神经肌电刺激对自发性脑出血患者下肢深静脉血栓形成预防效果与凝血功能的影响

Effect of neuromuscular electrical stimulation on prevention of lower extremity deep vein thrombosis and coagulation function in patients with spontaneous cerebral hemorrhage

目的 探讨神经肌电刺激对自发性脑出血患者下肢深静脉血栓形成(DVT)预防效果与凝血功能的影响。方法 收集2020年1月至2021年2月华中科技大学协和江南医院(武汉市江夏区第一人民医院)收治的94例自发性脑出血患者的临床资料,根据不同的治疗方式分为观察组和对照组,每组47例。对照组接受常规治疗,观察组在对照组基础上同时接受神经肌电刺激治疗。比较两组患者的下肢DVT发生率、凝血功能指标[凝血酶原时间(PT)、活化部分凝血酶时间(APTT)、纤维蛋白原(Fib)、D-二聚体(D-D)]、下肢股总静脉血流动力学指标[血流峰速(Vmax)、血流平均速度(Vmean)、血流阻力指数(RI)]、近期预后情况[美国国立卫生研究院卒中量表(NIHSS)评分、改良Rankin量表(mRS)评分]和不良反应的发生情况。结果 治疗14 d后,观察组患者下肢DVT发生率为4.26%,低于对照组患者的19.15%,差异有统计学意义(P=0.025)。治疗14 d后,两组患者PT、APTT均短于本组治疗前,Fib、D-D水平均低于本组治疗前,且观察组患者PT、APTT均短于对照组患者,Fib、D-D水平均低于对照组患者,差异均有统计学意义(P<0.05)。治疗14 d后,两组患者下肢股总静脉的Vmax、Vmean均高于本组治疗前,RI均低于本组治疗前,且观察组患者下肢股总静脉Vmax、Vmean均高于对照组患者,RI低于对照组患者,差异均有统计学意义(P<0.05)。治疗14 d后,两组患者mRS、NIHSS评分均低于治疗前,且观察组患者m RS、NIHSS评分均低于对照组患者,差异均有统计学意义(P<0.05)。两组患者的不良反应发生率比较,差异无统计学意义(P>0.05)。结论 神经肌电刺激有助于预防自发性脑出血患者下肢DVT的发生,可显著改善患者下肢血流动力指标和凝血功能,促进神经功能尽快恢复,未增加不良反应的发生风险,值得临床推广应用。

Objective To study the effect of neuromuscular electrical stimulation on the prevention of lower extremity deep vein thrombosis(DVT) and coagulation function in patients with spontaneous cerebral hemorrhage.Method A total of 94 patients with spontaneous cerebral hemorrhage in Union Jiangnan Hospital Huazhong University of Science and Technology(the First People’s Hospital of Jiangxia District, Wuhan) from January 2020 to February 2021 were collected. According to different treatment methods, they were divided into observation group and control group, with 47 cases in each group. The control group received routine treatment, and the observation group received neuromuscular electrical stimulation on the basis of the control group. The incidence of lower extremity DVT,coagulation function indexes [prothrombin time(PT), activated partial thromboplastin time(APTT), fibrinogen(Fib),D-dimer(D-D)] and lower extremity hemodynamics [maximum velocity(Vmax), mean velocity(Vmean), resistance index(RI)], short-term prognosis [scores of National Institutes of Health Stroke Scale(NIHSS) and modified Rankin scale(mRS)] and the adverse reactions in two groups were compared. Result After 14 days of treatment, the incidence of lower extremity DVT in observation group was lower than that in control group(4.26% vs 19.15%, P=0.025). After 14 days of treatment, the levels of PT, APTT, Fib, and D-D in two groups were lower than those before treatment(P<0.05), and the levels in the observation group were lower than those of the control group(P<0.05). After 14 days of treatment, the Vmax and Vmean of the lower extremity common femoral vein of two groups were higher than those before treatment(P<0.05), and RI lower than those before treatment(P<0.05);the Vmax and Vmean of the lower extremity common femoral vein of observation group were higher than those of the control group(P<0.05), RI of the lower extremity common femoral vein of observation group was lower than that of the control group(P<0.05). After 14days of treatment, the scores of mRS and NIHSS decreased than those before treatment in two groups, the scores of MRS and NIHSS in the observation group were lower than those in the control group(P<0.05). There was no significant difference for the incidence of adverse reactions between the two groups(P>0.05). Conclusion Neuromuscular electrical stimulation is beneficial to prevent the occurrence of lower extremity DVT in patients with spontaneous cerebral hemorrhage, which can significantly improve lower extremity hemodynamics and coagulation function, promote the recovery of nerve function prognosis, with fewer adverse reactions.