CAJ | 학술논문

目的探讨住院急性脑梗死患者并发下肢深静脉血栓(LDVT)的诊断,以及并发LDVT后适合抗凝治疗者的疗效和安全性. 方法根据Wells的临床怀疑LDVT的量化评分表,对怀疑者行压迫静脉超声(CUG)显像确诊.确诊并发LDVT的患者如适合抗凝治疗则给予低分子肝素(LMWH)皮下注射,同时当天口服华法林,口服华法林按Roberts的依年龄调整华法林的负荷量方法进行,当凝血酶原时间国际化比率(INR)2.0～3.0达2 d,则停用LMWH,口服华法林抗凝治疗3个月. 结果急性脑梗死患者2067例,经CUG确诊并发LDVTl8例,占同期急性脑梗死住院患者的0.9%.发生LDVT的肢体均为瘫痪肢体,其中左侧13例,右侧5例.18例均适合抗凝治疗,除1例患者在口服华法林第3天出现痔疮出血,于第4天停用华法林外,余17例口服华法林达3个月.18例均达到消除LDVT的症状,预防肺栓塞的治疗目标,停用华法林后观察达1年共12例,3个月5例,均未发现LDVT复发,未发现有临床症状的肺血栓栓塞者. 结论使用Wells临床怀疑LDVT量表,对可疑者行CUG检查,可较及时诊断急性脑梗死患者并发LDVT,对适合抗凝治疗者应用Roberts的依年龄调整华法林的负荷量方法可达到早期足量抗凝的目的 ,继而可达到消除LDVT症状、预防肺栓塞和静脉血栓复发的治疗目标、而且是安全的.由于种族和人群的差异以及其他未知的因素,惠州地区急性脑梗死患者并发LDVT的患病率相对较低,似无必要对该地区人群所有急性脑梗死患者给予LMWH以预防静脉血栓.
목적 탐토주원급성뇌경사환자병발하지심정맥혈전(LDVT)적진단,이급병발LDVT후괄합항응치료자적료효화안전성. 방법 근거Wells적림상부의LDVT적양화평분표,대부의자행압박정맥초성(CUG)현상학진.학진병발LDVT적환자여괄합항응치료칙급여저분자간소(LMWH)피하주사,동시당천구복화법림,구복화법림안Roberts적의년령조정화법림적부하량방법 진행,당응혈매원시간국제화비솔(INR)2.0～3.0체2 d,칙정용LMWH,구복화법림항응치료3개월. 결과급성뇌경사환자2067례,경CUG학진병발LDVTl8례,점동기급성뇌경사주원환자적0.9%.발생LDVT적지체균위탄탄지체,기중좌측13례,우측5례.18례균괄합항응치료,제1례환자재구복화법림제3천출현치창출혈,우제4천정용화법림외,여17례구복화법림체3개월.18례균체도소제LDVT적증상,예방폐전새적치료목표,정용화법림후관찰체1년공12례,3개월5례,균미발현LDVT복발,미발현유림상증상적폐혈전전새자. 결론 사용Wells림상부의LDVT량표,대가의자행CUG검사,가교급시진단급성뇌경사환자병발LDVT,대괄합항응치료자응용Roberts적의년령조정화법림적부하량방법 가체도조기족량항응적목적 ,계이가체도소제LDVT증상、예방폐전새화정맥혈전복발적치료목표、이차시안전적.유우충족화인군적차이이급기타미지적인소,혜주지구급성뇌경사환자병발LDVT적환병솔상대교저,사무필요대해지구인군소유급성뇌경사환자급여LMWH이예방정맥혈전.
Objective To explore the early diagnosis of lower extremity deep venous thrombosis (LDVT)and evaluate the therapeutic effect of anticoagulant therapy in hospitalized patients with acute ischemic stroke. Methods　According to Wells model for suspecting lower extremity deep venous thrombosis,patients with suspected LDVT were confirmed by compression ultrasonography. If the patients diagnosed with LDVT had no contraindications to anticoagulant therapy,they were treated with low molecular weight heparin(LMWH)subcutaneous injection and oral warfarin at the same time.The dosage of oral warfarin was determined by Roberts'age adjusted warfarin loading protocol.LMWH was stopped when the patients'international normalized ratio(INR)was 2.0～3.0 for two consecutive days. Results From January 2003 to August 2007,2067 cases with acute ischemic stroke were admitted to the department of neurology in Huizhou Municipal Central Hospital including 18 cases with LDVT and the incidence was 0.9%.The patients with LDVT all had paralytic extremities including 13 left legs and 5 right legs with deep vein thrombosis.All the 18 cases were treated by anticoagulant including 17 cases with oral warfarin treatment for 3 months.Symptoms in all LDVT patients were eliminated.12 cases had been observed for one year and 5 cases for three months after they stopped taking warfatin.There were no patients with pulmonary thromboembolism and LDVT recurrence. Conclusions　By using Wells model for suspecting LDVT,patients with acute ischemic stroke-complicated LDVT can be timely diagnosed.The goal of prompt and enough anticoagulant can be achieved according to Roberts'age adjusted warfarin loading protocol.Because of racial difference,population difference and other unknown factors,the incidence of acute ischemic stroke patients with complicated LDVT is much lower in Huizhou.It suggests that it should be unnecessary to use LMWH in patients with acute ischemic stroke to prevent LDVT in Huizhou.