急性脑卒中住院患者深静脉血栓形成危险因素分析

孙葵葵; 王辰; 庞宝森; 杨媛华; 何文; 陈天风; 赵奇煌; 张健

文章摘要

孙葵葵,王辰,庞宝森,杨媛华,何文,陈天风,赵奇煌,张健.急性脑卒中住院患者深静脉血栓形成危险因素分析[J].中华流行病学杂志,2004,25(12):1019-1023

急性脑卒中住院患者深静脉血栓形成危险因素分析

Study on the risk factors of deep venous thrombosis in acute hospitalized stroke patients

收稿日期:2004-02-01 出版日期:2014-09-17

DOI：

中文关键词: 脑卒中深静脉血栓形成危险因素

英文关键词: Stroke Deep venous thrombosis Risk factor

基金项目:国家"十五"科技攻关课题基金资助项目(2001BA703B15)

作者	单位
孙葵葵	首都医科大学附属北京朝阳医院北京呼吸疾病研究所, 北京 100020
王辰	首都医科大学附属北京朝阳医院北京呼吸疾病研究所, 北京 100020
庞宝森	首都医科大学附属北京朝阳医院北京呼吸疾病研究所, 北京 100020
杨媛华	首都医科大学附属北京朝阳医院北京呼吸疾病研究所, 北京 100020
何文	首都医科大学附属北京朝阳医院北京呼吸疾病研究所, 北京 100020
陈天风	首都医科大学附属北京朝阳医院北京呼吸疾病研究所, 北京 100020
赵奇煌	首都医科大学附属北京朝阳医院北京呼吸疾病研究所, 北京 100020
张健	首都医科大学附属北京朝阳医院北京呼吸疾病研究所, 北京 100020

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中文摘要:

目的前瞻性病例对照研究分析急性脑卒中住院患者深静脉血栓形成(DVT)的危险因素。方法连续调查了2001年12月至2002年12月收住北京朝阳医院神经内科及神经外科的脑卒中患者,经CT或MRI检查证实符台脑卒中诊断,共计488例调查步骤:(1)在入院次日清晨空腹抽每位入选患者血,进行D-二聚体(D-dimer)、血栓调节蛋白(TM)和抗凝血酶-Ⅲ(AT-Ⅲ)检测 (2)于发病7-10天行双下肢血管超声检查,在超声检查当日或次日复查D-dimer和AT-Ⅲ (3)高度可疑DVT的患者一周后重复超声检查 (4)研究结束前记录脑卒中的治疗情况。通过比较脑卒中并发DVT与脑卒中无DVT的患者,筛选脑卒中发生DVT的危险因素。结果脑卒中患者DVT的发生率为21 7% 多因素logistic分析显示,年龄(≥65岁)(OR=1.655,95%CI:1 005-2 725)、女性(OR=1 993,95%CI:1 221-3.253)、卧床(OR=3 275.95%CI:1 653-6.486)和DVT危险性评分≥2(OR=5.019,95%CI:2.685-9 381)是总体脑卒中患者DVT的独立危险因素女性(OR=2 828,95%6 CI:1.242-6 438)、白细胞计数> 10 0×109／L(OR=2 032,95%CI:0 897-4 602)和DVT危险性评分≥2(OR=8 809,95%CI:3 081-25 188)是出血性脑卒中患者DVT的独立危险因素年龄(≥65岁)(OR=2 167,95%CI:1 072-4 381)、卧床(OR=3 008,95%CI:1 43。

英文摘要:

Objective To identify the risk factors of deep venous thrombosis(DVT)in hospitalized patients with acute stroke， under a perspective case—control study．I订ethods 488 cases with stroke，identified by CT or MRI and admitted to the department of neur0109y and neurosurgery in Be巧ing Chaoyang HosDital between December 200 l and December 2002 were consecutively studied．There were 328 male and 160 female patients(95．5%Hans)with amean age of 65±11 years，Tanging 22—93 years．The procedure of study would include： (1)General condition，possible risk factorS，symptoms of DVT physical check—up to every eligible patient on first day of admission but the plasma concentrations of D—dimer(ELI≤呈A)，thrombomodulin，antithrombin一Ⅲ and bloOd routine examination were measured on the next morning． (2)The ultrasonography(US)was used for detecting both lower extremities at 7—10 days after the onset of stroke，and D—dimer and AT一Ⅲtests were repeated on the same or next day that the US was taken． (3)The uItrasound examination was repeated after a week in patients with high suspicion of DVT． (4)The therapy of stroke was recorded before the end of the study．Data of stoke patients with DVT was compared with those without DVT to identifv theDVT risk factorS．The effect of each variable on DVT was assessed by logistic regression analysis．Results The prevalence of DVT was 21．7%among the patients．In multivariate analysis，age≥65 years 01d(I：)R=1．655，95%CJ：1．005—2．725)，being male(oR=1．993，95%CJ：1．22l一3．253)，bedridd肌(oR=3．275，95%(x：1．653—6．486)and DVT asseSsment scores≥2(OR=5．019，95%C，：2．685—9．381)were independently assOciated with DVT in all the stroke patients． Being maIe(oR=2．828，95%C工：1．242—6．438)，white b100d celI count>10．0×10'／L(OR=2．032，95%CJ：0．897—4．602)and DVT assessment scores≥2(oR=8．809，95%C，：3．081—25．188)were the independent risk factors of DVT in hemo”hagic stroke group．Age≥65 years 01d(0尺：2．167，95%Cf：1．072—4．381)，bed“dden(oR=3．008，95%CJ：1．435—6．307)and DVT assessment scores≥2(oR=2．600，95%CI：1．077—6．278) were the independeni risk factors of DVT in ischemic stroke group．Conclusions Patients hoS硝talized with acute strOke were under high risk of DVT．Data suggested that 0ld age，female，bedridden and h逸h DVT assessment scores≥2 were independent risk factors for DVT in acutestroke patients that called for supervision and prophylaxis on DVT．

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