颅内出血患者静脉血栓的发生率和危险因素研究

Venous thromboembolism incidence and risk factors of intracranial hemorrhage

目的研究神经外科重症监护室（NSICU）的自发性或创伤性颅内出血患者中静脉血栓（vTE）的发病率并确定引起VTE的危险因素。方法通过回顾性队列试验收集入住NSICU的原发性蛛网膜下腔出血（SAH）、脑出血（ICH）或创伤性脑损伤（TBl）的成年患者。在ICU中，所有患者均使用低剂量普通肝素或依诺肝素，并使用间歇性充气加压设备。使用ICD-9分类系统对患者及VrE进行评估，使用统计学方法分析患者发生VTE的特征。结果发生VTE的整体（n=1195）发病率为3．8％。SAH患者（n=179）中VTE的发病率为6．7％，ICH患者（n=516）的发病率为2．9％，TBI患者（n=500）的发病率为3．8％。结论在三组病例中最常见的危险因素为不活动〉72h、感染和中央静脉导管滞留。因此，为了降低颅内出血患者静脉血栓，除采用常规抗凝治疗外，最有效的方法是增加患者的活动量。

Objective To investigate the incidence of symptomatic venous thromboembolism （VTE） in neurosurgery intensive care unit （NSICU） patients with spontaneous or traumatic intracranial hemorrhage and to identify the common VTE risk factors by injury type. Methods This retrospective, single-center cohort study included adult patients admitted to the NSICU with a primary diagnosis of sub- arachnoid hemorrhage （ SAH）, intracerebral hemorrhage （ ICH）, or traumatic brain injury （TBI）. Patients and VTE events were identified using ICD-9 codes. All patients received low-dose unfractionated heparin or enoxaparin and intermittent pneumatic compression device. Descriptive statistics were used to describe patient characteristics. Results The overall incidence of symptomatic VTE （n = 1195 ） was 3.8%. The incidence of VTE was 6.7% in SAH patients （n = 179）, 2. 9% in ICH patients （n =516） and 3.8% in TBI patients （ n = 500 ）. The most commonly identified risk factors in the three groups were： immobility due to paresis or restrictions for mechanical ventilation, infection, and presence of indwelling central venous catheter. There was no objective evidence of intracranial bleeding associated with pharmacologic VTE prophylaxis in VTE patients. Conclusions The most common risk factors in 3 groups of inactive 〉72 h, infection and central venous catheter retention. Therefore, in order to reduce intracranial hemorrhage in patients with venous thrombosis in addition to the conventional anticoagulant therapy, the most effective way is to increase the patient＇s activity.