학술논문
Risk factors for deep vein thrombosis after total knee arthroplasty / 인공 슬관절 전치환술 후 심부 정맥 혈전증 발생 위험 인자
Document Type
Dissertation/ Thesis
Author
Source
Subject
Language
English
Abstract
연구배경: 동양인에서 인공 슬관절 전치환술 후 합병증으로 심부 정맥 혈전증의 발병률이 증가함에 따라 예방의 중요성이 대두되고 있다. 이에 따라 근래 더 많은 의사들이 인공슬관절 전치환술 이 후, 환자에게 예방적 항응고제를 투여하고 있다. 그럼에도 불구하고 심부정맥 혈전증은 이 환자들에게서 발병한다. 이 연구는 인공 슬관절 전치환술 후 enoxaparin을 사용한 환자군에서 의 심부정맥 혈전증 발병 위험인자에 대해 알아보고자 시행되었다.연구방법: 103명의 인공 슬관절 전치환술을 받은 환자를 대상으로 후향적 연구를 하였다. 환자들 에게 술 후 2일 부터 60mg의 enoxaparin을 매일 피하주사 하였다. 그리고 술 후 7일에 컴퓨터 단층촬영 혈관 조영술을 시행하여 심부정맥 혈전증 발병 여부를 확인하였다. 술 후 심부정맥 혈전증 발병 위험인자로써 연구 대상자들의 성, 연령, 편측/양측 인공 슬관절 전치환술 여부, 집도의, 신체질량지수(Body Mass Index, BMI), 마취의 종류, 고혈압, 당뇨, 고지혈증, PT/INR을 전자의무 기록을 통해 조사하였다. 그리고 이 위험인자들과 심부정맥 혈전증의 발병 여부와의 통계적 유의성을 분석하였다.연구결과: 단일 변수 분석결과 편측/양측 인공 슬관절 전치환술 여부 (p=0.005), 신체질량지수 (Body Mass Index, BMI) (p=0.043), 고혈압 (p=0.078), 마취의 종류 (p=0.006)가 심부정맥 혈전증 발병과의 통계적 유의성이 검증되었다.이 변수들을 대상으로 다중회귀분석을 시행하였다. 편측/양측 인공 슬관절 전치환술 여부(p=0.024) 및 마취의 종류 (p=0.039)가 인공슬관절 전치환술 후 심부 정맥 혈전증 발병과의 관계에서 통계적 유의성을 보였다.연구결론: 따라서, 한번에 양측 인공 슬관절 전치환술을 받은 환자와 전신마취를 통하여 수술 받은 환자의 경우 noxaparin을 예방적으로 투여하였더라도 좀 더 심부정맥 혈전증 발생에 주의를 기울여야한다.핵심어: 심부 정맥 혈전증, 인공 슬관절 전치환술, 항응고제, enoxaparin, 위험 인자
Background: As an increasing trend of deep vein thrombosis(DVT) after Total knee arthroplasty(TKA) in Asian population in recent years, importance of prophylaxis is growing. More and more surgeons use prophylactic anticoagulant agent for their patients after TKA nowadays. Nevertheless, deep vein thrombosis occasionally develops in those patients. The purpose of this study was to identify the risk factors for DVT after TKAin cases of postoperative enoxaparin use.Methods: We designed a retrospective study with 103 patients who underwent primary total knee arthroplasty. From second day of postoperation, 60mg of enoxaparin was subcutaneously injected to those patients daily. At. postoperative 7th day, patients took computed tomography(CT) angiography to check whether they have deep vein thrombosis. Regarding risk factors we investigated patients' gender, age,unilateral/bilateral, surgeon, body mass index(BMI), type of anesthesia, preoperative hypertension, diabetes, hypercholesterolemia status and prothrombin time/international normalized ratio(PT/INR) from electronic medical records. We analyzed the statistical significance of these risk factors.Results: Statistically significant factors in the single variable analysis were surgical site(unilateral/bilateral, p=0.005), BMI (p=0.043), preoperative hypertension status (p=0.078) and type of anesthesia (p=0.006). Multiple logistic regression analysis with these factors revealed that the surgical site(unilateral/bilateral, p=0.024) and type of anesthesia (p=0.039) were the significant factors to the occurrence of postoperative DVT after TKA.Conclusion: Patients undergone simultaneous bilateral TKAs and patients taken TKA through general anesthesia need more attention regarding DVT even with DVT chemoprophylaxis using enoxaparin after TKA.
Background: As an increasing trend of deep vein thrombosis(DVT) after Total knee arthroplasty(TKA) in Asian population in recent years, importance of prophylaxis is growing. More and more surgeons use prophylactic anticoagulant agent for their patients after TKA nowadays. Nevertheless, deep vein thrombosis occasionally develops in those patients. The purpose of this study was to identify the risk factors for DVT after TKAin cases of postoperative enoxaparin use.Methods: We designed a retrospective study with 103 patients who underwent primary total knee arthroplasty. From second day of postoperation, 60mg of enoxaparin was subcutaneously injected to those patients daily. At. postoperative 7th day, patients took computed tomography(CT) angiography to check whether they have deep vein thrombosis. Regarding risk factors we investigated patients' gender, age,unilateral/bilateral, surgeon, body mass index(BMI), type of anesthesia, preoperative hypertension, diabetes, hypercholesterolemia status and prothrombin time/international normalized ratio(PT/INR) from electronic medical records. We analyzed the statistical significance of these risk factors.Results: Statistically significant factors in the single variable analysis were surgical site(unilateral/bilateral, p=0.005), BMI (p=0.043), preoperative hypertension status (p=0.078) and type of anesthesia (p=0.006). Multiple logistic regression analysis with these factors revealed that the surgical site(unilateral/bilateral, p=0.024) and type of anesthesia (p=0.039) were the significant factors to the occurrence of postoperative DVT after TKA.Conclusion: Patients undergone simultaneous bilateral TKAs and patients taken TKA through general anesthesia need more attention regarding DVT even with DVT chemoprophylaxis using enoxaparin after TKA.