摘要
目的分析神经重症脑梗死患者深静脉血栓(DVT)形成的危险因素,寻找早期、敏感的DVT预测和干预指标。方法选取2017年1月至2020年5月郑州大学第一附属医院神经重症科住院脑梗死患者226例,平均年龄(62.5±12.9)岁,搜集患者的临床资料、生化检测及下肢深静脉彩超结果,分析危险因素;利用ROC曲线确定截断值及曲线下面积、灵敏度及特异度。结果不考虑时间影响凝血机制的总体情况下年龄、血栓弹力图的凝血因子反应时间(R)、纤维蛋白原降解产物(FDP)是DVT的危险因素。依据时间分层分析,发病3 d内R值降低(OR=0.58,95%CI:0.40~0.84)及FDP升高(OR=1.17,95%CI:1.02~1.33)是DVT的危险因素,截断值分别为5.35 min、3.57 mg/L;3 d后D二聚体(D-dimer)升高(OR=2.73,95%CI:1.53~4.86)是DVT的危险因素,截断值为0.39 mg/L;7 d后D-dimer升高是DVT的危险因素(OR=2.57,95%CI:1.32~5.03),截断值为0.76 mg/L。排除FDP原发纤溶及D-dimer继发纤溶影响:发病3 d内DVT危险因素为血栓弹力图(TEG)的R值降低及高龄;发病3 d后及7 d后危险因素差异均无统计学意义(P<0.05)。结论神经重症脑梗死患者不同时期影响DVT的关键因素不同,3 d内R值降低是DVT形成预测指标;FDP、D-dimer是评估血栓形成的指标,作为预测指标欠妥。
Objective To analyze risk factors for deep vein thrombosis(DVT)in patients with severe cerebral infarction and to find early and sensitive indicators for the prediction and intervention of DVT.Methods A total of 226 patients with severe cerebral infaretion aged 62.5±12.9 years in our department from January 2017 to May 2020 were enrolled.Clinical data,biochemical examinations and color Doppler ultrasound results were collected.Risk factors for DVT were analyzed.The receiver operating characteristic curve(ROC)was used to determine the cut off value.area under the curve,sensitivity and speeificity.Results Age.reaction(R)time of blood coagulation factors on thromboelastography(TEG)and fibrinogen degradation products(FDP)were risk factors for DVT with no adjustment of the overall effect of time on coagulation mechanisms.According to time stratified analysis,decreased R time(OR=0.58.95%CI:0.40-0.84)and increased FDP(OR=1.17.95%CI:1.02-1.33)within 3 days of onset were risk factors for DVT.and the cut off values were 5.35 min and 0.39 mg/L.respectively:3 and 7 days after onset,increased D-dimer was a risk factor for DVT(OR=2.73.95%CI:1.53-4,86;OR=2.57.95%CI:1.32-5.03),and the cut off values were 0.39 mg/L and 0.76 mg/L,respectively.Excluding the effects of FDP primary and D-Dimer secondary fibrinolysis..risk factors for DVT within 3 days of onset were decreased R time on TEG and increased age,and all risk factors were not statistically significant 3 days and 7 days after onset(P<0.05).Conclusions The key factors affecting DVT in patients with severe cerebral infaretion are different at different stages.Decreased R time within 3 days of onset is a predictive indicator of DVT.FDP and D-dimer can be used to assess thrombosis*but may not be appropriate as predictive indicators.
作者
苗旺
张书语
申楠楠
郭俊爽
张丽娜
荆婧
王慧彬
滕军放
Miao Wang;Zhang Shuyu;Shen Nannan;Guo Junshuang;Zhang Lina;Jing Jing;Wang Huibin;Teng Junfang(Neurological Intensire Care Unit,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)
出处
《中华老年医学杂志》
CAS
CSCD
北大核心
2020年第9期1020-1024,共5页
Chinese Journal of Geriatrics
基金
河南省高等学校重点科研项目(17A320067)
河南省医学科技攻关计划联合共建项目(LHGJ20190087)。
关键词
脑梗死
深静脉血栓
预测指标
血栓弹力图
Cerebral infarction
Deep venous thrombosis
Predictive indicator
Thromboelastography
