脑卒中后偏瘫患者症状性下肢深静脉血栓形成的临床特点

摘要

目的 探讨脑卒中后偏瘫患者并发症状性下肢深静脉血栓(deep venous thrombosis,DVT)形成的临床特点.方法 回顾2006年1月-2011年12月收治的822例脑卒中患者,对其中35例脑卒中后偏瘫并下肢红肿疼痛经静脉造影和/或超声证实的DVT患者资料分析,并通过与同期收治的35例非DVT卒中患者进行血同型半胱氨酸(Hcy)、C反应蛋白(CRP)水平对比,了解症状性DVT的发生率、发生时间及可能的危险因素.结果 本院脑卒中后偏瘫患者症状性DVT的发病率为35/822(4.3%),DVT发生在瘫痪侧32例,其中同为左侧28例;脑卒中后发生症状性DVT的时间主要集中在住院2周～4周;肢体肌力0～Ⅱ级31例,Ⅲ级及以上者4例;年龄≥65岁28例;有股静脉置管史21例;合并高血压33例;有糖尿病19例;有心房纤颤者8例;合并高脂血症12例.脑卒中后DVT组血Hcy、CRP水平明显升高,与对照组相比有统计学意义.结论 高龄、重度肢体瘫痪、高血压、糖尿病、房颤、高脂血症、股静脉置管、高同型半胱氨酸血症、炎症可能是脑卒中后偏瘫患者发生DVT的危险因素,为避免DVT的发生及其所产生的不良后果,临床上应对具有上述危险因素的脑卒中患者给予必要的预防.%Objective To investigate clinical features of symptomatic deep venous thrombosis (DVT) post- stroke in hemiplegic patients. Methods Thirty - five patients with stroke hemiplegia and lower extremity deep venous thrombosis post - stroke were collected. Deep venous thrombosis was confirmed by ultrasound. Blood Hcy,CRP levels and possible risk factors were analyzed. Results DVT incidence in stroke hemiplegic patients was 35/822 (4. 3%). There were 32 cases with DVT developed in the paralyzed side and 28 cases in left side. Symptomatic DVT were developed at two to four weeks after stroke. Limb muscle strength was 0 to Ⅱ class in 31 cases,class Ⅲ and above in 4 cases. Age≥ 65 years,28 cases. There were 21 cases with femoral vein catheter history,33 cases with hypertension, 19 cases with diabetes,8 cases with atrial fibrillation,and 12 cases with combined hyperlipidemia. Qcy and CRP levels in post - stroke DVT group were significantly elevated compared with that in control group. Conclusion Aged, severe paralysis of limbs,high blood pressure,diabetes,atrial fibrillation,hyperlipidemia,femoral vein catheter history,hyperhomocysteinemia,hyperlipidemia, and inflammation may be the risk factor of DVT in stroke patients with hemiplegia.