恢复期脑出血患者下肢深静脉血栓形成的影响因素分析

目的 分析恢复期脑出血（ICH）患者住院期间并发下肢深静脉血栓（DVT）的影响因素。方法 回顾分析2015年8月至2017年8月中国科学技术大学附属第一医院（安徽省立医院）康复医学科收治的恢复期ICH患者126例，入院时完善血常规、凝血象、D-二聚体及瘫痪侧下肢静脉彩超检查。根据下肢静脉彩超表现，将其分为伴DVT组（21例）和不伴DVT组（105例）。分别记录并比较两组患者的临床资料，并对单因素分析有统计学意义的指标进行多因素logistic回归分析，筛选ICH并发DVT的影响因素，将多因素分析有意义的计量指标利用ROC曲线进行效能分析。结果 两组患者临床资料比较，年龄、ICH治疗方式、留置尿管、异物置入、下肢肌张力、D-二聚体（D-D）差异具有统计学意义（P<0.05）；多因素logistic回归分析显示，下肢肌张力升高OR（95% CI）=7.564（1.313~43.571），P=0.024]、D-DOR（95% CI）=1.805（1.151~2.828），P=0.010]与恢复期ICH患者DVT的发生有关；ROC曲线分析表明，恢复期ICH发生DVT时，D-D的曲线下面积为0.768（P<0.05），相对应的95% CI为0.684~0.839。D-D的最佳截断值为0.68时，对恢复期ICH发生DVT的诊断灵敏度为95.24%，特异度为48.08%。结论 下肢肌张力升高是恢复期ICH患者发生DVT的保护性因素；D-D则是恢复期ICH患者并发DVT的危险因素，且对其具有预测价值。

Analysis of influencing factors of deep venous thrombosis in patients with convalescent intracerebral hemorrhage

Objective To analyze the influencing factors of deep venous thrombosis (DVT) of lower extremity in patients with convalescent intracerebral hemorrhage(ICH). Methods A retrospective analysis was conducted on 126 patients with ICH admitted to the Department of Rehabilitation Medicine of the First Affiliated Hospital of the University of Science and Technology of China (Anhui Provincial Hospital) from August 2015 to August 2017. The blood routine, blood coagulation, D-dimer, and color doppler ultrasonography of the lower extremity veins of the paralyzed side were completed upon admission. They were divided into DVT group(21 cases) and non-DVT group(105 cases). DVT was diagnosed according to results of color doppler ultrasonography. The clinical data of the two groups of patients were recorded and compared, and multivariate logistic regression analysis on the statistically significant indicators of single factor analysis was carried out to screen the influencing factors of cerebral hemorrhage complicated by DVT. Then meaningful measurement indicators resulted from multivariate analysis were done performance analysis through ROC curve. Results By comparison, differences in clinical data of the two groups including age, ICH treatment, indwelling catheter, foreign body placement, lower limb muscle tension, and D-dimer were statistically significant (P<0.05); multivariate logistic regression analysis showed that lower limbs increased muscle toneOR(95%CI)=7.564 (1.313~43.571), P=0.024], D-dimerOR(95%CI)=1.805 (1.151~2.828), P=0.010] was connected with the occurrence of DVT in ICH patients during convalescence; ROC curve analysis showed that when DVT occurred in ICH during convalescence, the area under the curve of D-dimerwas 0.768 (P<0.05), and the corresponding 95% CI was 0.684~0.839. When the optimal cut-off value of D-dimer was 0.68, the diagnostic sensitivity for DVT in convalescent ICH was 95.24%, and the specificity was 48.08%. Conclusion Increased muscle tone of the lower extremities is a protective factor for DVT in patients with ICH during convalescence; D-D is a risk factor for DVT in patients with ICH during convalescence, and has predictive value.