背景：深静脉血栓形成对公共健康构成威胁，对社会带来沉重的经济负担，经常是卧床患者的并发症或导致死亡的原因。如何预防深静脉血栓形成是临床实践中普遍关注的问题。然而，尚不确定深静脉血栓形成的危险因素是否会受到不同的卧床时间的影响。解决此问题对于提供更合理的医疗服务以预防深静脉血栓形成十分重要。

目的：探讨卧床持续时间是否会影响深静脉血栓形成的危险因素，并确定卧床持续时间不同的人群是否存在不同的危险因素。

设计：回顾性多中心病例对照研究。

场所和参与者：这项多中心研究是在中国25家综合医院卧床患者比例较高的病房中进行。参加者是来自这些病房的卧床患者。

方法：从卧床患者主要并发症研究数据库中识别卧床患者。通过基于电子的标准化在线病例报告表，从前瞻性描述研究中收集数据。病例定义为卧床患者在住院期间发生深静脉血栓形成（n = 186）。每个病例都与三个对照的卧床患者相匹配，这些患者（n = 558）在同一中心，相同的卧床时间，且未经历深静脉血栓形成。采用描述性统计，单变量分析和多元条件逻辑回归模型进行数据分析。

结果：在23985例患者中，住院期间深静脉血栓形成的总发生率为1.0％。多因素分析显示，对于卧床时间为4周或更短的患者，年龄较大（OR= 1.027，95％置信区间[CI] 1.013–1.041），并且在外科病房（OR = 2.527， 95％CI（1.541–4.144）与深静脉血栓形成的风险增加显著相关。女性（OR = 4.270，95％CI 1.227–14.862），吸烟（OR = 10.860，95％CI 2.130–55.370）和特殊治疗（OR = 3.455，95％CI 1.006-11.869）是预测卧床时间为5至8周的患者发生深静脉血栓形成的独立危险因素。对于卧床时间为9到13周的患者，Charlson合并症指数（OR = 1.612，95％CI 1.090-2.385）是深静脉血栓形成的唯一独立危险因素。

结论：不同卧床时间的患者深静脉血栓形成的危险因素各不相同。这一发现有助于护士提高不同卧床时间患者预防深静脉血栓形成的认识，为临床决策奠定更坚实的基础。

 

 

 Background: Deep vein thrombosis represents a threat to public health and a heavy economic burden to society, and often occurs as a complication or cause of death in bedridden patients. How to prevent deep vein thrombosis is a general concern in clinical practice. However, it remains uncertain whether the risk factors for deep vein thrombosis would be affected by different bed-rest durations. Solving this issue will be invaluable for the provision of more rational medical care to prevent deep vein thrombosis.

Objective: To explore whether risk factors for deep vein thrombosis are affected by bed-rest durations and to identify different risk factors in groups with different bed-rest durations.

Design: A retrospective multicenter case–control study.

Settings and participants: This multicenter study was conducted in wards with high rates of bed rest in 25 general hospitals in China. Participants were bedridden patients from these wards.

Methods: Bedridden patients were identified from the research database of bedridden patients’ major immobility complications. These data were collected from prospective descriptive studies by a standardized web-based online case report form. Cases were defined as bedridden patients who suffered deep vein thrombosis during hospitalization (n=186). Each case was matched with three controls, bedridden patients who did not suffer deep vein thrombosis in the same center with the same bed-rest duration (n=558). Descriptive statistics, univariate analysis, and multivariate conditional logistic regression models were employed.

Results: Among 23,985 patients, the overall incidence of deep vein thrombosis during hospitalization was 1.0%. Multivariate analysis showed that for patients with bed-rest duration of 4 weeks or less, older age (odds ratio [OR] =1.027, 95% confidence interval [CI] 1.013–1.041) and being in a surgical department (OR=2.527, 95% CI 1.541–4.144) were significantly associated with increased risk of deep vein thrombosis. Female sex (OR=4.270, 95% CI 1.227–14.862), smoking (OR=10.860, 95% CI 2.130–55.370), and special treatment (OR=3.455, 95% CI 1.006–11.869) were independent factors predicting deep vein thrombosis for patients with bed-rest durations from 5 to 8 weeks. For those with bed-rest durations from 9 to 13 weeks, Charlson Comorbidity Index (OR=1.612, 95% CI 1.090–2.385) was the only independent risk factor for deep vein thrombosis.

Conclusions: Risk factors for deep vein thrombosis varied among patients with different bed-rest durations. This finding is helpful for nurses to increase their awareness of prevention of deep vein thrombosis in patients with different bed-rest durations, and lays a more solid foundation for clinical decision making.

原文链接：

https://www.sciencedirect.com/science/article/pii/S0020748920303138

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