重症脑梗死患者下肢深静脉血栓形成的危险因素及预防

Related risk factors and preventive efficacy of deep venous thrombosis in critically neurological patients with cerebral infarction

目的探讨神经重症(NICU)脑梗死患者下肢深静脉血栓形成(DVT)的相关危险因素,观察低分子肝素(LMWH)及气压治疗(IPC)对DVT的预防效果。方法回顾性分析270例NICU脑梗死患者临床资料,通过单因素及多因素Logistic回归分析NICU脑梗死患者并发DVT的独立危险因素;在LMWH与IPC干预下,统计NICU脑梗死患者DVT发生情况;彩超观察DVT发生的特点。结果单因素分析发现,卧床时间、机械通气时间、年龄、高血压、糖尿病、入院NIHSS评分、静脉穿刺部位、刺激性药物应用、总胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白、纤维蛋白原、凝血酶原时间、D-二聚体与DVT发生相关(P<0.05),抗凝药物及抗血小板药物为保护因素(P<0.05),性别、吸烟史差异无统计学意义(P>0.05)。多因素分析进一步证,实年龄、卧床时间、D-二聚体、纤维蛋白原水平是影响DVT的独立危险因素,抗凝药物、抗血小板药物为保护因素(P<0.05)。LMWH联合IPC预防DVT效果最好(P<0.05),单独应用LMWH、IPC效果也优于常规预防(P<0.05)。结论 NICU脑梗死患者是DVT高发人群,存在多种发生DVT的高危因素,预防性使用LMWH联合IPC可显著降低DVT发生。

Objective To investigate the related risk factors for deep venous thrombosis （DVT） in critically neurological pa- tients with cerebral infarction,and to evaluate the efficacy of low molecular weight heparin （LMWH） and intermittent pneumatic compression （IPC） on preventing DVT. Methods We retrospectively analyzed the clinical data of 270 critically neurological pa- tients with cerebral infarction. Both single factor analysis and multivariate logistic regression analysis were used to the independent risk factors. We counted morbidity rate of DVT observed by color Doppler ultrasound （CDUS） after the treatment of LMWH and IPC. Results Single factor analysis indicated that bedridden time, duration of mechanical ventilation, age, hypertension, diabetes mellitus, NIHSS scores, venepuncture position, stimulant drugs, TC, TG, HDL：C, LDL-C, fibrinogen, PT and D-Dimer were high risk factors for DVT （all P 〈0. 05） ,and anticoagulant and anti-platelet drugs are protective factors （all P〈0. 05）, while gender, smoking showed no significant differences （P 〈 0. 05）. In multivariate Logistic regression analysis, age, NIHSS scores, D-Dimer and fibrinogen were independent risk factors for DVT and anticoagulant and anti-platelet drugs were protective factors. LMWH combined with IPC was the best strategy for preventing DVT （P〈0.05）. Conclusion The critically neurological patients with cerebral infarction have high morbidity rate of DVT and have many risk factors for DVT. The incidence of DVT reduces by using LMWH and IPC in cerebral infarction patients.