神经肌肉电刺激术预防自发性脑出血患者下肢深静脉血栓临床研究

Clinical study on the prevention of spontaneous intracerebral hemorrhage of lower extremity deep venous thrombosis by neuromuscular electrical stimulation

目的探讨神经肌肉电刺激术(NMES)预防自发性脑出血并发下肢深静脉血栓的有效性和安全性。方法以2019年1月至2020年1月诊治的76例自发性脑出血患者为观察对象,随机分为对照组(静脉血栓标准预防治疗)和标准预防+神经肌肉电刺激术组(NMES组),比较两组患者入院7 d内下肢深静脉血栓发生率、血浆D-二聚体水平和不良事件发生率,发病后3个月评价神经功能预后[Glasgow预后分级(GOS)]。结果入院7 d内两组患者无一例发生肺血栓栓塞症,NMES组下肢深静脉血栓发生率低于对照组[18.42%(7/38)对44.74%(17/38);χ2=6.090,P=0.014];入院后3 d,两组患者血浆D-二聚体水平高于入院当日(P=0.000)且NMES组高于对照组(P=0.000);治疗期间NMES组无一例发生皮肤损害或炎症反应等不良事件。发病后3个月,NMES组神经功能预后优于对照组[GOS分级(3.42±1.28)级对(2.55±1.13)级;t=3.124,P=0.000]。结论神经肌肉电刺激术有助于预防自发性脑出血患者并发的下肢深静脉血栓。

Objective To investigate the effectiveness and safety of neuromuscular electrical stimulation(NMES)in the prevention of spontaneous intracranial hemorrhage(sICH)in lower extremity deep venous thrombosis(DVT).Methods A total of 76 patients with sICH from January 2019 to January 2020 were included.They were randomized to receive basic prevention methods of venous thrombosis(control group,n=38)and treatment with NMES(NMES group,n=38).The incidence of DVT of lower extremity,plasma D-dimer levels and adverse event rates were compared between 2 groups on 7 d of admission.The prognosis of neurological function was evaluated with Glasgow Outcome Scale(GOS)3 months after onset.Results No pulmonary thromboembolism occurred in 2 groups within 7 d after admission,and the incidence of lower extremity DVT in the NMES group was lower than that in the control group[18.42%(7/38)vs.44.74%(17/38);χ~2=6.090,P=0.014].Three days after admission,the plasma D-dimer level in the2 groups was higher than that on the day of admission(P=0.000),while plasma D-dimer level in the NMES group was also higher than that in the control group(P=0.000).No adverse events such as skin damage or inflammation occurred in the NMES group.The prognosis of the NMES group was better than that of the control group 3 months after onset[GOS grade(3.42±1.28)vs.(2.55±1.13);t=3.124,P=0.000].Conclusions NMES can help to prevent DVT of lower extremity in patients with sICH.