神经重症患者静脉血栓栓塞的发生率、危险因素及住院结局分析

doi:10.3969/j.issn.1673-5765.2021.07.010

摘要/Abstract

摘要： 目的探讨神经重症患者静脉血栓栓塞（venous thromboembolism，VTE）的发生率，并分析VTE相关的危险因素及其对住院结局的影响。方法基于电子病历系统数据回顾性分析2019年10月-2020年9月首都医科大学附属北京天坛医院的神经重症患者，根据患者住ICU期间是否发生VTE分为VTE组和无VTE组，计算VTE的发生率，通过多因素logistic回归分析神经重症患者VTE的危险因素，并比较两组间死亡率、住ICU时间、住院时间及住院费用的差异。结果共纳入神经重症患者723例，年龄中位数52岁，男性383例（53.0%），其中330例（45.6%）患者发生VTE。多因素logistic回归分析结果显示，年龄（OR 1.078，95%CI 1.053～1.104）、BM（I OR 1.082， 95%CI 1.013～1.156）和D-二聚体水平（OR 1.042，95%CI 1.006～1.079）升高是发生VTE的独立危险因素。两组死亡率无统计学差异（4.8% vs 3.6%，P =0.388），VTE组住院天数（21 d vs 18 d）、住I CU天数（8 d vs 5 d）及住院费用（121 358元 vs 93 717元）较无VTE组增加（均P＜0.001）。结论神经重症患者VTE的发生率为45.6%，年龄、BMI和D-二聚体水平升高是其独立危险因素。发生VTE可延长患者住院时间、住ICU时间，增加患者住院费用。

文章导读： 神经重症患者系VTE高风险人群，VTE的发生可延长患者的住院时间，增加患者的住院费用，而高龄、高BMI和D-二聚体水平升高是其发生的独立危险因素。

关键词: 静脉血栓栓塞; 深静脉血栓; 肺栓塞; 神经重症; 发生率; 危险因素

Abstract: Objective To explore the incidence and risk factors of venous thromboembolism (VTE) in neurocritical patients, and the influence of VTE on in-hospital outcomes. Methods The data of the neurocritical patients in Beijing Tiantan Hospital from October 2019 to September 2020 were retrospectively analyzed. According to the presence of VTE or not after SAH during ICU hospitalization, the patients were divided into VTE group and non-VTE group. The incidence of VTE was calculated. The differences in mortality, the length of ICU stay and hospital stay, and the cost of hospitalization were compared between the two groups. Multivariate logistic regression analysis was used to identify the risk factors of VTE in neurocritical patients. Results A total of 723 patients were included in this study, with a median age of 52 years old and 383 males (53.0%), and 330 patients (45.6%) had VTE. Multivariate logistic regression analysis showed that the age (OR 1.078, 95%CI 1.053-1.104), BMI (OR 1.082, 95%CI 1.013-1.156), and D-dimer level (OR 1.042, 95%CI 1.006-1.079) were independent risk factors for VTE. The inhospital mortality between the two groups had no statistical difference (4.8% vs 3.6%, P =0.388). However, compared with non-VTE group, the length of hospital stay (21 d vs 18 d), the length of

ICU stay (8 d vs 5 d) and the cost of hospitalization (121 358 CNY vs 93 717 CNY) increased in

VTE group (all P <0.001). Conclusions The incidence of VTE in neurocritical patients was 45.6%. The elder age, BMI and increased D-dimer level may be independent risk factors for VTE. Additionally, VTE might increase the length of hospital stay, the length of ICU stay and hospitalization cost.

Key words: Venous thromboembolism; Deep vein thrombosis; Pulmonary embolism;Neurocritical; Incidence; Risk factor

高浩然, 王岩, 段雨晴, 徐珊珊, 苗明月, 程昆明, 周建新, 张琳琳. 神经重症患者静脉血栓栓塞的发生率、危险因素及住院结局分析[J]. 中国卒中杂志, 2021, 16(07): 694-698.

GAO Hao-Ran, WANG Yan, DUAN Yu-Qing, XU Shan-Shan, MIAO Ming-Yue, CHENG Kun-Ming, ZHOU Jian-Xin, ZHANG Lin-Lin. Incidence, Risk Factors and In-hospital Outcome of Venous Thromboembolism in Neurocritical Patients[J]. Chinese Journal of Stroke, 2021, 16(07): 694-698.

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