神經(jīng)危重癥患者下肢深靜脈血栓形成的相關(guān)危險(xiǎn)因素及預(yù)后分析
發(fā)布時(shí)間：2018-08-25 15:50
【摘要】：目的：通過(guò)觀察收住于我院神經(jīng)內(nèi)科危重癥監(jiān)護(hù)病房的重癥患者肢體深靜脈血栓形成的發(fā)病情況、臨床特點(diǎn)、相關(guān)危險(xiǎn)因素及預(yù)后情況，分析導(dǎo)致深靜脈血栓形成的相關(guān)危險(xiǎn)因素，，加深臨床醫(yī)生對(duì)該病的認(rèn)識(shí)，在工作中做到早預(yù)防、早診斷、早治療，避免不良后果的發(fā)生。 方法：選擇2013年6月-2013年12月于吉林大學(xué)白求恩第一臨床醫(yī)院神經(jīng)內(nèi)科重癥監(jiān)護(hù)室住院的患者為研究對(duì)象，對(duì)于入院后符合入組標(biāo)準(zhǔn)的患者，記錄其一般人口資料（包括年齡、性別、既往史等）、入院后24小時(shí)內(nèi)最差的APACHE-II評(píng)分、肢體癱瘓情況；入院時(shí)血紅蛋白量、中性粒細(xì)胞百分比、血小板比容、血脂、白蛋白水平。住院期間是否感染、氣管插管、呼吸機(jī)輔助呼吸、氣管切開、氣管切開，亞低溫，深靜脈置管，住院期間藥物治療：鎮(zhèn)靜藥、調(diào)節(jié)血壓藥物、脫水藥及促醒藥納美芬的應(yīng)用等可能導(dǎo)致深靜脈血栓形成的觀察指標(biāo)，并分別在第5天、第10天、第15天及出院前對(duì)患者雙下肢深靜脈進(jìn)行二維和彩色多普勒超聲檢查，根據(jù)深靜脈血栓形成是否陽(yáng)性將患者分為血栓組和非血栓組。比較兩組患者入院時(shí)基本情況、住院期間的病情變化及治療方面的差異等。數(shù)據(jù)采用SPSS19.0軟件進(jìn)行統(tǒng)計(jì)學(xué)處理，計(jì)數(shù)資料的比較用x2檢驗(yàn)；計(jì)量資料采用均數(shù)±標(biāo)準(zhǔn)差（x_±s）表示，應(yīng)用t檢驗(yàn)；多因素分析采用Logistic回歸分析后進(jìn)一步行逐步回歸分析；非正態(tài)分布的計(jì)量資料用秩和檢驗(yàn)，P0.05有統(tǒng)計(jì)學(xué)意義。 結(jié)果：深靜脈血栓形成組與未發(fā)生深靜脈血栓組患者的糖尿病病史，飲酒史，入院時(shí)的APCHE-II評(píng)分、白細(xì)胞計(jì)數(shù)、血小板比容及血脂、同型半胱氨酸水平比較，P0.05，差異有統(tǒng)計(jì)學(xué)意義，其中APCHE-II評(píng)分與DVT呈正相關(guān)，APCHE-II評(píng)分越高發(fā)生DVT的可能性就越大；兩組患者住院期間出現(xiàn)的感染、低蛋白血癥、低血壓，給予亞低溫、鎮(zhèn)靜、氣管插管、納美芬藥物治療比較，P0.05，差異有統(tǒng)計(jì)學(xué)意義。兩組患者的年齡、性別、高血壓病史、吸煙史，入院時(shí)的中性粒細(xì)胞百分比、淋巴細(xì)胞絕對(duì)值、血紅蛋白、白蛋白、紅細(xì)胞比容、化驗(yàn)指標(biāo)無(wú)明顯差異；兩組患者住院期間呼吸機(jī)輔助呼吸、氣管切開、深靜脈置管、脫水藥的應(yīng)用比較無(wú)顯著差異；兩患者住院天數(shù)、轉(zhuǎn)歸比較，P0.05，差異有統(tǒng)計(jì)學(xué)意義。 結(jié)論：神經(jīng)內(nèi)科危重癥患者的糖尿病病史、飲酒史、入院時(shí)的高同型半胱氨酸、高血小板比容、高脂血癥、APCHE-II評(píng)分；住院期間感染、低蛋白血癥、鎮(zhèn)靜、亞低溫、氣管插管是深靜脈血栓形成的危險(xiǎn)因素；深靜脈血栓形成的發(fā)生與患者入院時(shí)的APCHE-II評(píng)分呈正相關(guān)，APACHE-II評(píng)分越高者，發(fā)生深靜脈血栓形成的可能性越大。納美芬藥物的應(yīng)用可能對(duì)深靜脈血栓形成的發(fā)生有預(yù)防作用。神經(jīng)危重癥患者在發(fā)病的前5天內(nèi)發(fā)生深靜脈血栓形成可能性大。神經(jīng)危重癥患者合并深靜脈血栓形成者預(yù)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 鹵standard deviation (x _ 鹵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.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R741;R543.6
[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 鹵standard deviation (x _ 鹵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.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R741;R543.6
【參考文獻(xiàn)】
相關(guān)期刊論文 前10條
1 蒙濤;馬樹人;鮑智;李江津;于昆;;辛伐他汀預(yù)防慢性心力衰竭患者下肢深靜脈血栓形成的臨床觀察[J];重慶醫(yī)學(xué);2011年04期
2 萬(wàn)圣云;徐周緯;潘升權(quán);丁洋;;下肢深靜脈血栓形成的病因及診斷的研究進(jìn)展[J];當(dāng)代醫(yī)學(xué);2009年34期
3 萬(wàn)雙林,趙凱;下肢深靜脈血栓形成9例報(bào)告[J];骨與關(guān)節(jié)損傷雜志;2000年02期
4 陳潔茹;陳偉燕;熊旭明;;APACHEⅡ評(píng)分系統(tǒng)在綜合ICU中的應(yīng)用[J];廣東醫(yī)學(xué);2013年01期
5 楊廷俠;;尿激酶聯(lián)合丹紅注射液治療下肢深靜脈血栓形成療效分析[J];中國(guó)醫(yī)藥科學(xué);2013年04期
6 黃海星;陳冰玲;林玉璇;;醫(yī)用壓力襪預(yù)防ICU危重病人下肢深靜脈血栓形成的護(hù)理研究[J];當(dāng)代醫(yī)學(xué);2013年16期
7 劉春霞;孟翠巧;申麗e
本文編號(hào)：2203389
本文鏈接：http://sikaile.net/yixuelunwen/shenjingyixue/2203389.html
最近更新
教材專著
