摘要
目的探讨住院急性脑梗死患者并发下肢深静脉血栓（LDVT）的诊断，以及并发LDVT后适合抗凝治疗者的疗效和安全性。方法根据Wells的临床怀疑LDVT的量化评分表，对怀疑者行压迫静脉超声（CUG）显像确诊。确诊并发LDVT的患者如适合抗凝治疗则给予低分子肝素（LMWH）皮下注射，同时当天口服华法林，口服华法林按Roberts的依年龄调整华法林的负荷量方法进行，当凝血酶原时间国际化比牢（INR）2．0～3．0达2d，则停用LMWH，口服华法林抗凝治疗3个月。结果急性脑梗死患者2067例，经CUG确诊并发LDVT18例，占同期急性脑梗死住院患者的0．9％。发生LDVT的肢体均为瘫痪肢体，其中左侧13例，右侧5例。18例均适合抗凝治疗，除1例患者在口服华法林第3天出现痔疮出血，于第4天停用华法林外，余17例口服华法林达3个月。18例均达到消除LDVT、的症状，预防肺栓塞的治疗目标，停用华法林后观察达1年共12例，3个月5例，均未发现LDVT复发，未发现有临床症状的肺血栓栓塞者。结论使用Wells临床怀疑LDVT量表，对可疑者行CUG检查，可较及时诊断急性脑梗死患者并发LDVT，对适合抗凝治疗者应用Roberts的依年龄调整华法林的负荷量方法可达到早期足量抗凝的目的，继而可达到消除LDVT症状、预防肺栓塞和静脉血栓复发的治疗目标、而且是安全的。由于种族和人群的差异以及其他未知的因素，惠州地区急性脑梗死患者并发LDVT的患病率相对较低，似无必要对该地区人群所有急性脑梗死患者给予LMWH以预防静脉血栓。
Objective To explore the early diagnosis of lower extremity deep venous thrombosis （LDVT）and evaluate the therapeutic effect of anticoagulant therapy in hospitalized patients with acute ischemic stroke. Methods According to Wells model for suspecting lower extremity deep venous thrombosis, patients with suspected I.DVT were confirmed by compression ultrasonography. If the patients diagnosed with LDVT had no eontraindications to anticoagulant therapy, they were treated with low molecular weight heparin （LMWH） subcutaneous injection and oral warfarin at the same time. The dosage of oral warfarin was determined by Roberts＇ age adjusted warfarin loading protocol. LMWH was stopped when the patients＇ international normalized ratio （INR） was 2.0-3.0 for two consecutive days. Results From January 2003 to August 2007, 2067 cases with acute ischemic stroke were admitted to the department of neurology in Huizhou Municipal Central Hospital including 18 cases with LDVT and the incidence was 0.9%. The patients with LDVT all had paralytic extremities including 13 left legs and 5 right legs with deep vein thrombosis. All the 18 cases were treated by anticoagulant including 17 cases with oral warfarin treatment for 3 months. Symptoms in all LDVT patients were eliminated. 12 cases had been observed for one year and 5 cases for three months after they stopped taking warfarin. There were no patients with pulmonary thromboembolism and LDVT recurrence. Conclusions By using Wells model for suspecting LDVT, patients with acute ischemic stroke-complicated LDVT can be timely diagnosed. The goal of prompt and enough anticoagulant can he achieved according to Roberts＇ age adjusted warfarin loading protocol. Because of racial difference, population difference and other unknown factors, the incidence of acute ischemic stroke patients with complicated LDVT is much lower in Huizhou. It suggests that it should be unnecessary to use LMWH in patients with acute ischemic stroke to prevent LDVT in Huizhou.
出处
《中华老年医学杂志》
CAS
CSCD
北大核心
2009年第2期104-108,共5页
Chinese Journal of Geriatrics
关键词
静脉血栓形成
脑梗塞
抗凝药
华法林
Venous thrombosis
Brain infarction
Anticoagulans
Warfarin
