高原地区ICU患者下肢深静脉血栓发生现状及影响因素分析

doi:10.3761/j.issn.0254-1769.2022.24.008

摘要/Abstract

摘要：

目的调查高原地区ICU患者发生下肢深静脉血栓的现状，并分析其影响因素。方法采取便利抽样法，于2020年5月—10月以连续入组的方式，选取青海省某三级甲等医院ICU患者作为调查对象，收集患者的一般资料、临床资料，采用彩色多普勒超声检测仪对ICU患者实施双下肢静脉血栓超声诊断，分析ICU患者下肢深静脉血栓形成的影响因素。结果共调查ICU患者192例，ICU患者下肢深静脉血栓发生率为10.42%。单因素分析结果显示，性别、民族、年龄、居住地海拔高度、疾病类型、急性生理与慢性健康状况评分、活化部分凝血活酶时间、尿素氮、C反应蛋白与下肢深静脉血栓形成有关，差异具有统计学意义（均P<0.05）。多因素分析结果显示，女性（OR=9.094，95%CI为2.035~40.639，P=0.004）、少数民族（OR=5.510，95%CI为1.082~28.052，P=0.040）、居住地海拔2 000~2 500 m（OR=4.395，95%CI为1.433~44.572，P=0.021）、活化部分凝血活酶时间>37.05 s（OR=6.727，95%CI为1.117~40.496，P=0.037）、C反应蛋白>3.07 mg/L（OR=9.545，95%CI为1.403~64.945，P=0.021）是ICU患者发生下肢深静脉血栓的独立危险因素。结论对于入住ICU的患者应进行下肢深静脉血栓的早期筛查，女性、少数民族、居住地海拔2 000~2 500 m、活化部分凝血活酶时间>37.05 s、C反应蛋白>3.07 mg/L的ICU患者应作为深静脉血栓的重点筛查人群。

关键词: 重症监护, 静脉血栓形成, 危险因素, 高原, 护理

Abstract:

Objective To investigate the status of deep venous thrombosis（DVT） of lower limbs in ICU patients in plateau area，and to analyze its influencing factors. Methods The convenience sampling method was adopted to select ICU patients in a tertiary A hospital in Qinghai Province from May to October 2020 as research subjects. The general demographic data and clinical data of the patients were collected. Doppler color ultrasound was used to diagnose the venous thrombosis of both lower limbs in ICU patients. The independent risk factors of DVT in ICU patients were analyzed. Results A total of 192 patients were investigated. The incidence of DVT in ICU patients was 10.42%. Univariate analysis showed that gender，ethnicity，age，altitude of residence，diagnosis，Acute Physiology and Chronic Health Evaluation Ⅱ，APTT，urea nitrogen and C-reactive protein were associated with lower extremity DVT，and the differences were statistically significant（all P<0.05）. The results of multivariate analysis showed that female（OR=9.094，95%CI 2.035~40.639，P=0.004），ethnic minorities（OR=5.510，95%CI 1.082~28.052，P=0.040），the altitude of residence 2 000~2 500 m（OR=4.395，95%CI 1.433~44.572，P=0.021），APTT>37.05 s（OR=6.727，95%CI 1.117~40.496，P=0.037），C-reactive protein >3.07 mg/L（OR=9.545，95%CI 1.403~64.945，P=0.021） were independent risk factors for DVT in ICU patients. Conclusion Early screening of DVT should be carried out for patients admitted to ICU，and the ICU patients who are female，ethnic minority with APTT>37.05 s and C-reactive protein>3.07 mg/L at altitude of 2 000~2 500 m should be regarded as the focus group of concern for DVT.

Key words: Intensive Care, Venous Thrombosis, Risk Factors, Plateau, Nursing Care

孙丽娟, 李月美, 潘世琴, 张成斌, 刘娟丽, 李晓芳, 董守云. 高原地区ICU患者下肢深静脉血栓发生现状及影响因素分析[J]. 中华护理杂志, 2022, 57(24): 2997-3003.

SUN Lijuan, LI Yuemei, PAN Shiqin, ZHANG Chengbin, LIU Juanli, LI Xiaofang, DONG Shouyun. Deep vein thrombosis of lower extremity in ICU patients in plateau area：a cross-sectional study[J]. Chinese Journal of Nursing, 2022, 57(24): 2997-3003.

图/表 3

表1 ICU患者下肢深静脉血栓形成的单因素分析（n=192）

Table 1 （Contiuned） Univariate analysis of general data and deep vein thrombosis of ICU patients（n=192）

表2 自变量赋值表

Table 2 Independent variables assignment

表3 ICU患者下肢深静脉血栓形成的多因素分析

Table 3 Multiple linear regression analysis of influencing factors of DVT in ICU patients

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