神经危重症患者下肢深静脉血栓形成的相关危险因素及预后分析

发布时间：2018-08-25 15:50

【摘要】：目的：通过观察收住于我院神经内科危重症监护病房的重症患者肢体深静脉血栓形成的发病情况、临床特点、相关危险因素及预后情况，分析导致深静脉血栓形成的相关危险因素，，加深临床医生对该病的认识，在工作中做到早预防、早诊断、早治疗，避免不良后果的发生。方法：选择2013年6月-2013年12月于吉林大学白求恩第一临床医院神经内科重症监护室住院的患者为研究对象，对于入院后符合入组标准的患者，记录其一般人口资料（包括年龄、性别、既往史等）、入院后24小时内最差的APACHE-II评分、肢体瘫痪情况；入院时血红蛋白量、中性粒细胞百分比、血小板比容、血脂、白蛋白水平。住院期间是否感染、气管插管、呼吸机辅助呼吸、气管切开、气管切开，亚低温，深静脉置管，住院期间药物治疗：镇静药、调节血压药物、脱水药及促醒药纳美芬的应用等可能导致深静脉血栓形成的观察指标，并分别在第5天、第10天、第15天及出院前对患者双下肢深静脉进行二维和彩色多普勒超声检查，根据深静脉血栓形成是否阳性将患者分为血栓组和非血栓组。比较两组患者入院时基本情况、住院期间的病情变化及治疗方面的差异等。数据采用SPSS19.0软件进行统计学处理，计数资料的比较用x2检验；计量资料采用均数±标准差（x_±s）表示，应用t检验；多因素分析采用Logistic回归分析后进一步行逐步回归分析；非正态分布的计量资料用秩和检验，P0.05有统计学意义。结果：深静脉血栓形成组与未发生深静脉血栓组患者的糖尿病病史，饮酒史，入院时的APCHE-II评分、白细胞计数、血小板比容及血脂、同型半胱氨酸水平比较，P0.05，差异有统计学意义，其中APCHE-II评分与DVT呈正相关，APCHE-II评分越高发生DVT的可能性就越大；两组患者住院期间出现的感染、低蛋白血症、低血压，给予亚低温、镇静、气管插管、纳美芬药物治疗比较，P0.05，差异有统计学意义。两组患者的年龄、性别、高血压病史、吸烟史，入院时的中性粒细胞百分比、淋巴细胞绝对值、血红蛋白、白蛋白、红细胞比容、化验指标无明显差异；两组患者住院期间呼吸机辅助呼吸、气管切开、深静脉置管、脱水药的应用比较无显著差异；两患者住院天数、转归比较，P0.05，差异有统计学意义。结论：神经内科危重症患者的糖尿病病史、饮酒史、入院时的高同型半胱氨酸、高血小板比容、高脂血症、APCHE-II评分；住院期间感染、低蛋白血症、镇静、亚低温、气管插管是深静脉血栓形成的危险因素；深静脉血栓形成的发生与患者入院时的APCHE-II评分呈正相关，APACHE-II评分越高者，发生深静脉血栓形成的可能性越大。纳美芬药物的应用可能对深静脉血栓形成的发生有预防作用。神经危重症患者在发病的前5天内发生深静脉血栓形成可能性大。神经危重症患者合并深静脉血栓形成者预后差。
[Abstract]:Objective: to observe the incidence, clinical characteristics, related risk factors and prognosis of limb deep vein thrombosis (DVT) in critical care unit of neurology department of our hospital. The related risk factors leading to deep venous thrombosis were analyzed to deepen the clinical doctors' understanding of the disease and to prevent early diagnosis and early treatment in order to avoid the occurrence of adverse consequences. Methods: from June 2013 to December 2013, the patients in ICU of Department of Neurology, first Clinical Hospital of Jilin University were selected as the study subjects. The general population data (including age) were recorded for those patients who met the admission criteria after admission. Gender, past history, etc., the worst APACHE-II score within 24 hours after admission, limb paralysis, hemoglobin, neutrophil percentage, platelet volume, blood lipid, albumin level at admission. Infection during hospitalization, tracheal intubation, ventilator assisted breathing, tracheotomy, mild hypothermia, deep vein catheterization, medication during hospitalization: sedatives, blood pressure regulators, The use of dehydration and namefen may lead to deep venous thrombosis. The patients were examined by two dimensional and color Doppler ultrasound on the 5th day, 10th day, 15th day and before discharge. Patients were divided into thrombus group and non-thrombotic group according to the positive rate of deep venous thrombosis. Comparison of the two groups of patients at the admission of the basic situation, hospitalization changes and treatment differences. The statistical data were processed by SPSS19.0 software, the data were compared by x2 test, the measured data were expressed by mean 卤standard deviation (x _ 卤s), t test was used, the multivariate analysis was performed by Logistic regression analysis and stepwise regression analysis was carried out. The non-normal distribution of the measurement data by rank sum test (P0.05) has statistical significance. Results: the history of diabetes, alcohol consumption, APCHE-II score, white blood cell count, platelet volume, blood lipid and homocysteine levels in patients with deep venous thrombosis were significantly higher than those without deep venous thrombosis (P 0.05). The higher the APCHE-II score, the higher the probability of DVT. The infection, hypoproteinemia, hypotension, mild hypothermia, sedation, endotracheal intubation occurred during hospitalization in both groups. The drug treatment of nalmefen was compared with that of P0.05, and the difference was statistically significant. There was no significant difference in age, sex, history of hypertension, smoking history, percentage of neutrophils at admission, lymphocyte absolute value, hemoglobin, albumin, specific volume of red blood cell, and test index between the two groups. There was no significant difference in the application of ventilator assisted breathing tracheotomy deep vein catheterization and dehydration between the two groups. Conclusion: the history of diabetes, alcohol consumption, hyperhomocysteine, hyperplatelet volume, hyperlipidemia and APCHE-II, infection during hospitalization, hypoproteinemia, sedation, mild hypothermia in patients with critically ill neurological diseases, Endotracheal intubation was a risk factor for deep venous thrombosis, and the higher the APCHE-II score at admission, the higher the risk of deep venous thrombosis. The use of natmefen may prevent the occurrence of deep venous thrombosis. Deep venous thrombosis (DVT) is more likely to occur in neurocritical patients within 5 days before onset. The prognosis of neurocritical patients with deep venous thrombosis is poor.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R741;R543.6

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