颈动脉狭窄支架置入术后下肢深静脉血栓形成与肢体制动时间和方式的关系研究  

Method and duration of limb immobilization associating with deep venous thrombosis of the lower extremity after carotid artery stenting

作　　者：符晓艳[1] 王羚入[1] 周华东[1] FU Xiao-yan WANG Ling-ru ZHOU Hua-dong.(Department of Neurology, Daping Hospital, the Third Military Medical University, Chongqing 400042, Chin)

机构地区：[1]第三军医大学大坪医院野战外科研究所神经内科,重庆400042

出　　处：《中华全科医学》2017年第9期1469-1471,1502,共4页Chinese Journal of General Practice

基　　金：重庆市自然科学基金项目(CS7C;2006BB5101)

摘　　要：目的分析研究颈动脉狭窄支架置入术后下肢深静脉血栓形成(deep vein thrombosis,DVT)与年龄、术侧肢体制动时间、凝血功能的相关性。方法选取2010年1月—2015年1月在第三军医大学大坪医院野战外科研究所神经内科行颈动脉狭窄支架置入术的417例患者为研究对象。术前行双下肢超声多普勒检查排除深静脉血栓,术后12 h采用床旁超声检查作为筛查病人是否存在深静脉血栓。根据床旁超声检查结果分为DVT组和无DVT组,分析颈动脉狭窄支架置入术后DVT的发生与年龄、术侧肢体制动时间、凝血功能的相关性。采用SPSS17.0软件进行统计学分析,计量资料数据以±s表示,比较采用t检验,DVT的发生与年龄、术侧肢体制动时间、凝血功能的分析用率表示,采用χ~2检验,P<0.05为差异有统计学意义。结果颈动脉狭窄支架置入术后DVT的发生率为3.8%(16/417)。其中80岁以上的患者8例,占50.0%(8/16),与无DVT组13.5%(54/401)比较,差异有统计学意义(χ2~=13.466,P=0.002);术侧肢体制动时间24 h的患者8例,占50.0%(8/16),与无DVT组2.2%(9/401)比较,差异有统计学意义(P<0.001);D-二聚体增高异常的患者9例发生DVT,占56.3%(9/16),与无DVT组2.7%(11/401)比较,差异有统计学意义(P<0.001)。结论颈动脉狭窄支架置入术患者术前和术后要检测凝血功能,尽早做好预防,术后应密切观察患者足背动脉搏动情况,尽早进行术侧肢体被动和主动活动,是预防和减少DVT发生的护理要点。Objective To analyze the association of the deep venous thrombosis （DVT） of the lower extremity with age and blood coagulation function of the patients and the method and duration of limb immobilization after carotid artery stenting（CAS）. Methods Total 417 patients undergoing CAS in our department from January,2010 to January,2015 were enrolled in this study. Preoperative Doppler sonography for DVT of the lower extremity was performed. According to the results of bedside ultrasound examination at postoperative 12 hours, the patients were assigned into DVT group and non DVT group. The relevance of DVT with the age and blood coagulation function of the patients and the duration of limb im- mobilization was statistically analyzed by using SPSS 17.0. Results The total incidence of DVT after CAS was 3.8% （ 16/417 ）. The patients aged over 80 years old accounted for 50.0% （8/16） in DVT group, only for 13.5 % （54/401） in non DVT group ,there was a significant difference（ Xz = 13. 466, P = 0. 002 ）. The patients with the duration of operated limb immobilization over 24 hours accounted for 50% （8/16） in DVT group,only fi）r 2.2% （9/401） in non DVT group, there was a significant difference（ P 〈 0. 001 ）. The patients with elevated D-dimer level accounted for 56.3% （9/16） in DVT group, only for 2.7 % （ 11/401 ） in non DVT group, there was a significant difference （ P 〈 0. 001 ）. Conclusion It is important to test the coagulation function of the patients before and after CAS. The pulsation of the foot dorsal artery should be closely observed after the operation, and do some passive and active activities for the operated limbs as early to prevent and reduce the occurrence of DVT.

关 键 词：颈动脉狭窄 血管介入 深静脉血栓 

分 类 号：R543.4[医药卫生—心血管疾病] R654.4[医药卫生—内科学]