Correlation of secondary thoracotomy with risk of thrombosis during perioperative period following thoracic trauma / 中华创伤杂志

ABSTRACT

Objective To investigate the effect of perioperative secondary thoracotomy on the risk of thrombosis in patients with thoracic trauma.Methods A retrospective case control study was conducted on the clinical data of 175 patients with thoracic trauma who underwent thoracotomy from January 2000 to December 2016.According to whether the patients underwent secondary thoracotomy,they were divided into secondary thoracotomy group (36 cases) and the control group (139 cases).In the secondary thoracotomy group,there were 25 males and 11 females,with age of (65.4 ± 5.5) years and thoracic abbreviated injury score (AIS) of (3.8 ±0.6) points.In the control group,there were 98 males and 41 females,with the age of (64.6 ±5.3)years and thoracic AIS of (3.7 ±0.8)points.The ICU stay,thoracic drainage,bed rest time,and the incidence of thrombosis in two groups were compared,and the levels of endothelin (ET-1),D-dimer aggregation and platelet were measured.Logistic regression analysis was used to analyze the impact of secondary thoracotomy on the risk of thrombosis.Results Compared with the control group,patients in the secondary thoracotomy group had longer ICU stay [(4.2 ± 1.4) d ∶(1.8± 1.0)d](P＜0.01),more thoracic drainage [(1 550 ±250)ml ∶ (635 ± 184)ml] (P＜0.01),and longer bed rest time [(5.4 ± 1.6) days ∶ (1.5 ± 0.9) days] (P ＜ 0.01).There were significant differences in levels of ET-1 and D-dimer aggregation between two groups (P＜0.01).There was significant difference in platelet count after 5 days (P ＜ 0.01).Twelve cases of deep venous thrombosis (33％) occurred in the secondary thoracotomy group,of which six cases died of thrombus related complications.Eight cases (5.7％) of deep venous thrombosis occurred in the control group,all of which recovered (P ＜ 0.05).In multivariate analysis,ET-1 (OR =7.46,95％ CI 4.53-11.06,P ＜ 0.05),D-dimer aggregation (OR =4.28,95％ CI 2.65-8.37,P ＜ 0.05),and platelet count (OR =1.13,95 ％ CI 0.56-1.98,P ＜ 0.05) were independent risk factors for thrombosis events.Conclusions Perioperative secondary thoracotomy increases the risk of thrombotic events.ICU hospitalization,thoracic drainage,and bed time are associated with thrombosis events.ET-1,D-dimer aggregation,and platelet count are independent risk factors for thrombosis events.