急性脑卒中重度瘫痪患者入NICU后下肢深静脉血栓形成的相关危险因素分析  

Analysis of Risk Factors for Deep Venous Thrombosis after Acute Stroke in Patients with Severe Paralysis

作　　者：张立[1,2] 戴崇亮 叶楠 乔楠 张汉夫 尹小燕 袁兴运 宋文锋[1] 张潇[3] 罗国刚 ZHANG Li;DAI Chong-liang;YE Nan;QIAO Nan;ZHANG Han-fu;YIN Xiao-yan;YUAN Xing-yun;SONG Wen-feng;ZHANG Xiao;LUO Guo-gang(Department of Neurology,the First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,China;Department of Neurology,Xi’an Red Cross Hospital,Xi’an 710054,China;Department of Neurology,Xijing Hospital,Air Force Military Medical University,Xi’an 710032,China)

机构地区：[1]西安交通大学第一附属医院神经内科,西安710061 [2]西安红会医院神经内科,西安710054 [3]空军军医大学附属西京医院神经内科,西安710032

出　　处：《中国临床神经科学》2020年第1期27-34,共8页Chinese Journal of Clinical Neurosciences

基　　金：西安交通大学一附院临床研究项目(编号:XJTU1AF-CRF-2016-013)。

摘　　要：目的探讨因脑卒中造成重度瘫痪患者入住神经科重症监护病房(NICU)后深静脉血拴形成的发生率和相关危险因素。方法连续纳入2017年10月至2019年4月入住NICU的172例首发脑卒中重度瘫痪患者,入住NICU后72h内行首次双下肢静脉超声检査,转出NICU前行第2次双下肢静脉超声检查,根据第2次超声结果分为深静脉血栓形成组和无深静脉血拴形成组。采用多中心、开放性、回顾性调査对两组患者相关临床资料进行分析比较,应用多因素Logistic回归分析进行相关危险因素分析。结果172例脑卒中重度瘫痪患者,检出深静脉血栓形成60例(34.88%),其中有临床症状4/60例(6.67%),无临床症状56/60例(93.33%)。相关分析显示:年龄、房颤、心力衰竭、肿瘤病史、GCS评分、血小板计数.D-二聚体升高趋势、入NICU前后接受氯吡格雷治疗与下肢深静脉血栓形成均呈显著相关。多因素Logistic回归分析显示:肿瘤病史(OR=14.847,95%CI:1.751-125.897)与急性脑卒中重度瘫痪患者发生深静脉血栓形成具有相关性。结论首发脑卒中重度瘫痪患者的N1CU院内下肢深静脉血栓形成发病率为34.88%,其中93.33%无明显临床症状。既往肿瘤病史是NICU发生深静脉血栓形成的危险因素。Aim To investigate the incidence of deep venous thrombosis(DVT)and the risk factors of DVT after acute stroke with severe paralysis admitted to the neurological intensive care unit.Methods This multicenter retrospective study included 172 patients with severe paralysis who were initially admitted to the neurological intensive care unit(NICU)from October 2017 to April 2019.All the patients accepted more than twice ultrasound test of double lower extremity venous,the first test was performed within 72 hours after admission,the second one was performed before discharge.The patients were divided into two groups:a non-DVT group and a DVT group based on the second ultrasound result.The incidence of DVT in both groups was analyzed and compared.The risk factors were analyzed.Results 60(34.88%)patients of 172 were diagnosed DVT and only 4(6.67%)patients of DVT patients had symptoms.The risk factors included age,atrial fibrillation,heat failure,history of oncology,GCS,platelet count,increase of D-dimer,treatment with clopidogrel.Logistic regression analysis suggested that the independent risk factors for DVT after acute stroke with severe paralysis including history of oncology(OR=14.847,95%CI:1.751-125.897).Conclusion The incidence of DVT after acute stroke in severe paralysis patients was 34.88%and 93.33%of these patients were asymptomatic.History of oncology was associated with DVT after acute stroke with severe paralysis.

关 键 词：急性脑卒中 重度瘫痪 深静脉血栓形成 神经科重症监护病房 

分 类 号：R743[医药卫生—神经病学与精神病学]