住院脑卒中患者下肢深静脉血栓形成发病情况分析

THE PREVALENCE OF DEEP VENOUS THROMBOSIS IN HOSPITALIZED PATIENTS WITH STROKE

目的 了解住院脑卒中患者深静脉血栓形成 (DVT)的发生情况 ;分析卒中患者并发DVT的临床特点 ;初步观察抗凝治疗对卒中后DVT的预防效果。方法 连续调查了 2 0 0 1年 12月至 2 0 0 2年 12月收住入北京朝阳医院神经内科及神经外科的卒中患者 ,经CT或磁共振成像检查证实符合卒中诊断 ,共计 4 88例 ,男 32 8例 ,女 16 0例 ;年龄 :2 2～ 93岁 ,平均 6 5岁± 11岁 ;95 5 %为汉族。调查步骤 :(1)对每位入院的卒中患者进行详细的病史询问、体格检查。 (2 )于发病 7～ 10d行双下肢血管超声检查。 (3)高度可疑DVT的患者 ,1周后重复超声检查。结果 (1)DVT的总体检出率为 2 1 7% ;(2 )检出率最高的年龄组为 70～ 79岁组 (2 8 0 % )。 (3)女性DVT的发生率 (2 9 4 % )高于男性 (18 0 % ) ,P =0 0 0 4。 (4)卒中合并严重瘫痪者DVT发生率为 2 5 9%。 (5 )DVT最常见的局部症状为肿胀 (13 3% ) ,但下肢增粗与DVT定位无相关性 ;74 5 %的DVT患者无明显的临床症状。(6 )DVT主要累及下肢远端静脉 ,近端DVT :远端DVT =1 0 :2 3,以腓静脉最常见 (30 4 % ) ,77 3%的DVT超声表现为充盈缺损。 (7)使用低分子肝素可使缺血性卒中患者的DVT发生率减低4 0 0 %。结论 (1)急性脑卒中住院患者为DVT高发人群。 (2 )大多数DVT患?

OBJECTIVE TO INVESTIGATE THE PREVALENCE AND THE CLINICAL MANIFESTATIONS OF DVT IN HOSPITALIZED PATIENTS WITH ACUTE STROKE, AND TO EVALUATE THE SHORT-TERM PROPHYLAXIS EFFECT OF LOW MOLECULAR WEIGHT HEPARIN (LMWH) TO PREVENT DVT.METHODS 488 CASES WITH STROKE ADMITTED TO THE DEPARTMENT OF NEUROLOGY AND NEUROSURGERY IN BEIJING CHAOYANG HOSPITAL BETWEEN DECEMBER 2001 AND DECEMBER 2002 WERE CONSECUTIVELY INVESTIGATED. THE DIAGNOSIS OF STROKE WAS IDENTIFIED BY CT OR MRI. THE PATIENTS(95.5% HANS)WERE COMPRISED OF 328 MALE AND 160 FEMALE,WITH A MEAN AGE OF (65±11) YEARS,RANGING 22～93 YEARS. THE PROCEDURE OF INVESTIGATION:(1)A DETAILED HISTORY WAS TAKEN AND A PHYSICAL EXAMINATION WAS PERFORMED TO EVERY ELIGIBLE PATIENT. (2)THE ULTRASONOGRAPHY(US) WAS USED FOR DETECTING BOTH LOWER EXTREMITIES AT 7～10 DAYS AFTER ACUTE STROKE. (3)THE ULTRASOUND EXAMINATION WAS REPEATED AFTER A WEEK IN PATIENTS HIGHLY SUSPECTED OF DVT.RESULTS (1)THE PREVALENCE OF DVT WAS 21.7% AMONG THE PATIENTS. (2)DVT WAS THE MOST FREQUENT(28.0%) IN THE PATIENTS RANGING 70～79 YEARS. (3)A HIGHER INCIDENCE OF DVT WAS OBSERVED IN FEMALE THAN IN MALE (29.4% VS 18.0%, P=0.004). (4)THE INCIDENCE OF DVT IN SEVERELY PARALYZED PATIENTS WAS 25.9%. (5)LEG EDEMA WAS THE MOST COMMON SYMPTOMS OF DVT WITH THE FREQUENCY OF 13.3%,BUT THERE WAS A POOR CORRELATION BETWEEN THE SYMPTOMS AND THE LOCATION OF DVT. AND 74.5% PATIENTS WERE ASYMPTOMATIC. (6)MOST DVTS OCCURRED IN DISTAL EXTREMITIES. THE DVTS IN PROXIMAL VEINS AND IN DISTAL VEINS WERE IN A RATIO OF 1.0 TO 2.3.FIBULAR VEINS WERE MOST FREQUENTLY ATTACKED (30.4%). THE PRESENCE OF A FILLING DEFECT ON ULTRASOUND IMAGES WAS DESCRIBED IN 77.3% OF THE DVTS.(7) A 40.0% REDUCTION OF DVT INCIDENCE WAS CAUSED BY LWMH TREATMENT IN ISCHEMIC STROKE PATIENTS.CONCLUSIONS (1)THE HOSPITALIZED PATIENTS WITH ACUTE STROKE WERE THE CROWD WITH HIGH RISK OF DVT. (2)MOST DVTS WERE ASYMPTOMATIC; THE SIGNS WERE NONSPECIFIC, WHICH INDICATED THE DIAGNOSIS OF DVT COULDN'T DEPEND MERELY ON CLINICAL MANIFESTATION. (3)MOST DVTS WERE IN DISTAL EXTREMITIES. FILLING DEFECT WAS THE MOST COMMON MANIFESTATION OF ULTRASONOGRAPHY IN DVT. (4)THE INCIDANCE OF DVT COULD BE REDUCED BY USING LMWH IN ACUTE ISCHEMIC STROKE PATIENTS.