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康复患者下肢深静脉血栓形成的发病率及分布:对筛查的意义

Incidence and distribution of lower extremity deep vein thrombosis in rehabilitation patients: implications for screening.

作者信息

Sachdev Ulka, Teodorescu Victoria J, Shao Michael, Russo Theresa, Jacobs Tikva S, Silverberg Daniel, Carroccio Alfio, Ellozy Sharif H, Marin Michael L

机构信息

Department of Vascular Surgery, Mount Sinai Medical Center, New York, NY 10029, USA.

出版信息

Vasc Endovascular Surg. 2006 May-Jun;40(3):205-11. doi: 10.1177/153857440604000305.

Abstract

Patients admitted to in-patient rehabilitation programs have an increased risk for developing deep venous thrombosis (DVT). However, the utility of screening for lower extremity DVT using duplex ultrasound in this high-risk population is not well characterized. The purpose of this study is to identify whether or not screening lower-extremity duplex exams are indicated in this high-risk population. Screening lower extremity duplex exams were performed on all patients admitted to the rehabilitation center at Mt. Sinai Hospital over a 3-year period. Charts were reviewed for patient age, gender, diagnosis, date of screening and follow-up duplex exams, presence and location of venous thrombosis at each duplex exam, history of anticoagulation, and medical DVT prophylaxis. The presence of DVT at screening, the location of DVT along the lower extremity, and the outcome of calf DVT were analyzed in terms of gender, underlying diagnosis, and history of DVT prophylaxis. Lower extremity DVT was detected in 34% of patients. Twenty-three percent of patients had isolated calf vein thrombosis. Men were more likely than women to have DVT. Calf DVTs progressed in 3% of patients over an average follow-up of 2 weeks. The presence of DVT, its location along the lower extremity, and the outcome of calf vein DVT had no significant relationship to underlying diagnosis or history of prophylaxis. Screening duplex exams to detect lower extremity DVT in rehabilitation patients is useful. Screening altered management in 26% of patients, prompting either anticoagulation or repeat duplex exam.

摘要

入住住院康复项目的患者发生深静脉血栓形成(DVT)的风险增加。然而,在这一高危人群中使用双功超声筛查下肢DVT的效用尚未得到充分描述。本研究的目的是确定在这一高危人群中是否需要进行下肢双功超声检查筛查。对西奈山医院康复中心3年内收治的所有患者进行了下肢双功超声检查筛查。查阅病历以了解患者的年龄、性别、诊断、筛查日期和随访双功超声检查结果、每次双功超声检查时静脉血栓形成的存在情况和部位、抗凝治疗史以及医学上的DVT预防措施。根据性别、潜在诊断和DVT预防史分析筛查时DVT的存在情况、下肢DVT的部位以及小腿DVT的转归。34%的患者检测到下肢DVT。23%的患者存在孤立的小腿静脉血栓形成。男性比女性更易发生DVT。在平均2周的随访中,3%的患者小腿DVT有进展。DVT的存在情况、其在下肢的部位以及小腿静脉DVT的转归与潜在诊断或预防史无显著关系。对康复患者进行双功超声检查筛查以检测下肢DVT是有用的。筛查改变了26%患者的治疗管理,促使进行抗凝治疗或重复双功超声检查。

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