脑卒中康复患者静脉血栓的发病率及对功能的影响

doi:10.3969/j.issn.1006-9771.2022.01.007

Abstract

Abstract:

Objective To explore the risk of venous thromboembolism (VTE), especially lower-extremity deep vein thrombosis (DVT) and pulmonary embolism (PE), for stroke patients in rehabilitating, and the functional outcome. Methods A total of 3 557 stroke patients in the neurological rehabilitation center of Beijing Bo'ai Hospital for stroke rehabilitation from January, 2015 to October, 2020 were reviewed through the electronic medical record system. Demographic characteristics, stroke characteristics (type and location), laboratory data (D-dimer polymer and arterial partial pressure of oxygen), motor function (Brunnstrom stage, Fugl-Meyer Assessment of motor and balance, modified Ashworth Scale score of triceps crus, and Holden Walking Ability Classification), activities of daily living (Barthel Index), and anticoagulant/antiplatelet treatment data were collected and analyzed. Results The incidence of DVT and PE was 28.5% and 1.29%, respectively. Most were found 30 days later after onset. The incidence of PE was higher after ischemic stroke (χ² = 12.49, P < 0.001) rather than hemorrhagic stroke. The patients with hemispheric stroke, severe lower-extremity paralysis, and poor activities of daily living were more prone to complications associated with VTE. After rehabilitation, the function of stroke patients with PE could be improved (|t| > 4.302, P < 0.001). Conclusion The risk of DVT and PE in patients during stroke convalescence may not be negligible, and those with older age, previous history of thrombosis, severe stroke, and severe limb paralysis may be stratified in high-risk. Following anticoagulation treatment, early individualized comprehensive rehabilitation can be done for patients with PE to improve their function and activities of daily living.

Key words: stroke, venous thromboembolism, pulmonary embolism, rehabilitation, risk factors

CLC Number:

R743.3

WU Xiaoli,HU Xueyan,ZHANG Yuge,YE Changqing,CHEN Yudong,LI Hanzhi,YANG Lingyu,GAO Fei,YANG Yuqi,SHAN Lei,LIU Lixu. Epidemiology and functional outcome of venous thromboembolism after stroke in rehabilitation wards[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(1): 44-49.

Figures/Tables 3

References 44

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项目	脑梗死(n = 1 349)	脑出血(n = 2 208)	χ²/t值	P值
并发DVT/n	623	391	333.126	< 0.001
性别(男/女)/n	371/252	266/125	7.397	0.007
年龄/岁	65.6±10.45	58.91±11.36	9.598	< 0.001
瘫痪情况(偏瘫/双瘫)/n	609/14	376/11^a	6.748	0.034
并发DVT和PE/n	26	15	0.070	0.791

项目		脑梗死(n = 1 349)	脑出血(n = 2 208)	χ²/t值	P值
并发PE/n		29	17	12.490	< 0.001
性别(男/女)/n		14/15	13/4	3.514	0.061
年龄/岁		66.76±6.43	59.71±12.73	2.501	0.016
住院时病程/d		51.14±46.91	50.53±61.55	0.038	0.970
既往史/n	高血压	17	17	9.517	0.002
	冠心病	0	1
	房颤	6	0
	恶性肿瘤	1	2
	糖尿病	7	1
	既往卒中病史	9	0
吸烟/n		13	5	1.069	0.301
饮酒/n		10	6	0.003	0.956
病灶部位/n	皮层	3	2	0.600	0.741
	皮层下	9	7
	皮层和皮层下	17	8
瘫痪侧/n	左	16	8	2.778	0.249
	右	10	9
	双侧	3	0
NIHSS评分		11.59±4.562	12.06±4.562	-0.366	0.716
下肢NIHSS评分		2.76±1.527	3.24±1.033	-1.141	0.260
FMA平衡评分		2.76±1.527	1.59±2.785	1.866	0.069
FMA下肢运动评分		8.66±6.909	6.41±5.087	1.164	0.251
下肢Brunnstrom分期		2.48±1.153	2.24±1.30	0.670	0.506
BI评分		25.17±17.702	19.71±16.533	1.035	0.306
Holden步行能力分级		0.34±0.769	0.12±0.485	1.095	0.280
小腿三头肌MAS评分		0.28±0.649	0.12±0.332	0.933	0.356
D-二聚体/mg·L^-1		4.51±4.17	7.23±10.81	-1.213	0.232
动脉血氧分压/mmHg		70.40±8.31	69.31±8.36	0.431	0.669
无症状PE/n		7	6	1.220	0.543
轻症PE/n		9	3
重度PE/n	严重	12	8
重度PE/n	死亡	1	0

项目	入院时 (n = 45)	出院时 (n = 45)	t值	P值
NIHSS评分	11.60±4.78	7.40±4.76	5.753	< 0.001
FMA运动评分	22.04±23.30	27.42±26.20	-4.302	< 0.001
FMA平衡评分	2.64±3.25	4.71±3.85	-4.713	< 0.001
下肢Brunnstrom分期	2.42±1.20	2.84±1.07	-4.855	< 0.001
BI评分	23.44±17.38	36.33±19.67	-7.712	< 0.001
Holden步行能力分级	0.27±0.69	0.82±1.07	-4.748	< 0.001

Epidemiology and functional outcome of venous thromboembolism after stroke in rehabilitation wards

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