肝损伤作为创伤后静脉血栓栓塞的危险因素
Michael D Cobler-Lichter1, Jessica M Delamater, Nicole B Lyons
1From the Division of Trauma and Surgical Critical Care, DeWitt Daughtry Family Department of Surgery, Ryder Trauma Center, University of Miami Miller School of Medicine, Miami, FL.
Journal of the American College of Surgeons
|January 22, 2025
概括
严重受伤患者的肝损伤 (LI) 独立预测肺栓塞 (PE),但不是深静脉血栓塞 (DVT). 这一发现表明,LI可能通过独特的机制为PE发展做出贡献.
科学领域:
- 创伤外科 手术 创伤外科
- 血管外科 血管外科
- 关键护理医学 关键护理医学
背景情况:
- 静脉血栓栓塞 (VTE) 是严重受伤患者死亡的重要原因.
- 目前的VTE风险分层和预防方法不足,表明对VTE风险因素的理解存在差距.
- 肝脏在凝血中的关键作用促使人们对肝损伤 (LI) 作为潜在的VTE风险因素进行调查.
研究的目的:
- 为了确定肝损伤 (LI) 是否与严重受伤患者的静脉瘤风险增加独立相关.
- 要区分LI与肺栓塞 (PE) 与深静脉血栓塞 (DVT) 的相关性.
主要方法:
- 美国外科医生学院TQIP数据库 (2017-2021) 的回顾性审查.
- 纳入标准:严重受伤的患者 (最大腹部缩短伤害评分≥4) 有或没有LI.
- 排除标准:转移,烧伤,任何原因的死亡率,年龄在18岁以下的患者.
- 使用后勤回归分析来评估LI对PE和DVT发展的独立影响,控制混因素.
主要成果:
- 该研究分析了44506名患者;18642人 (41.9%) 患有LI,1736人 (3.9%) 患有DVT,890人 (2.0%) 患有PE.
- 在调整了混因子后,LI与PE独立相关 (aOR 1.279,95% CI 1.088-1.504).
- LI与DVT没有独立相关 (aOR为1.011,95%CI为0.897-1.140).
结论:
- 肝损伤是严重受伤患者肺栓塞 (PE) 的独立预测因素.
- LI与深静脉血栓症 (DVT) 无关,这表明PE可能来自与肝脏相关的局部前血栓机制.
- 需要进一步的研究来阐明机制 (例如,门静脉凝血,内皮损伤,血液静止) 并考虑LI在VTE风险分层.
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