脑卒中急性期血栓形成的预测因素

Q4 Medicine
S. A. Chazov, S. Mekhryakov, A. V. Pavlova, A. Kulesh, L. Syromyatnikova, J. Karakulova, V. Shestakov, P. Astanin
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In addition to the standard examination, all patients underwent duplex scanning of the veins of the lower extremities upon admission and on the 7th day of inpatient treatment.Results. The incidence of DVT was 13%. Compared with patients without DVT, patients with thrombosis were characterized by higher median values of age (77 vs 67 years, p = 0.015), time from stroke to hospital admission (24 vs 5 hours, p = 0.026), stroke severity by NIHSS score at admission (16 vs 5 points, p = 0.006) and completion of the first stage of treatment (10 vs 3 points, p = 0.010), movement disorders in the leg according to the Medical Research Council scale (4 vs 1 points, p = 0.011) and IMPROVE-VTE scales (4 vs 2 points, p < 0.001). In half of patients with DVT, thrombosis occurred already at admission to the hospital, in the rest it occurred during treatment. 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引用次数: 0

摘要

介绍。据国外研究,脑卒中急性期无症状深静脉血栓形成(DVT)的发生频率在10% ~ 75%之间,临床上较为明显——在2% ~ 10%之间。深静脉血栓是一种危及生命的并发症,因为它可以导致肺栓塞(PE)的发展。研究目的:根据区域血管中心(RVC)的注册表,确定中风患者下肢DVT发展的预测因素。材料和方法。对2021年11月至12月入住RVC病房/重症监护病房的100名中风患者进行了检查。除标准检查外,所有患者在入院时和住院治疗第7天对下肢静脉进行双工扫描。深静脉血栓的发生率为13%。与病人没有深静脉血栓形成,血栓形成患者具有更高的年龄中值(77 vs 67年,p = 0.015),时间从中风住院(24 vs 5小时,p = 0.026),中风严重性署在录取分数(16 vs 5分,p = 0.006),完成第一阶段的治疗(10 vs 3分,p = 0.010),运动障碍的腿据医学研究委员会规模(4和1点,p = 0.011)和IMPROVE-VTE尺度(4和2分,P < 0.001)。在一半的深静脉血栓患者中,血栓形成在入院时已经发生,其余患者在治疗期间发生。在1 / 4的患者中,血栓累及近端静脉,1例患者并发PE,其余患者为远端DVT。在所有病例中,深静脉血栓都发生在双亲肢体。在所有患者中,血栓形成最初被认为是无症状的,仅通过静脉双工扫描进行诊断。卒中急性期发生DVT的最显著危险因素为:年龄64岁及以上(OR = 8.1)、入院时NIHSS量表的卒中严重程度为6分及以上(OR = 5.6)、入院时间为10小时及以上(OR = 3.8)、腿部力量不超过3分(OR = 4.5)和改善- vte评分为3分及以上(OR = 9.5)。利用识别出的危险因素建立logistic回归模型,训练样本和测试样本的准确率分别为83%和85%。卒中急性期有13%的患者出现深静脉血栓形成,根据IMPROVE-VTE量表,深静脉血栓形成与患者的年龄、卒中和运动障碍的严重程度、出现症状到住院的时间以及发生静脉血栓栓塞并发症的风险相关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Predictors of thrombosis development in the acute period of stroke
Introduction. According to foreign studies, the frequency of asymptomatic deep vein thrombosis (DVT) in the acute period of stroke varies from 10 to 75%, clinically obvious — from 2 to 10%. DVT is a life-threatening complication as it can lead to the development of pulmonary embolism (PE).Purpose of the study: to identify predictors of DVT development in the lower extremities in patients with stroke according to the registry of the Regional Vascular Center (RVC).Materials and methods. 100 patients with stroke who were admitted to the wards/intensive care unit of the RVC from November to December 2021 were examined. In addition to the standard examination, all patients underwent duplex scanning of the veins of the lower extremities upon admission and on the 7th day of inpatient treatment.Results. The incidence of DVT was 13%. Compared with patients without DVT, patients with thrombosis were characterized by higher median values of age (77 vs 67 years, p = 0.015), time from stroke to hospital admission (24 vs 5 hours, p = 0.026), stroke severity by NIHSS score at admission (16 vs 5 points, p = 0.006) and completion of the first stage of treatment (10 vs 3 points, p = 0.010), movement disorders in the leg according to the Medical Research Council scale (4 vs 1 points, p = 0.011) and IMPROVE-VTE scales (4 vs 2 points, p < 0.001). In half of patients with DVT, thrombosis occurred already at admission to the hospital, in the rest it occurred during treatment. In a quarter of patients, thrombosis involved the proximal veins and was complicated by the development of PE in one patient, the rest had distal DVT. In all cases, DVT developed in the paretic limb. In all patients, thrombosis was initially regarded as asymptomatic and was diagnosed only by duplex scanning of the veins. The most significant risk factors for developing DVT in the acute period of stroke were age 64 years and over (OR = 8.1), stroke severity on the NIHSS scale at admission of 6 points and above (OR = 5.6), time to admission from 10 hours or more (OR = 3.8), leg strength not more than 3 points (OR = 4.5) and an IMPROVE-VTE score of 3 points or more (OR = 9.5). When building a logistic regression model using the identified risk factors, accuracy values were obtained equal to 83% and 85% for the training and test samples, respectively.Conclusion. DVT is observed in 13% of patients in the acute period of stroke and is associated with the age of patients, the severity of stroke and movement disorders, the time from the development of symptoms to hospital admission, and the risk of venous thromboembolic complications according to the IMPROVE-VTE scale.
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来源期刊
Russian Neurological Journal
Russian Neurological Journal Medicine-Neurology (clinical)
CiteScore
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