作者：田润，张蜜，郭利涛，韩娟，马佳佳

单位：

西安交通大学第一附属医院重症医学科

Units：

Department of Critical Care Medicine, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China

关键词：

静脉血栓形成; 重症监护病房; 影响因素分析;

Keywords：

Venous thrombosis; Intensive care units; Root cause analysis

CLC：

DOI：

10.12114/j.issn.1008-5971.2023.00.126

Funds：

西安交通大学第一附属医院科研发展基金（2020HL-04）

摘要：

目的 分析重症患者入住ICU前静脉血栓发生情况及其影响因素。方法 选取2021年西安交通大学第一附属医院重症医学科收治的重症患者263例为研究对象。建立ICU患者超声诊断下静脉血栓监测系统，收集患者一般资料。根据静脉血栓发生情况，将患者分为血栓组和非血栓组。采用多因素Logistic回归分析探讨重症患者入住ICU前发生静脉血栓的影响因素。结果 263例患者中，发生静脉血栓128例（48.7%）。血栓组和非血栓组年龄及肾综合征出血热、中心静脉置管者占比比较，差异有统计学意义（P<0.05）。263例患者中，91例（34.6%）发生浅静脉血栓（STP），共累及139个静脉，其中上肢静脉127例次（头静脉82例次、贵要静脉24例次、肘正中静脉21例次）、下肢静脉12例次（均为大隐静脉）。263例患者中，81例（30.8%）发生深静脉血栓（DVT），共累及166个静脉，其中上肢静脉14例次（肱静脉5例次、颈内静脉4例次、腋静脉3例次、锁骨下静脉2例次）、下肢静脉152例次（肌间静脉113例次、股静脉14例次、腘静脉7例次、胫后静脉7例次、髂外静脉4例次、股浅静脉4例次、胫前静脉3例次）。155例行中心静脉置管的患者中，49例（31.6%）发生导管相关静脉血栓（CRT），均属于DVT。多因素Logistic回归分析结果显示，年龄、肾综合征出血热、中心静脉置管是重症患者入住ICU前发生静脉血栓的影响因素（P<0.05）。结论 重症患者入住ICU前静脉血栓发生率较高，为48.7%，其中STP主要发生在上肢、DVT主要发生在下肢，STP主要累及头静脉、DVT主要累及肌间静脉；且年龄增长、中心静脉置管是重症患者入住ICU前发生静脉血栓的危险因素，而肾综合征出血热是其保护因素。

Abstract：

Objective To analyze the incidence of venous thrombosis and its influencing factors in severe patients before admission to ICU. Methods A total of 263 critically ill patients admitted to the Department of Critical Care at the First Affiliated Hospital of Xi'an Jiaotong University in 2021 were selected as the research subjects. A venous thrombosis monitoring system for ICU patients under ultrasonic diagnosis was established, and general data of patients were collected. According to the occurrence of venous thrombosis, the patients were divided into thrombus group and non-thrombus group. Multivariate Logistic regression analysis was used to investigate the influencing factors of venous thrombosis in critically ill patients before admission to ICU. Results Among 263 patients, 128 (48.7%) had venous thrombosis. There were statistically significant differences in age, and the proportion of hemorrhagic fever with renal syndrome and central vein catheterization between thrombus group and non-thrombus group (P < 0.05) . Among 263 patients, 91 (34.6%) developed superficial venous thrombosis (STP) , involving 139 veins, including 127 in the upper limb vein (82 in the cephalic vein, 24 in the noble vein, 21 in the median cubitus vein) and 12 in the lower limb vein (all were great saphenous vein) . Of the 263 patients, 81 (30.8%) developed deep vein thrombosis (DVT) , involving 166 veins, including 14 cases of upper limb vein (5 cases of brachial vein, 4 cases of internal jugular vein, 3 cases of axillary vein, 2 cases of subclavian vein) , 152 cases of lower limb vein (113 cases of intermuscular vein, 14 cases of femoral vein, 7 cases of popliteal vein, 7 cases of posterior tibial vein, 4 cases of external iliac vein, 4 cases of superficial femoral vein, 3 cases of anterior tibial vein) . Among 155 patients undergoing central venous catheterization, 49 cases (31.6%) developed catheter-related venous thrombosis (CRT) , all of which were DVT. Multivariate Logistic regression analysis results showed that age, hemorrhagic fever with renal syndrome and central venous catheterization were the influencing factors for the occurrence of venous thrombosis in critically ill patients before admission to ICU (P < 0.05) . Conclusion The incidence of venous thrombosis in critically ill patients before admission to ICU is higher (48.7%) , of which STP mainly occurs in the upper limbs, DVT mainly occurs in the lower limbs, STP mainly involves the cephalic vein, and DVT mainly involves the intermuscular vein. Moreover, increased age and central venous catheterization are the risk factors for venous thrombosis in critically ill patients before admission to ICU, while hemorrhagic fever with renal syndrome is the protective factor.

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