机械通气患者深静脉血栓的发病率和危险因素分析

doi:10.3969/j.issn.1006-5253.2022.01.004

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Abstract Objective To explore the incidence and risk factors of deep vein thrombosis(DVT) in invasive mechanically ventilated patients.Methods Clinical data of mechanical ventilation patients admitted to the Emergency Care Unit of Jinhua Hospital Affiliated to Zhejiang University School of Medicine from January 2019 to December 2019 were collected, and the preventive measures of venous thrombosis, incidence of deep venous thrombosis, onset time, length of ICU stay, and 90-day all-cause mortality rate of the patients were recorded. Multivariate logistic regression analysis was used to assess the independent risk factors for DVT. Results Two hundred mechanically ventilated patients with a mean age of (59.3±16.8) years old, a median APACHEⅡ score of 19(14,24), a median Caprini 2009 score of 8(6,10), a median ICU length of stay of 9 (5,18) days, and a 90-day all-cause mortality rate of 24.5%. The incidence of DVT was 23.0%, and the median time of onset was 7(4,13) days after ICU admission. Multivariate Logistic regression analysis showed that patient′s age (OR=1.029, 95% CI: 1.005-1.055), and length of ICU stay (OR=1.057, 95% CI: 1.033-1.082) were independent risk factors for the development of DVT in ICU patients. Conclusion Patients receiving mechanical ventilation in the ICU are at high risk for DVT, and patients with DVT had significantly longer ICU stays. Independent risk factors for DVT were age and length of ICU stay.

Key words： mechanical ventilation deep vein thrombosis incidence risk factor

Received: 04 February 2022

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	Lou Xiaohua
	Zhang Bingwen
	Jing Daoyuan

Cite this article:

Lou Xiaohua,Zhang Bingwen,Jing Daoyuan. Deep venous thrombosis in invasive mechanically ventilated patients: incidence and risk factors[J]. journal1, 2022, 29(1): 18-24.

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http://manu58.magtech.com.cn/Jwk_zgyytj/EN/10.3969/j.issn.1006-5253.2022.01.004 OR http://manu58.magtech.com.cn/Jwk_zgyytj/EN/Y2022/V29/I1/18

［1］MAHAN C E, BORREGO M E, WOERSCHING A L, et al. Venous thromboembolism: Annualised United States models for total, hospitalacquired and preventable costs utilising long-term attack rates［J］. Thromb Haemost, 2012, 108(2):291-302. DOI:10.1160/TH12-03-0162.
［2］GEERTS W H, BERGQVIST D, PINEO G F, et al. Prevention of venous thromboembolism: American college of chest physicians evidence-based clinical practice guidelines: 8th edition［J］. Chest, 2008, 133(6 Suppl):381S-453S. DOI:10.1378/chest.08-0656.
［3］MINET C, POTTON L, BONADONA A, et al. Venous thromboembolism in the ICU: Main characteristics, diagnosis and thromboprophylaxis［J］. Crit Care, 2015, 19(8):287-295. DOI:10.1186/s13054-015-1003-9.
［4］CHEN X L, HUANG J L, LIU J X, et al. Venous thromboembolism risk factors and prophylaxis of elderly intensive care unit patients in a Chinese general hospital［J］. Ann Palliat Med, 2021, 10(4):4453-4462. DOI:10.21037/apm-21-464.
［5］TRITSCHLER T, KRAAIJPOEL N, LE GAL G, et al. Venous thromboembolism: Advances in diagnosis and treatment［J］. JAMA, 2018, 320(15):1583-1594. DOI:10.1001/jama.2018.14346.
［6］IBRAHIM E H, IREGUI M, PRENTICE D, et al. Deep vein thrombosis during prolonged mechanical ventilation despite prophylaxis［J］. Crit Care Med, 2002, 30(4):771-774. DOI:10.1097/00003246-200204000-00008.
［7］BAHL V, HU H M, HENKE P K, et al. A validation study of a retrospective venous thromboembolism risk scoring method［J］. Ann Surg, 2010, 251(2):344-350. DOI:10.1097/SLA.0b013e3181b7fca6.
［8］高春华,冯洁惠,尹慧芳,等.ICU机械通气患者早期运动方案的制订及安全管理［J］.中华护理杂志,2012,47(9):810-812.DOI:10.3761/j.issn.0254-1769.2012.09.015.
［9］KEARON C, AKL E A, ORNELAS J, et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report［J］. Chest, 2016, 149(2):315-352. DOI:10.1016/j.chest.2015.11.026.

