全部患者均随访12个月,每月进行随访,观察下肢深静脉血栓的发生率.并应用Logistic回归分析,分析老年卧床患者血液高凝状态的独立危险因素.结果 两组基线血栓弹力图指标:凝固角(α)、CI、凝固时间(K)、血栓最大幅度(MA)、凝血反应时间(R)比较差异均有统计学意义(P均<0.05).针对长期卧床老年患者高凝状态的相关因素的单因素分析结果显示,高凝状态与年龄(P=0.047)、糖尿病史(P=0.001)、卧床时间(P=0.043)、肿瘤(P=0.001)、骨折(P=0.002)相关,与性别、血脂、血压、饮酒、左心室射血分数无关.对可能导致长期卧床老年患者高凝状态的因素实施多因素Logistic回归分析,结果显示骨折[OR(95%CI):5.634(1.114~28.496),P=0.037]、肿瘤[OR(95%CI):4.652(1.142~18.955),P=0.032]及糖尿病[OR(95%CI):6.269(1.528~25.725),P=0.011]是老年卧床患者血液高凝状态的独立危险因素.结论 在长期卧床老年患者中,以CI值升高定义的高凝患者下肢深静脉血栓发生率明显高于CI值正常的患者;高凝状态的独立危险因素包括骨折、肿瘤及糖尿病.

Objective To investigate the clinical value of thromboelastogram(TEG) in predicting the deep venous thrombosis(DVT) formation of bedridden senile patients and further explore the risk factors for hypercoagulability in those patients.Methods Patients lying on bed for at least 1 year because of alzheimer's disease,stroke and fracture,aged between 70 to 90 years old,were selected in the Geriatrics Department of Shougang Hospital of Peking University from February 2013 to February 2014.Those patients were divided by Clotting composite index(CI) measured with TEG,CI less than and equal to 3 was control group,CI more than 3 was hypercoagulable group.The patients were followed-up for one year to identify the formation of DVT.Logistic regression analysis was used to analyze the independent risk factors of elderly patients with high blood coagulation state in bed.Results Two groups of baseline blood clots elastic graph indicators:Angle(α) of solidification,CI,coagulation time(K),the biggest thrombosis(MA),blood coagulation reaction time(R) comparative differences were statistically significant(P<0.05).In view of the bedridden elderly patients of high coagulation state,according to the result of single factor analysis of related factors,high coagulation state revealed with age(P=0.047),history of diabetes(P=0.001),bed time(P=0.043),tumor(P=0.001),fracture(P=0.002),but unrelated with sex,blood lipids,blood pressure,alcohol consumption,left ventricular ejection fraction.The multivariate logistic regression analysis indicated that fracture(OR(95%CI):5.634(1.114~28.496),P=0.037),tumor(OR(95%CI):4.652(1.142~18.955),P=0.032) and diabetes mellitus(OR(95%CI):6.269(1.528~25.725),P=0.011) were independent risk factors for DVT.Conclusion The incidence of DVT in bedridden senile patients with hypercoagulability identified by CI is higher than those with normal coagulability.Tumor,fracture and diabetes mellitus are independent risk factors for DVT.