开颅术后ICU老年患者下肢深静脉血栓的危险因素预测效能研究^*

Study on the predictive efficacy of risk factors for lower extremity deep vein thrombosis in elderly icu patients post-craniotomy

摘要

目的 探讨开颅术后ICU老年患者下肢深静脉血栓(DVT)形成的危险因素和预测效能。方法 选取2023年6月—2024年6月首都医科大学附属北京天坛医院重症医学科收治的年龄≥65岁的开颅术后患者进行回顾性研究。根据ICU住院期间下肢超声检查结果,将患者分为DVT组和无DVT组。计算下肢DVT的发生率,收集和比较两组相关资料,采用多因素logistic回归模型分析老年开颅术后ICU患者下肢DVT形成的危险因素,采用ROC曲线评估各指标的预测价值。结果 共收集190例开颅术后入住ICU并完成下肢超声检查的老年患者,其中存在下肢DVT的131例为DVT组(发病率68.95%),未发现下肢DVT的59例为无DVT组。两组格拉斯哥昏迷评分、C反应蛋白、纤维蛋白降解产物、D-二聚体及纤维蛋白原比较,差异均有统计学意义(P<0.05)。多因素logistic回归分析显示,C反应蛋白及D-二聚体是老年开颅术后ICU患者下肢DVT发生的独立危险因素(P<0.05)。ROC曲线提示C反应蛋白>50.07 mg/L [AUC(95%CI): 0.597(0.505~0.689), P=0.033]和D-二聚体>6.52 μg/mL [AUC(95%CI): 0.802(0.738~0.867), P<0.001]为截断点时预测性能最佳。结论 在开颅术后老年ICU患者中,C反应蛋白和D-二聚体是下肢DVT的独立危险因素和预测因素。

Abstract

Objective To explore the risk factors, predictive efficacy of lower extremity deep venous thrombosis (DVT) in elderly patients after craniotomy admitted to the ICU. Methods A retrospective study was conducted in patients aged ≥ 65 years after craniotomy admitted to the department of critical care medicine of Beijing Tiantan Hospital, Capital Medical University from June 2023 to June 2024. Patients were divided into a DVT group and a non-DVT group based on the results of lower extremity ultrasound examinations during their ICU stay. The incidence of lower extremity DVT was calculated. Relevant data from both groups was collected and compared. Multivariate logistic regression model was used to analyze the risk factors of DVT formation in elderly ICU patients after craniotomy, and a ROC curve was used to assess the predictive value of each index. Results A total of 190 elderly post-craniotomy patients admitted to the ICU who completed lower extremity ultrasound examinations were included in the study. Among them, 131 patients were diagnosed with lower extremity DVT (DVT group, incidence rate: 68.95%), while 59 patients showed no evidence of DVT (non-DVT group). Significant differences were observed between the two groups in Glasgow Coma Scale score, C-reactive protein, fibrin degradation products, D-dimer, and fibrinogen levels (all P<0.05). Multivariate logistic regression analysis revealed that C-reactive protein and D-dimer were independent risk factors for lower extremity DVT in elderly ICU patients after craniotomy (P<0.05). ROC curve analysis indicated that CRP > 50.07 mg/L [AUC (95% CI): 0.597 (0.505 - 0.689), P = 0.033] and D-dimer > 6.52 μg/mL [AUC (95%CI): 0.802 (0.738-0.867), P<0.001] were the optimal cutoff values for predicting DVT. Conclusion In elderly patients undergoing craniotomy and admitted to the ICU, C-reactive protein and D-dimer are independent predictors of lower extremity DVT.

关键词

下肢深静脉血栓 / 开颅术后 / C反应蛋白 / D-二聚体 / 危险因素

Key words

Lower extremity deep vein thrombosis / Post-craniotomy / C-reactive protein / D-dimer / Risk factors

参考文献

[1] Filiberto D M, Byerly S, Lenart E K, et al. Body mass index and pharmacologic venous thromboembolism prophylaxis in traumatic brain injury[J]. J Surg Res, 2023, 291: 245-249.

[2] Skrifvars M B, Bailey M, Presneill J, et al. Venous thromboembolic events in critically ill traumatic brain injury patients[J]. Intensive Care Med, 2017, 43(3): 419-428.

[3] Ali A B, Khawaja A M, Reilly A, et al. Venous thromboembolism risk and outcomes following decompressive craniectomy in severe traumatic brain injury: an analysis of the nationwide inpatient sample database[J]. World Neurosurg, 2022, 161: e531-e545.

[4] Sun T, Chen Y, Ge S, et al. Analysis of upper gastrointestinal bleeding complicated with deep vein thrombosis in elderly gastric cancer patients by gastric cancer imaging[J]. Biotechnol Genet Eng Rev, 2024, 40(3): 1472-1488.

[5] 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.

[6] Vascular Surgery Group of Chinese Society of Surgery. Guidelines for the Diagnosis and Treatment of Deep Vein Thrombosis (Third Edition)[J]. Chin J General Surg, 2017, 32(9): 807-812.

[7] Zhang P, Bian Y, Xu F, et al. The incidence and characteristics of venous thromboembolism in neurocritical care patients: a prospective observational study[J]. Clin Appl Thromb Hemost, 2020, 26: 1076029620907954.

[8] Shi S, Cheng J, Chen H, et al. Preoperative and intraoperative predictors of deep venous thrombosis in adult patients undergoing craniotomy for brain tumors: a Chinese single—center, retrospective study[J]. Thromb Res, 2020, 196: 245-250.

[9] 刘靖, 陈建伟, 张军, 等 . 老年下肢手术患者术后1个月内发生下肢深静脉血栓的危险因素分析[J]. 血管与腔内血管外科杂志, 2024, 10(7): 861-865.

