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目的分析缺血性脑卒中后下肢深静脉血栓形成(LDVT)的主要原因,以指导临床采用合理的预防和治疗措施。方法分析50例缺血性脑卒中并发下肢深静脉血栓患者的临床特点及血液凝血、抗凝和纤溶系统分子标志物指标的变化情况。结果50例缺血性脑卒中并发LDVT患者中,65岁以上者占60%;卧床2～4周者的发病率最高;伴发疾病中以高血压、高血脂最常见;与正常对照组相比,缺血性脑卒中并发LDVT患者的vWF、GMP-140、F1+2含量、PAI-1活性均明显升高,而AT活性、总PS含量、PC活性、PLg活性均明显降低,均有非常显著性差异(P<0.01～0.001)。结论高龄、卧床及血液的高凝状态是缺血性脑卒中并发LDVT的主要因素。临床上应对高龄、长期卧床及存在高凝状态的缺血性脑卒中患者,给予必要的抗凝、抗血小板、溶栓药物及早期康复锻炼等预防性措施,以防止LDVT的发生。
Objective To analyze the main causes of lower extremity deep vein thrombosis (LDVT) after ischemic stroke in order to guide clinical use of reasonable preventive and therapeutic measures. Methods Fifty patients with ischemic stroke complicated with deep venous thrombosis of lower extremities were analyzed for clinical features and changes of blood coagulation, anticoagulant and fibrinolytic system molecular markers. Results Among the 50 patients with LDVT, the incidence of ischemic stroke was more than 65% in patients over 65 years old. The morbidity was the highest in 2 to 4 weeks of bedridden patients, and the most common was hypertension and hyperlipidemia in patients with concomitant disease. The levels of vWF, GMP-140, F1 + 2, and PAI-1 in patients with LDVT were significantly higher than those in patients with ischemic stroke, while the AT activity, total PS content, PC activity and PLg activity were significantly decreased Very significant difference (P <0.01 ~ 0.001). Conclusion Older age, bedridden and hypercoagulable state of blood are the main factors of LDVT in ischemic stroke. Clinical response to the elderly, long-term bedridden and hypercoagulable state of ischemic stroke patients, given the necessary anticoagulant, antiplatelet, thrombolytic drugs and early rehabilitation exercise and other preventive measures to prevent the occurrence of LDVT.