［10］MINET C, LUGOSI M, SAVOYE P Y, et al. Pulmonary embolism in mechanically ventilated patients requiring computed tomography: Prevalence, risk factors, and outcome［J］. Crit Care Med, 2012, 40(12):3202-3208. DOI:10.1097/CCM.0b013e318265e461.
［11］中国健康促进基金会血栓与血管专项基金专家委员会.静脉血栓栓塞症机械预防中国专家共识［J］.中华医学杂志,2020,100(7):484-492.DOI:10.3760/cma.j.issn.03762491.2020.07.010.
［12］周佳,李莉,甄军海,等.浙江省41家三甲医院ICU静脉血栓栓塞症的防治现状［J］.中华内科杂志,2021,60(2):139142.DOI:10.3760/cma.j.cn1121382020031800257.[ZK)]
［13］VIARASILPA T, PANYAVACHIRAPORN N, MARASHI S M, et al. Prediction of symptomatic venous thromboembolism in critically ill patients: The ICU-venous thromboembolism score［J］. Crit Care Med, 2020, 48(6):e470-e479. DOI:10.1097/CCM.0000000000004306.
［14］VOICU S, BONNIN P, ST-PANIAN A, et al. High prevalence of deep vein thrombosis in mechanically ventilated COVID-19 patients［J］. J Am Coll Cardiol, 2020, 76(4):480-482. DOI:10.1016/j.jacc.2020.05.053.
［15］BIKDELI B, MADHAVAN M V, JIMENEZ D, et al. COVID-19 and thrombotic or thromboembolic disease: Implications for prevention, antithrombotic therapy, and follow-up［J］. J Am Coll Cardiol, 2020, 75(23):2950-2973. DOI:10.1016/j.jacc.2020.04.031.
［16］LIPPI G, FAVALORO E J, CERVELLIN G. Prevention of venous thromboembolism: Focus on mechanical prophylaxis［J］. Semin Thromb Hemost, 2011, 37(3):237-251. DOI:10.1055/s-0031-1273088.
［17］FOWLER R A, MITTMANN N, GEERTS W, et al. Costeffectiveness of dalteparin vs unfractionated heparin for the prevention of venous thromboembolism in critically ill patients［J］. JAMA, 2014, 312(20):2135-2145. DOI:10.1001/jama.2014.15101.
［18］HANIFY J M, DUPREE L H, JOHNSON D W, et al. Failure of chemical thromboprophylaxis in critically ill medical and surgical patients with sepsis［J］. J Crit Care, 2017, 37:206-210. DOI:10.1016/j.jcrc.2016.10.002.
［19］LOPES R D, DE BARROS E SILVA P G M, FURTADO R H M, et al. Therapeutic versus prophylactic anticoagulation for patients admitted to hospital with COVID-19 and elevated D-dimer concentration (ACTION):An open-label, multicentre, randomised, controlled trial［J］. Lancet, 2021, 397(10291):2253-2263. DOI:10.1016/S0140-6736(21)01203-4.
［20］GUPTA E, SIDDIQI F S, KUNJAL R, et al. Association between aspirin use and deep venous thrombosis in mechanically ventilated ICU patients［J］. J Thromb Thrombolysis, 2017, 44(3):330-334. DOI:10.1007/s11239-017-1525-x.
［21］夏艳秋,鲁桂英.早期活动在降低慢性阻塞性肺疾病机械通气病人下肢深静脉血栓形成中的作用［J］.全科护理,2018,16(31):38413844.DOI:10.12104/j.issn.1674-4748.2018.31.001.［22］GASPARD D, VITO K, SCHORR C, et al. Comparison of chemical and mechanical prophylaxis of venous thromboembolism in nonsurgical mechanically ventilated patients［J］. Thrombosis, 2015, 2015:849142. DOI:10.1155/2015/849142.
［23］VAN GENT J M, CALVO R Y, ZANDER A L, et al. Risk factors for deep vein thrombosis and pulmonary embolism after traumatic injury: A competing risks analysis［J］. J Trauma Acute Care Surg, 2017, 83(6):1154-1160. DOI:10.1097/TA.0000000000001652.
［24］ARABI Y M, AL-HAMEED F, BURNS K E A, et al. Adjunctive intermittent pneumatic compression for venous thromboprophylaxis［J］. N Engl J Med, 2019, 380(14):1305-1315. DOI:10.1056/NEJMoa1816150.
［25］COOK D, CROWTHER M, MEADE M, et al. Deep venous thrombosis in medicalsurgical critically ill patients: Prevalence, incidence, and risk factors［J］. Crit Care Med, 2005, 33(7):1565-1571. DOI:10.1097/01.ccm.0000171207.95319.b2.
［26］LAMONTAGNE F, MCINTYRE L, DODEK P, et al. Nonleg venous thrombosis in critically ill adults: A nested prospective cohort study［J］. JAMA Intern Med, 2014, 174(5):689-696. DOI:10.1001/jamainternmed.2014.169.
［27］BEITLAND S, WIMMER H, LORENTSEN T, et al. Venous thromboembolism in the critically ill: A prospective observational study of occurrence, risk factors and outcome［J］. Acta Anaesthesiol Scand, 2019, 63(5):630-638. DOI:10.1111/aas.13316.
［28］MOUMNEH T, RIOU J, DOUILLET D, et al. Validation of risk assessment models predicting venous thromboembolism in acutely ill medical inpatients: A cohort study［J］. J Thromb Haemost, 2020, 18(6):1398-1407. DOI:10.1111/jth.14796.
［29］ZHANG C L, ZHANG Z J, MI J, et al. The cumulative venous thromboembolism incidence and risk factors in intensive care patients receiving the guideline-recommended thromboprophylaxis［J］. Medicine (Baltimore), 2019, 98(23):e15833. DOI:10.1097/MD.0000000000015833.