[10] Liu J, Chen J W, Zhang J, et al. Analysis of risk factor for lower extremity deep vein thrombosis in elderly patients undergoing lower extremity surgery within one month after surgery[J]. JVES, 2024, 10(7): 861-865.

[11] 李晶, 孟亚楠, 李晶晶, 等 . 脑卒中患者住院康复期间发生下肢深静脉血栓的危险因素分析[J]. 血管与腔内血管外科杂志, 2024, 10(10): 1207-1210.

[12] Li J, Meng Y N, Li J J, et al. Risk factors of lower extremity deep vein thrombosis in stroke patients during hospitalization and rehabilitation[J]. JVES, 10(10): 1207-1210.

[13] 李婷婷 . 气压治疗仪联合低分子肝素钠预防脑卒中后合并偏瘫患者下肢深静脉血栓形成的效果[J]. 临床医学工程, 2021, 28(9): 1173-1174.

[14] Li T T. Effect of pressure therapeutic apparatus combined with low molecular weight heparin sodium on the prevention of formation of lower extremity deep venous thrombosis in patients with hemiplegia after stroke[J]. Clin Med Engin, 2021, 28(9): 1173-1174.

[15] Ruan Y, Wang F, Du X, et al. Rehabilitation nursing after lower limb fracture: Preventing deep vein thrombosis and enhancing quality of life[J]. Medicine (Baltimore), 2023, 102(47): e36180.

[16] 隋松涛, 范凤, 孙金波 . 低剂量低分子肝素钙在老年脑出血患者下肢深静脉血栓预防中的作用[J]. 中国老年学杂志, 2022, 42(22): 5429-5431.

[17] Sui S T, Fan F, Sun J B. Effect of low dose low molecular weight heparin calcium in prevention of lower extremity deep venous thrombosis in elderly patients with cerebral hemorrhage[J]. Chin J Gerontol, 2022, 42(22): 5429-5431.

[18] 张嵘, 何地芹, 刘红娟, 等 . 低分子肝素钠治疗高血压脑出血合并下肢深静脉血栓形成的疗效观察[J]. 颈腰痛杂志, 2021, 42(3): 407-409.

[19] Zhang R, He D Q, Liu H J, et al. Efficacy of low molecular weight heparin sodium in the treatment of hypertensive intracerebral hemorrhage with lower extremity deep venous thrombosis[J]. J Cervicodyn Lumbodyn, 2021, 42(3): 407-409.

[20] Condon F, Grigorian A, Russell D, et al. Venous thromboembolism chemoprophylaxis in geriatric trauma patients with isolated severe traumatic brain injury[J]. Eur J Trauma Emerg Surg, 2024, 50(1): 197-203.

[21] Peng S, Zhang M, Jin J, et al. The effectiveness of venous thromboembolism prophylaxis interventions in trauma patients: a systematic review and network meta—analysis[J]. Injury, 2023, 54(12): 111078.

[22] 张莎莎, 许彬, 颜伟, 等 . 老年脑出血患者术后下肢深静脉血栓风险模型的构建[J]. 国际老年医学杂志, 2024, 45(1): 59-63.

[23] Zhang S S, Xu B, Yan W, et al. Establishment of risk model of postoperative deep venous thrombosis in elderly patients with cerebral hemorrhage[J]. Int J Geriatr, 2024, 45(1): 59-63.

[24] Parmontree P, Ketprathum P, Ladnok T, et al. Predictive risk factors for venous thromboembolism in neurosurgical patients: a retrospective analysis single center cohort study[J]. Ann Med Surg (Lond), 2022, 77: 103628.

[25] 彭建忠, 董海丹, 罗晓军 . D—二聚体 hs—CRP 联合 Wells 评分早期诊断 VTE 的临床价值[J]. 安徽医学, 2022, 43(2): 182-185.

[26] Peng J Z, Dong H D, Luo X J. Clinical value of D—dimer hs—CRP combined with Wells score in early diagnosis of VTE[J]. Anhui Med J, 2022, 43(2): 182-185.

[27] 马伟刚 . 血清 hs—CRP、IL—6 和 D—D 检测对下肢深静脉血栓形成的诊断和疗效评估价值[J]. 河南外科学杂志, 2022, 28(1): 136-138.

[28] Ma W G. Value of serum hs—CRP, IL—6 and D—D in the diagnosis and therapeutic evaluation of lower extremity deep venous thrombosis[J]. Henan J Surg, 2022, 28(1): 136-138.

[29] 王芳, 赵配配, 徐美娜, 等 . 围手术期间歇性充气加压对重度颅脑损伤患者下肢深静脉血栓形成的预防效果[J]. 中国实用神经疾病杂志, 2024, 27(8): 1045-1048.

[30] Wang F, Zhao P P, Xu M N, et al. Preventive effect of intermittent inflation and compression during perioperative period on lower limb deep vein thrombosis in patients with severe head injury[J]. Chin J Pract Nerv Dis, 2024, 27(8): 1045-1048.

[31] 孙晓敏, 孙晓红 . 间歇性充气加压预防重度颅脑损伤患者下肢深静脉血栓形成的效果[J]. 血栓与止血学, 2022, 28(1): 173-174.

[32] Sun X M, Sun X H. Effect of intermittent pneumatic compression on prevention of deep venous thrombosis in patients with severe craniocerebral injury[J]. Chin J Thromb Hemost, 2022, 28(1): 173-174.

[33] Fernando S M, Tran A, Cheng W, et al. VTE prophylaxis in critically ill adults: a systematic review and network meta—analysis[J]. Chest, 2022, 161(2): 418-428.

基金资助

^*贵阳市科技计划项目(〔2024〕2-24)