CAJ | 학술논문

目的调查卒中后急性期和随访期深静脉血栓形成(DVT)发生率,并探讨DVT发生的危险因素.方法采用多中心、前瞻性研究设计.所有患者于发病后10～14 d进行双下肢静脉超声检查,出院后继续随访6个月.计算出卒中后急性期和随访期DVT发生率.通过比较卒中后并发DVT与卒中后无DVT的患者多种相关因素,筛选出卒中后DVT发生的危险因素.结果卒中急性期DVT发生率为4.49%,其中有DVT症状者为51.6%,无症状者为48.4%;多因素Logistic分析显示:年龄(≥70岁,OR=1.63,95%CI 1.08～2.84)、卧床(OR=4.85,95%CI 2.65～9.68)、Wells评分≥2(OR=3.96,95%CI 1.86～7.86)、下肢NIHSS评分≥3分(OR=4.56,95%CI 2.07～8.85)、D-二聚体水平高(OR=3.45,95%CI 2.01～8.52)、Barthel指数(BI)评分低(OR=2.98,95%CI 1.52～6.47)、是否康复治疗(OR=1.82,95%CI 1.22～3.43)、是否抗凝治疗(OR=1.91,95%CI 1.34～4.92)是急性期卒中患者DVT发生的独立危险因素,其中康复治疗和抗凝治疗是保护因素;卒中随访期DVT发生率为1.51%,年龄(≥70岁,OR=1.82,95%CI 1.21～3.98)、出院后仍卧床(OR=5.12,95% CI 2.82～11.32)、出院时下肢NIHSS评分≥3分(OR=4.25,95%CI 2.11～7.87)、出院时BI评分低(OR=2.18,95%CI 1.18～6.23)、急性期有DVT(OR=3.81,95% CI 1.87～7.48)是随访期卒中患者DVT发生的独立危险因素.结论卒中后DVT多发生于老年患者,48.4%DVT无症状,卒中患者发生DVT的独立危险因素多,对有上述危险因素卒中患者进行DVT监测和预防干预十分必要,康复治疗和抗凝治疗可能能降低DVT的发生.
목적 조사졸중후급성기화수방기심정맥혈전형성(DVT)발생솔,병탐토DVT발생적위험인소.방법 채용다중심、전첨성연구설계.소유환자우발병후10～14 d진행쌍하지정맥초성검사,출원후계속수방6개월.계산출졸중후급성기화수방기DVT발생솔.통과비교졸중후병발DVT여졸중후무DVT적환자다충상관인소,사선출졸중후DVT발생적위험인소.결과 졸중급성기DVT발생솔위4.49%,기중유DVT증상자위51.6%,무증상자위48.4%;다인소Logistic분석현시:년령(≥70세,OR=1.63,95%CI 1.08～2.84)、와상(OR=4.85,95%CI 2.65～9.68)、Wells평분≥2(OR=3.96,95%CI 1.86～7.86)、하지NIHSS평분≥3분(OR=4.56,95%CI 2.07～8.85)、D-이취체수평고(OR=3.45,95%CI 2.01～8.52)、Barthel지수(BI)평분저(OR=2.98,95%CI 1.52～6.47)、시부강복치료(OR=1.82,95%CI 1.22～3.43)、시부항응치료(OR=1.91,95%CI 1.34～4.92)시급성기졸중환자DVT발생적독립위험인소,기중강복치료화항응치료시보호인소;졸중수방기DVT발생솔위1.51%,년령(≥70세,OR=1.82,95%CI 1.21～3.98)、출원후잉와상(OR=5.12,95% CI 2.82～11.32)、출원시하지NIHSS평분≥3분(OR=4.25,95%CI 2.11～7.87)、출원시BI평분저(OR=2.18,95%CI 1.18～6.23)、급성기유DVT(OR=3.81,95% CI 1.87～7.48)시수방기졸중환자DVT발생적독립위험인소.결론 졸중후DVT다발생우노년환자,48.4%DVT무증상,졸중환자발생DVT적독립위험인소다,대유상술위험인소졸중환자진행DVT감측화예방간예십분필요,강복치료화항응치료가능능강저DVT적발생.
Objective To study incidence of deep vein thrombosis (DVT) in the acute phase and follow-up period after stroke, and to investigate risk factors of DVT. Methods This was a prospective study at multi-centers. Ultrasonography was used for detecting DVT on both lower extremities in all patients at 10-14 days after the onset of stroke. All patients were followed up for 6 months after discharge. The incidence of DVT was examined in the acute phase and in the follow-up period of stroke. A variety of patient and treatment related factors were compared between stroke patients with DVT and without DVT to identify DVT risk factors. Results The incidence of DVT in the acute period of stroke was 4. 49%. Among DVT patients, 51.6% patients presented clinical DVT symptoms. By multiple factors logistic regression analysis,age ( ≥70 years, OR = 1.63, 95% CI 1.08-2. 84), bedridden( OR =4. 85, 95% CI 2.65-9. 68 ), wells score ≥ 2 ( OR = 3.96, 95% CI 1.86-7. 86 ), lower limbs NIHSS score ≥ 3 ( OR = 4. 56, 95% CI 2. 07-8. 85 ), high D-dimer ( OR = 3.45, 95% CI 2. 01-8. 52 ), low BI scores ( OR = 2. 98, 95% CI 1.52-6. 47 ), rehabilitation therapy ( OR = 1.82, 95% CI 1.22-3.43 ) and anticoagulant therapy ( OR =1.91,95% CI 1. 34-4. 92 ) were independent risk factors of DVT in the acute phase of stroke. Among them, the rehabilitation therapy and anticoagulant therapy were protective factors. The incidence of DVT in the follow-up periods was 1. 51%. Age ( ≥ 70 years, OR = 1.82, 95% CI 1.21-3.98 ), bedridden after discharge( OR = 5. 12, 95% CI 2. 82-11.32), lower limbs NIHSS score ≥3 ( OR = 4. 25, 95% CI 2. 11-7. 87), low BI score( OR = 2. 18, 95% CI 1.18-6.23 )at the time of discharge and DVT in acute period (OR =3.81,95%CI 1.87-7.48)were independent risk factors of DVT in the follow-up period of stroke.Conclusions Stroke patients, particularly old-aged stroke patients, are a high-risk group of developing DVT. 48.4% DVT patients had no clinical DVT symptoms but were diagnosed only by ultrasonography.There are multiple independent risk factors of DVT after stroke. It is necessary to monitor and prevent DVT in the stroke patients with the risk factors. The rehabilitation therapy and anticoagulant therapy may decrease incidence of DVT.