Clinical analysis of head and neck malignant tumor patients with postoperative venous thromboembolism
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摘要: 目的 探讨头颈恶性肿瘤手术后静脉血栓栓塞症(VTE)的发生情况、危险因素及预防治疗。方法 选择中南大学湘雅三医院2014年2月—2020年2月耳鼻咽喉头颈外科收治的889例头颈恶性肿瘤手术患者作为研究对象，以发生VTE的16例患者为观察组，从未发生VTE的873例患者中随机抽取30例作为对照组，对相关评价指标进行单因素及多因素Logistic回归分析。结果 ① 头颈外科恶性肿瘤手术患者889例，发生VET者16例，VTE在头颈恶性肿瘤患者中的发病率为1.80%。②单因素分析发现头颈恶性肿瘤术后发生VTE与性别、年龄、BMI、术前深静脉置管(PICC)、手术时间及卧床时间有关；多因素Logistic回归分析提示，年龄≥60岁(OR=0.087，95%CI：0.012~0.643)、术前PICC(OR=0.133，95%CI：0.021~0.856)及手术时间≥3 h(OR=0.119，95%CI：0.016~0.889)是头颈恶性肿瘤术后VTE发生的独立危险因素(P < 0.05)。结论 VTE是头颈恶性肿瘤手术后严重的并发症，术后VTE发生的危险因素包括年龄≥60岁、术前PICC及手术时间≥3 h。提前预防和及时治疗是降低术后VTE死亡率的关键。Abstract: Objective To investigate the incidence, risk factors, prevention and treatment of venous thromboembolism(VTE) after head and neck malignant tumor surgery.Methods From February 2014 to February 2020, a total of 889 patients with head and neck malignant tumor treated in the Department of Otolaryngology Head and Neck Surgery of the Third Xiangya Hospital of Central South University were selected as the research objects. 16 patients with VTE were selected as the observation group, and 30 patients were randomly selected as the control group from 873 patients without VTE. The related evaluation indexes were analyzed by univariate and multivariate logistic regression.Results ① VTE occurred in 16 cases of 889 patients with head and neck malignancy, and the incidence of VET in head and neck malignant tumor patients was 1.80%. ② Univariate analysis showed that postoperative VTE was related to gender, age, BMI, preoperative PICC, operation time and bed rest time. Multivariate logistic regression analysis indicated that age≥60 years old(OR=0.087, 95%CI: 0.012-0.643), preoperative PICC(OR=0.133, 95%CI: 0.021-0.856) and operation time≥3 h(OR=0.119, 95%CI: 0.016-0.889) was an independent risk factor of VTE after head and neck malignant tumor operation (P < 0.05).Conclusion VTE is a serious complication after operation for head and neck malignant tumor. The risk factors of postoperative VTE include age≥60 years, preoperative PICC and operation time≥3 h. Early prevention and timely treatment are the key to reduce postoperative VTE mortality.
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Key words:
- head and neck neoplasms /
- venous thromboembolism /
- risk factors
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表 1 16例VTE患者的基本资料
例序 性别 年龄/岁 吸烟史 合并症 术前PICC 栓塞方式 栓塞血管 术后止血药使用情况 术后下床活动 介入治疗 转归 1 男 48 有 无 无 PTE 右肺动脉 矛头蝮蛇血凝酶，2 U，qd，3 d 无 无 有效 2 男 64 有 糖尿病史 无 PTE+DVT 双腘静脉和双肺动脉 无 有 有 有效 3 男 44 有 无 有 PTE 肺动脉 蛇毒血凝酶，2 U，qd，3 d 无 无 死亡 4 女 77 无 鼻咽癌、舌癌史 无 PTE 肺动脉 矛头蝮蛇血凝酶，2 U，qd，1 d 无 无 死亡 5 男 65 有 无 无 DVT 双胫后静脉 氨甲环酸，0.5 g，qd，1 d 无 无 有效 6 男 57 有 无 有 DVT 右锁骨下动脉 白眉蛇毒血凝酶，2 kU，qd，2 d 有 无 有效 7 男 60 有 银屑病史 有 DVT 双肺动脉 无 有 无 有效 8 男 75 有 脑梗死史、高血压史 无 PTE 肺动脉 无 有 无 死亡 9 男 77 有 高血压史 无 DVT 右颈内静脉 无 有 有 有效 10 男 71 有 高血压史 有 DVT 右腓静脉和双肺动脉 矛头蝮蛇血凝酶，1U，qd，1 d 有 无 有效 11 男 59 有 无 有 PTE+DVT 双肺动脉 无 无 无 死亡 12 男 67 有 糖尿病史 有 DVT 右锁骨下动脉 白眉蛇毒血凝酶，1 kU，qd，3 d 有 无 有效 13 男 50 有 高血压史 有 DVT 左大隐静脉 氨甲环酸，0.5 g，qd，1 d 有 无 有效 14 男 69 有 无 无 DVT 左小腿皮下浅静脉 无 有 无 有效 15 女 49 无 甲亢史 无 PTE 右下肺动脉 无 有 无 有效 16 男 71 无 冠心病及右肾切除史 无 DVT 左下肢静脉 无 有 无 有效 
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表 2 头颈恶性肿瘤手术后VTE形成的单因素分析
相关因素 观察组 对照组 χ2 P 相关因素 观察组 对照组 χ2 P 性别 3.920 0.048 心血管病 2.128 0.145 有 14 30 有 5 4 女 2 0 无 11 26 年龄 4.546 0.033 高脂血症 1.917 0.166 ≥60岁 10 9 有 1 0 < 60岁 6 21 无 15 30 BMI 5.306 0.021 术前PICC 3.970 0.046 ≥24 7 4 有 7 5 < 24 9 26 无 9 25 饮酒 0.267 0.605 手术时间 5.275 0.022 有 10 21 ≥3 h 11 10 无 6 9 < 3 h 5 20 吸烟 1.304 0.253 术中输血 0.213 0.644 有 11 25 有 1 1 无 5 5 无 15 29 糖尿病 3.124 0.077 卧床时间 6.017 0.014 有 3 1 ≥3 d 3 0 无 13 29 < 3 d 13 30
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表 3 头颈恶性肿瘤术后发生VTE的多因素Logistic回归分析
相关因素 B SE Wald P OR 95% CI 年龄≥60岁 -2.443 1.021 5.727 0.017 0.087 0.012~0.643 BMI≥24 -1.635 1.160 1.987 0.159 0.195 0.020~1.894 术前PICC -2.018 0.950 4.511 0.034 0.133 0.021~0.856 手术时间≥3 h -2.130 1.027 4.303 0.038 0.119 0.016~0.889 性别 -3.291 1.990 2.733 0.098 0.037 0.016~0.889 卧床时间≥3 d -0.351 1.685 0.043 0.835 0.704 0.026~19.145
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