Kadyan Vivek, Clinchot Daniel M, Mitchell G Lynn, Colachis Sam C
Department of Physical Medicine and Rehabilitation, The Ohio State University Medical Center, The Ohio State University, Columbus, Ohio 43210, USA.
J Spinal Cord Med. 2003 Fall;26(3):231-5. doi: 10.1080/10790268.2003.11753689.
To determine the prevalence of deep vein thrombosis (DVT) by surveillance duplex ultrasound in the traumatic spinal cord injury (SCI) population on admission to rehabilitation.
Retrospective sequential case series.
Midwest regional, university-based, Commission on Accreditation of Rehabilitation Facilities-accredited acute rehabilitation center.
Charts of all patients with traumatic SCI admitted and discharged from January 1, 1996 through December 31, 1998 were reviewed. Preadmission data were collected on demographics, severity of injury, and DVT prophylaxis information, along with rehabilitation duplex ultrasound results and incidence of thromboembolic events.
Ninety-two participants met the inclusion criteria. There were 68 men and 24 women with a mean age on admission of 32.4 years. On admission, 45 participants (49%) were classified as tetraplegic and 47 (51%) were classified as paraplegic; 63 (69%) had motor-complete lesions and 29 (31%) had motor-incomplete lesions. Of all the participants, 8 (8.7%) were found to have DVT on admission to rehabilitation. There were no statistically significant differences among participants with regard to age, sex, level of injury, or completeness of injury, when comparing those participants with DVT on admission, those without DVT on admission, and those with thromboembolic events diagnosed later in their hospitalization. Of the 84 participants who had negative duplex ultrasounds on admission, 4 individuals (4.8%) were found to have DVT and 4 (4.8%) had pulmonary emboli subsequently. In these 84 participants, DVT prophylaxis with low-molecular-weight heparin was found to be more effective than was adjusted-dose heparin in preventing thromboembolic phenomenon.
Incidence of DVT remains high despite prophylaxis in traumatic SCI patients. Two thirds of DVT diagnosed in rehabilitation was identified on admission and one third was diagnosed later. Duplex ultrasound is an effective and valuable tool that assists in the diagnosis of asymptomatic DVT in patients with traumatic SCI who are initiating in-patient rehabilitation.
通过监测性双功超声检查确定创伤性脊髓损伤（SCI）患者入院接受康复治疗时深静脉血栓形成（DVT）的患病率。
回顾性连续病例系列研究。
位于中西部地区的一所大学附属、经康复设施认证委员会认证的急性康复中心。
回顾了1996年1月1日至1998年12月31日期间收治并出院的所有创伤性SCI患者的病历。收集入院前的人口统计学数据、损伤严重程度和DVT预防信息，以及康复双功超声检查结果和血栓栓塞事件的发生率。
92名参与者符合纳入标准。其中男性68名，女性24名，入院时平均年龄为32.4岁。入院时，45名参与者（49%）被归类为四肢瘫痪，47名（51%）被归类为截瘫；63名（69%）有运动完全性损伤，29名（31%）有运动不完全性损伤。在所有参与者中，8名（8.7%）在入院接受康复治疗时被发现患有DVT。在比较入院时患有DVT的参与者、入院时未患有DVT的参与者以及住院后期被诊断为血栓栓塞事件的参与者时，在年龄、性别、损伤水平或损伤完整性方面，参与者之间没有统计学上的显著差异。在入院时双功超声检查结果为阴性的84名参与者中，有4人（4.8%）随后被发现患有DVT，4人（4.8%）患有肺栓塞。在这84名参与者中，发现低分子量肝素预防DVT比调整剂量的肝素在预防血栓栓塞现象方面更有效。
尽管对创伤性SCI患者进行了预防，但DVT的发生率仍然很高。在康复过程中诊断出的DVT中有三分之二是在入院时发现的，三分之一是后来诊断出的。双功超声是一种有效且有价值的工具，有助于诊断开始住院康复的创伤性SCI患者的无症状DVT。
