Zhongguo cuzhong zazhi (Aug 2023)
严重自发性脑出血患者术后下肢深静脉血栓形成的危险因素分析 Factors Related to the Deep Vein Thrombosis in Severe Spontaneous Intracerebral Hemorrhage Patients after Surgical Treatment
Abstract
目的 为经手术治疗的严重自发性脑出血患者术后下肢深静脉血栓形成（deep vein thrombosis，DVT）风险判断和管理提供依据。 方法 回顾性分析2017年1月—2019年12月首都医科大学附属北京天坛医院神经外科经手术治疗的94例严重自发性脑出血患者的临床资料。根据出血后30 d内下肢深静脉超声结果，将患者分为DVT组和非DVT组，对比两组间的临床特点和术前影像学特点的差异。采用logistic回归分析探讨患者术后DVT的危险因素。 结果 94例患者中，19例（20.2%）术后出现DVT。DVT组有糖尿病病史患者比例（42.1% vs. 4.0%，P<0.001）、缺血性心脑血管疾病病史患者比例（47.4% vs. 6.7%，P<0.001）、长期抗血小板治疗史患者比例（47.4% vs. 20.0%，P=0.034）、术前Caprini评分[3（2～5）分 vs. 2（1～2）分，P<0.001]和术前血肿扩大患者比例（36.8% vs. 16.0%，P=0.044）均高于非DVT组，差异有统计学意义。多因素logistic回归分析显示，有缺血性心脑血管疾病病史（OR 7.23，95%CI 2.80～18.66，P=0.025）、长期抗血小板治疗史（OR 2.52，95%CI 1.28～4.98，P=0.019）和术前Caprini评分高（OR 3.19，95%CI 1.62～6.27，P=0.007）是脑出血患者术后出现DVT的独立危险因素。 结论 有缺血性心脑血管疾病病史、出血前长期抗血小板治疗史和术前Caprini评分高是严重自发性脑出血患者术后出现DVT的危险因素。对于具有这些危险因素的患者，应在术后早期行下肢深静脉超声检查，尽早开始相关预防和治疗。 Abstract: Objective To provide evidences for risk assessment and management of deep vein thrombosis (DVT) in operated severe spontaneous intracerebral hemorrhage patients. Methods This study retrospectively reviewed 94 patients, who underwent surgery for severe spontaneous intracerebral hemorrhage in the department of neurosurgery of Beijing Tiantan Hospital, Capital Medical University from January 2017 to December 2019. Based on the result of ultrasound examination within 30 days after hemorrhage, all patients were divided into DVT group and non-DVT group. The differences of clinical features and preoperative imaging features were compared between DVT group and non-DVT group. The risk factors of postoperative DVT was investigated using logistic regression analysis. Results 94 appropriate patients was enrolled in this study, including 19 (20.2%) patients underwent DVT. The proportion of diabetic patients in DVT group (42.1% vs. 4.0%, P<0.001), the proportion of patients with a history of ischemic cardiovascular and cerebrovascular diseases (47.4% vs. 6.7%, P<0.001), proportion of patients with long-term antiplatelet treatment (47.4% vs. 20.0%, P=0.034), preoperative Caprini score [3 (2-5) vs. 2 (1-2), P<0.001] and the proportion of patients with preoperative hematoma expansion (36.8% vs. 16.0%, P=0.044) were higher than those in non-DVT group, and the differences were statistically significant. Multivariate logistic regression analysis demonstrated the past ischemic cardiovascular and cerebrovascular diseases (OR 7.23, 95%CI 2.80-18.66, P=0.025), long-term antiplatelet treatment before hemorrhage (OR 2.52, 95%CI 1.28-4.98, P=0.019) and high preoperative Caprini score (OR 3.19, 95%CI 1.62-6.27, P=0.007) as independent risk factors of DVT. Conclusions Past ischemic cardiovascular and cerebrovascular diseases, long-term antiplatelet treatment before hemorrhage and high preoperative Caprini score were independent risk factors for DVT in patients with severe spontaneous intracerebral hemorrhage. For patients with these risk factors, ultrasound examination of deep vein of lower extremity should be performed in the early postoperative period, and relevant prevention and treatment should be admitted as soon as possible.
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