神经内科ICU患者下肢不同肌力对深静脉血栓形成的影响

Effect of different muscle strength of lower extremity on deep venous thrombosis in patients with neurological ICU

目的探讨神经内科ICU患者下肢不同肌力与深静脉血栓形成(DVT)的相关因素并进行研究与分析,为早期预防DVT提供依据。方法制订神经内科ICU患者发生下肢DVT相关因素的调查表,通过对首都医科大学宣武医院神经内科ICU195例患者临床资料的收集,使用英国医学研究理事会(MRC)徒手肌力评定量表进行分级评定,将患者分为肌力4~5级组(至少一侧肢体肌力≥4级)和肌力0~3级组(双下肢肌力均≤3级),通过性别、年龄、股静脉置管、格拉斯哥昏迷量表(GCS)评分、卧床时间、纤维蛋白原、D-二聚体值进行2组比较,分析出下肢不同肌力发生下肢DVT的主要影响因素,同时通过分组比较不同肌力发生下肢DVT的情况。结果神经内科ICU患者肌力0~3级组的卧床时间、GCS评分、D-二聚体分别为18.96(14.00,27.00)d、9.0(6.00,10.15)分、2.15(1.24,3.58)mg/L,肌力4~5级组分别为13.50(5.75,22.00)d、13.5(10.00,15.00)分、1.52(0.76,2.99)mg/L,差异有统计学意义(Z=-3.767、-5.811、-2.296,P<0.01或0.05)。而性别、置管、纤维蛋白原、抗凝药物使用、年龄差异无统计学意义(P>0.05)。单侧下肢肌力分组比较,左下肢肌力分组,0~3级组血栓发生率为26.9%(32/119),4~5级组血栓发生率为14.5%(11/76),差异有统计学意义(χ2=4.160,P<0.05)。右下肢肌力分组,0~3级组血栓发生率为32.8%(41/125),4~5级组血栓发生率为15.7%(11/70),差异有统计学意义(χ2=6.698,P<0.05)。结论神经内科ICU患者双下肢肌力≤3级的患者,发生DVT的影响因素较多,单侧肢体肌力≤3级的下肢,DVT发生率较高,应加强下肢DVT的早期防控与监测,预防下肢DVT发生。

Objective To discuss the correlation between different muscle strength of lower extremitiess and the formation of deep vein thrombosis (DVT) in neurological ICU patients, and to provide evidence for effective nursing intervention. Methods A questionnaire was developed to investigate the factors related to lower extremities DVT in patients with neurological ICU.By collecting clinical data of 195 patients from neurological ICU in Xuanwu Hospital of Capital Medical University, using the UK Medical Research Council(MRC) scale of freehand muscle strength for grading evaluation, patients were divided into a muscle strength grade 4-5 group (at least one extremities muscle strength grade 4) and a muscle strength grade 0-3 group (both lower extremities muscle strength grade 3).Gender, age, deep venous catheterization, Glasgow Coma Scale(GCS) score, bed time, fibrinogen value, D-dimer value were compared between the two groups.The main influencing factors of lower extremities DVT with different muscle strength were analyzed, and the incidence of lower extremities DVT with different muscle strength was compared. Results The comparison between muscle strength grade 4-5 group and muscle strength grade 0-3 group in neurological ICU patients showed that bed time, GCS score, and D-dimer of the 0-3 muscle strength group were 18.96(14.00, 27.00) d, 9.00(6.00, 10.15), and 2.15(1.24, 3.58) mg/L, while those of the 4-5 muscle strength group were 13.50(5.75, 22.00)d, 13.50(10.00, 15.00), 1.52(0.76, 2.99) mg/L, the difference was statistically significant (Z=-3.767,-5.811,-2.296, P<0.01 or 0.05).While gender, catheterization, fibrinogen, anticoagulant use and age had no statistical significance (P > 0.05). Grouping comparison of unilateral lower extremities muscle strength showed that the left lower extremities muscle strength group,the incidence of thrombosis in grade 0-3 group was 26.9%(32/119), and that in grade 4-5 group was 14.5%(11/76), the incidence of left lower extremities DVT had statistical significance (χ2=4.160, P<0.05),and the right lower extremities muscle strength group,the incidence of thrombosis was 32.8%(41/125) in the 0-3 group and 15.7%(11/70) in the 4-5 group, the incidence of right lower extremities DVT had statistical significance (χ2=6.698, P<0.05). Conclusions Patients with grade 0-3 lower extremities muscle strength in neurological ICU have more factors influencing DVT.The incidence of DVT is high in the lower extremities with unilateral extremities muscle strength grade 0-3, and early monitoring of lower extremities DVT should be strengthened to prevent the occurrence of lower extremities DVT.