神经重症急性期患者深静脉血栓形成因素分析

Analysis on the factors of deep vein thrombosis in acute stage of neuro-intensive care unit

目的回顾性分析神经重症患者血栓(Deep vein thrombosis,DVT)形成的相关因素,为寻找早期、敏感的DVT预测和干预指标提供参考。方法选取2018-07―2019-12郑州大学第一附属医院行四肢深静脉彩色超声检查的2031患者为研究对象,统计其DVT的发生率。并将生化、血栓弹力图(Thromboelastography,TEG)及下肢深静脉彩超结果均齐全的284例患者分为有血栓组和无血栓组进行对比分析。结果2031患者中DVT 516例,发生率25.4%。资料齐全的284例患者中,DVT 120例,无DVT 164例;其中无症状DVT 109例(90.83%),包括肌间DVT 103例,肌间合并非肌间3例,非肌间DVT3例;症状性DVT 11例(9.17%)。与无DVT组相比,DVT组患者年龄较大(63.28±12.20 vs 57.77±15.62);TEG-R值减小4.30(3.80,5.60)vs 4.80(4.10,5.80);TEG-K值减小1.50(1.20,1.80)vs 1.60(1.30,2.20);部分活化凝血酶时间(Activated partial thrombin time,APTT)缩短28.05(26.03,30.8)vs 29.10(27.00,31.58);D-二聚体增高0.76(0.35,1.85)vs 0.46(0.18,0.90),纤维蛋白降解产物(Fibrinogen degradation products,FDP)升高6.31(2.79,12.77)vs 3.98(1.87,8.49);以上差异均具有统计学意义(P<0.05)。结论神经重症急性期约1/4患者将发生DVT,且以无症状性的下肢肌间静脉血栓为主;与DVT相关因素为患者年龄偏大,凝血因子功能增强,纤维蛋白原功能增强,FDP和D-二聚体升高。

Objective The incidence of deep vein thrombosis(DVT)in patients with severe acute neurological disease is increasing,which seriously affects the prognosis of patients.The aim of this article was to provide reference for early and sensitive DVT prediction and intervention indicators by retrospective analysis of the related factors of thrombosis in patients with severe neurological diseases.Methods From July 2018 to December 2019 in the First Affiliated Hospital of Zhengzhou University,the incidence of DVT was statistically analyzed in 2031 patients who underwent color Doppler ultrasound examination of limbs deep vein.284 patients with complete biochemical,thromboelastography(TEG)and color Doppler ultrasound of lower extremity deep vein were divided into thrombosis group and non-thrombosis group.Results There were 516 cases of DVT in 2031 patients,the overall incidence was 25.4%.Among the 284 patients with complete data,there were 120 cases of DVT and 164 cases of No-DVT,109 cases(90.83%)were asymptomatic DVT,including 103 cases of intermuscular DVT,3 cases of intermuscular and non-intramuscular DVT,and 11 cases(9.17%)of symptomatic DVT.Compared with the group without DVT,the patients in DVT group were older(63.28±12.20 vs 57.77±15.62);TEG-R decreased(4.30(3.80(3.80,5.60)vs 4.80(4.10,5.80));TEG-K(1.50(1.20,1.80)vs 1.60(1.30,2.20)),activated partial thrombin time(APTT)(28.05(26.03,30.8)vs 29.10(27.00,31.58)),D-dimer decreased(4.30(3.80,5.60 vs 4.80(4.10,5.80)).The levels of fibrinogen degradation products(FDP)were increased(6.31(2.79,12.77)vs 3.98(1.87,8.49)),and the differences were statistically significant(P<0.05).Conclusion DVT will occur in about 1/4 patients in the acute stage of severe neurological disease,and the main cause of DVT is asymptomatic intermuscular venous thrombosis,the factors related to DVT are older patients,enhanced coagulation factor function,enhanced fibrinogen function,increased FDP and D-dimer.