Clinical Features And Risk Factors For Lower-extremity Deep Venous Thrombosis In Postoperative Neurosurgical Patients

ObjectiveTo investigate clinical features and risk factors for lower-extremity DVT inpostoperative neurosurgical patients in order to provide guidance for clinicalprevention and treatment.MethodsFrom Jan2012to Dec2013,196patients who had neurosurgical operations inthe Department of Neurosurgery of the First Affiliated Hospital of ZhengzhouUniversity, were selected as the research subjects. All patients had no DVT beforesurgery. Bedside color dopple ultrasonography and measurements of D-dimer levelswere performed on the3rd,7th, and14th days after surgery. Follow-up clinical datawere recorded for the investigation of incidence of lower-extremity DVT inpostoperative neurosurgical patients and analysis of related clinical features. Allpatients were divided into thrombus group and control group according to theexistence of postoperative DVT. Statistical analysis were performed after all theinformation was entering into the computer. Measurement data were presented asmean±standard deviation（x±s）and t-test was used for the comparison between twogroups, p <0.05was considered statistically significant. The possible risk factors forDVT in postoperative neurosurgical patients, including sex, age, hypertension,coronary heart disease,diabetes, smoking, alcohol consumption, operationtime,bedridden or paralysis, tumor, postoperative dehydration,glucocorticoid,wereused for the analysis of risk factors.First,single factor analysis was used to selectstatistically significant factors(the method of chi-square test was used); thenmultivariate analysis was used to determine risk factors for lower-extremity DVT inpostoperative neurosurgical patients(binary logistic regression analysis wasused)p<0.05was set for statistically significant in two methods. ResultsLower-extremity DVT occurred in61patients and the incidence was31.1%.Inthe thrombus group,31cases(50.8%) were male and30cases(49.2%) were female,with a mean age of55.38±13.21years old ranging21-83years old; in40cases(65.6%),thrombus were detected less than1week after surgery,and in21case(34.4%), the time was more than1week after sugery;37cases(60.7%) had noclinical symptoms and24cases(39.3%)showed clinical symptoms. The commonsymptoms were limb swelling, lower extremity pain and increased soft tissue tension,which occurred in20cases (83.3%),16cases(66.7%) and11cases(45.8%), and all ofthese symptoms occurred in7cases(29.2%);38cases(62.3%) were left lowerextremity thrombosis,14cases(23.0%) were right lower extremity thrombosis, and9cases(14.8%) were both lower extremity thrombosis；the common sites of venousinvolvement were calf muscle vein, peroneal vein and posterior tibial vein, whichoccurred in52cases (85.2%),24cases(39.3%) and11cases(18.0%).The difference ofpreoperative plasma D-dimer levels between two groups was notstatisticallysignificant; postoperative plasma D-dimer levels in thrombus group were higher thanin the control group(p<0.05)，and plasma D-dimer levels of two groups were allhigher than the normal reference values. In the analysis of risk factors, the singlefactor analysis showed statistically significant difference of factors including age,hypertension, smoking, operation time,bedridden or paralysis, tumor, postoperativedehydration and glucocorticoid between two groups (p<0.05); binary Logisticregression analysis showed age>50years old, hypertension, bedridden or paralysis,tumor, postoperative dehydration were risk factors for lower-extremity deep venousthrombosis in postoperative neurosurgical patients.Conclusions1．Lower-extremity deep venous thrombosis was a common complication ofpostoperative neurosurgical patients, and the incidence was31.1%.Most patients hadno obvious symptoms; the common symptoms included limb swelling, lowerextremity pain and increased soft tissue tension. Most DVT occurred less than1week after surgery, and thrombosis in the left lower extremity was more often observedthan on the right side; the most common site of venous involvement was calf musclevein.2． Age>50years old, hypertension, bedridden or paralysis,postoperativedehydration and tumor were risk factors for DVT in neurosurgical patients, bedriddenor paralysis was the highest risk factor.3．Color doppler ultrasound had many advantages, such as high accuracy,non-invasive, repeatable and convenient for bedside examination, so it was thepreferred and effective method for monitoring of deep vein thrombosis inpostoperative neurosurgical patients.4．For neurosurgical patients who had risk factors, the prevention and monitoringmeasures should be strengthened for early diagnosis and treatment.