出血性卒中患者康复期下肢深静脉血栓临床特点和风险因素分析  

Analysis of Clinical Characteristics and risk factors of lower extremity deep venous thrombosis in hemorrhagic stroke during rehabilitation phase

作　　者：王泳[1] 高亚利[1] WANG Yong;GAO Ya-li(Department of Hyperbaric Oxygen,Fuxing Hospital,Capital Medical University,Beijing 100038,China)

机构地区：[1]首都医科大学附属复兴医院高压氧科,北京100038

出　　处：《中国急救复苏与灾害医学杂志》2018年第7期648-651,共4页China Journal of Emergency Resuscitation and Disaster Medicine

摘　　要：目的探讨出血性卒中患者进入康复期后下肢深静脉血栓（deepvenousthrombosis，DVT）的临床特点和相关风险因素。方法回顾性连续纳入2010年5月-2016年10月于首都医科大学附属复兴医院高压氧科住院的出血性卒中患者232例，包括164例脑出血intracerebralhaemorrhage，ICH）164例和动脉瘤性蛛网膜下腔出血（subarachnoidhaemorrhage，aSAH）68例。采用多普勒超声确诊下肢DVT，分析DVT的临床特点，采用单因素和Logistic回归分析评估与DVT形成相关的风险因素。结果共55例（23．7％）患者检出DVT，无症状DVT40例（72．7％）多于症状性DVT15例（27．3％），下肢远端DVT32例（58．2％）多于下肢近端11例（20．0％）和全下肢12例（21．8％），累及患肢35个（47．9％）少于非患肢38个（52．1％）。DVT阳性组和阴性组比较，年龄（P=0．000）、D-dimer值（P=-0．000）、美国国立卫生研究院卒中量表（nationalinstitutesofhealthstrokescale，NIHSS）（P=0．003）、GCS≤8分（P：0．000）和气管切开（P=0．021）差异有显著性。Logistic回归分析显示，年龄（OR=1．04；95％CI，1．01-1．07），D-dimer值（OR=1．44；95％CI，1．23～1．68）和GCS≤8分（OR=4．54；95％CI，2．13~9．67）为下肢DVT的独立风险因素。结论出血性卒中康复期DVT不少见，以无症状下肢远端DVT多见。对于老龄合并严重意识障碍和D—dimer明显升高的出血性卒中患者要作为重点筛查DVT的目标。Objective To explore the clinical characteristics and risk factors of lower extremity deep venous thrombosis （DVT） in hemorrhagic stroke during rehabilitation phase. Methods 232 consecutively hospitalized patients with hemorrhagic apoplexy, 154 males （66.4%）and 78 females （33.6%）, aged （55.5±14.4） （10-88）, of which 164 suffered from intracranial hemorrhage （ICH） （70.7%） and 60 suffered from aneurysmal subarachnoid hemorrhage （aSAH） （29.3%）, underwent color Doppler ultrasound examination of the lower extremities to find DVT, D-dimer test of the arterial blood, and grading of the neurological deficit by the National Institutes of Health Stroke Scale （NIHSS） and Glasgow Coma Scale （GCS）. Univariate and muhivariable logistic regression analyses were used to determine the factors associated with risk of DVT. Results 55 of the 232 patients （23.7%） , 35 with ICH and 20 with aSAH, were identified as with deep venous thrombosis （DVT）, 72.7% being asymptomatie, 52.1% in the non-hemiparetic side, and 58,2% being distal DVT, 21.8% being proximal DVT, and 21.8% being total lower-limb DVT, The number of the patients undergoing tracheotomy was higher in the DVT positive group. The D-dimer level of the DVT（＋） group was （8.7±13.0） rag/L, significantly higher than that of the DVT （-） group [（2.2±1.8） rag/L, P=0.000]. The NIHSS of the DVT（＋） group was （27.8±7.4）, significantly higher than that of the DVT （-） group [（23.6±9.0 ）, P=0.003 ]. 55.6% of the DVT （＋） patients showed their GCS ≤ 8, a proportion significantly higher than that of the DVT （-）group （26.0%, P=0.000）. Multivariate Logistic regression analysis showed that age（OR=1.04; 95% CI, 1.01-1.07）, D-dimerm （OR= 1.44; 95% CI, 1.23-1.68） and GCS≤8 （OR=4.54; 95% CI, 2.13-9.67） as the independent risk factors of DVT.Conclusion DVT is not rare during the convalescence of hemorrhagic stroke, especially asymptomatic distal DVT in lower extremities. Attention s

关 键 词：出血性卒中 下肢深静脉血栓 康复期 风险因素 

分 类 号：R743[医药卫生—神经病学与精神病学]