缺血性脑卒中后深静脉血栓形成50例临床分析

The etiological analysis of cerebroascular disease with deep vein thrombosis in lower limb

目的分析缺血性脑卒中后下肢深静脉血栓形成(LDVT)的主要原因,以指导临床采用合理的预防和治疗措施。方法分析50例缺血性脑卒中并发下肢深静脉血栓患者的临床特点及血液凝血、抗凝和纤溶系统分子标志物指标的变化情况。结果50例缺血性脑卒中并发LDVT患者中,65岁以上者占60%;卧床2～4周者的发病率最高;伴发疾病中以高血压、高血脂最常见;与正常对照组相比,缺血性脑卒中并发LDVT患者的vWF、GMP-140、F1+2含量、PAI-1活性均明显升高,而AT活性、总PS含量、PC活性、PLg活性均明显降低,均有非常显著性差异(P<0.01～0.001)。结论高龄、卧床及血液的高凝状态是缺血性脑卒中并发LDVT的主要因素。临床上应对高龄、长期卧床及存在高凝状态的缺血性脑卒中患者,给予必要的抗凝、抗血小板、溶栓药物及早期康复锻炼等预防性措施,以防止LDVT的发生。

Objective To investigate the mechanism of cerebroascular disease with deep vein thrombosis in lower limb in order to discover the strategies for diagnosis, tretment and prophylaxis. Methods 50 patients of LDVT were selected. Analysis was made on their clinical manifestations and Molecular markers of coagulant,anticoagulant and fibrinolytic parameters. Results Among 50 cases of LDVT, 60% patients were over 65 years old; the mortality was high in the Patients who had lain in bed over 2～4 weeks compared with other patients with diseases, such as hypertension. The level of vWF,GMP-140,F1-2 and PAI-1 in the deep venous thrombosis in lower limb group were significantly increased compared with those of the controls; The level of AT,PS PC and PLg in the deep venous thrombosis in lower limb group were significantly decreased compared, with those of the controls （P〈O.01-O.O01）. Conclusions Senility,unambulatory and Hypercoagulation are the high-risk factors. Prophylaxis should be taken for elder patients, and patients who are confined to bed for a long time as well as those patients who are liabile to deep venous thrombosis. Anticoagulatic therapy and thrombolytic therapy are effective managements to prevent deep vein thrombosis and pulmary embolism.