肢体血管超声及血浆D-二聚体、纤维蛋白原对脑卒中瘫痪患者下肢深静脉血栓形成的评估价值分析  

Value of limb vascular ultrasound and plasma D-dimer and fibrinogen in evaluating lower extremity deep venous thrombosis in stroke patients with paralysis

作　　者：邵仲萍 卞心怡 姜彬彬 Shao Zhongping;Bian Xinyi;Jiang Binbin(Department of Rehabilitation Medicine,Suixi County Hospital,Huaibei 235000,China)

机构地区：[1]安徽省濉溪县医院康复医学科,淮北235000 [2]安徽医科大学第一附属医院康复医学科

出　　处：《中华保健医学杂志》2024年第2期133-136,共4页Chinese Journal of Health Care and Medicine

基　　金：安徽省卫生健康委科研项目(AHWJ2021a0103)。

摘　　要：目的分析肢体血管超声及血浆D-二聚体(D-D)、纤维蛋白原对脑卒中瘫痪患者下肢深静脉血栓形成(DVT)的评估价值。方法选取2019年1月~2023年3月安徽省濉溪县医院康复医学科收治的脑卒中瘫痪患者91例,根据患者有无下肢DVT分为血栓组(n=45)和无血栓组(n=46)。比较两组患者临床资料、病情情况、肢体血管超声结果及实验室指标,混杂因素校正分析肢体血管超声及血浆D-D、纤维蛋白原与脑卒中瘫痪患者下肢DVT的关系,受试者工作特征(ROC)曲线分析肢体血管超声及血浆D-D、纤维蛋白原对脑卒中瘫痪患者下肢DVT的评估价值。结果血栓组患者年龄≥60岁、入院时美国国立卫生研究院卒中量表(NIHSS)评分≥16分、卧床时间≥14 d、瘫痪肢体分级0~1级、有静脉置管、肢体血管回声异常占比明显高于无血栓组,差异有统计学意义(χ^(2)=4.837、8.004、5.166、9.570、6.721、15.182,P<0.05)。血栓组患者肢体血管内径明显大于无血栓组,肢体血流速度明显低于无血栓组,差异有统计学意义(t=10.364、16.358,P<0.05)。血栓组患者血浆D-D、纤维蛋白原水平明显高于无血栓组差异有统计学意义(t=17.680、26.729,P<0.05)。校正混杂因素分析显示,肢体血管内径大,肢体血流速度慢、血浆D-D、纤维蛋白原水平高是脑卒中瘫痪患者下肢DVT的独立危险因素(Waldχ^(2)=14.608、9.960、5.994、16.484、27.016,P<0.05)。ROC曲线分析提示肢体血管超声及血浆D-D、纤维蛋白原联合检测评估脑卒中患者下肢DVT的曲线下面积0.884、特异性97.30%,较4项指标单独检测高。结论肢体血管超声及血浆D-D、纤维蛋白原水平与脑卒中瘫痪患者下肢DVT密切相关,通过严密监测患者肢体血管超声及血浆D-D、纤维蛋白原水平,能够早期特异性识别脑卒中瘫痪患者DVT的风险。Objective To analyze the value of limb vascular ultrasound and plasma D-dimer(D-D)and fibrinogen in evaluating lower limb deep venous thrombosis(DVT)in stroke patients with paralysis.Methods A total of 91 stroke patients with hemiplegia admitted to the department of rehabilitation medicine at Suixi County Hospital in Anhui province from January 2019 to March 2023 were divided into the thrombosis group(n=45)and the non-thrombosis group(n=46)according to the presence or absence of lower extremity DVT.Clinical data,conditions,limb vascular ultrasound examination result,and laboratory indicators of the two groups were compared.The relationship between limb vascular ultrasound,plasma D-D and fibrinogen and lower extremity DVT in stroke patients with paralysis was analyzed.The value of limb vascular ultrasound andplasma D-D and fibrinogen in evaluating lower extremity DVT in stroke patients with paralysis was analyzed using the receiver operating characteristic(ROC)curve.Results The proportions of patients aged 60 or older,patients with the NIHSS score of 16 or higher at admission,patients with bed rest time of 14 days or longer,patients with grade 0~1 paralysis,patients with venous catheters and patients with abnormal echos of limb blood vessels in the thrombosis group were significantly higher than those in the non-thrombosis group(χ^(2)=4.837,8.004,5.166,9.570,6.721,15.182,P<0.05).The diameter of limb blood vessel in the thrombosis group was significantly larger than that in the non-thrombosis group,and blood flow velocity was significantly lower than that in the non-thrombosis group(t=10.364,16.358,P<0.05).Plasma D-D and fibrinogen levels in the thrombosis group were significantly higher than those in the non-thrombosis group(t=17.680,26.729,P<0.05).After correcting the confounding factors,it was found that large limb blood vessel diameter,low limb blood flow velocity and high plasma D-D and fibrinogen levels were independent risk factors for lower extremity DVT in stroke patients with paralysis(Wald χ^(2)=14.608

关 键 词：脑卒中瘫痪 肢体血管超声 D-二聚体 纤维蛋白原 下肢深静脉血栓 

分 类 号：R743[医药卫生—神经病学与精神病学]