Liang Feng, Chao Min, Li Jue-Bao, Ye Xiang-Ming
Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, No.158, Shangtang Road, Xiacheng District, Hangzhou, 310014, Zhejiang, China.
Department of Rehabilitation Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China.
J Thromb Thrombolysis. 2021 Apr;51(3):798-804. doi: 10.1007/s11239-020-02254-w. Epub 2020 Aug 27.
Deep vein thrombosis (DVT) in hemiplegic patients mainly affects hemiplegic limbs, DVT can also occur only in healthy limbs, and some hemiplegic patients have DVT in both limbs. Characteristics and risk factors of DVT in hemiplegic, healthy, and bilateral limbs are unknown. To describe the proportion, risk factors, extent, and timing of DVT in hemiplegic, healthy and bilateral limbs. A 10-year retrospective review of consecutive patients was performed. DVT affected hemiplegic limbs in 34 (62%), healthy limbs in 11 (20%), and was bilateral in 10 (18%). DVT was more likely to develop in healthy limbs of hemiplegic patients without surgery (odds ratio (OR) 0.022; 95% confidence interval (CI) 0.001-0.922), and without diabetes (OR 0.023, 95% CI 0.001-0.853). Among the veins at the level of which DVT occurred, intermuscular veins represented 20 (45%) in hemiplegic, 5 (37%) in healthy, and 6 (74%) in bilateral limbs. The median time that DVT occurred after hemiplegia onset was 18 days (interquartile range [IQR] 9-79) in hemiplegic, 17 days (IQR 10-56) in healthy, and 21 days (IQR 8-27) in bilateral limbs. Early and effective prevention of DVT after surgery and optimal management of diabetes may reduce the risk of DVT in bilateral limbs. It's important to prevent proximal extension of calf vein DVT. DVT prophylaxis should be started early and continued for at least 3 weeks after hemiplegia onset.
偏瘫患者的深静脉血栓形成（DVT）主要影响偏瘫侧肢体，DVT也可能仅发生在健侧肢体，部分偏瘫患者双侧肢体均出现DVT。偏瘫侧、健侧及双侧肢体DVT的特征和危险因素尚不清楚。目的是描述偏瘫侧、健侧及双侧肢体DVT的比例、危险因素、范围及发生时间。对连续患者进行了为期10年的回顾性研究。DVT累及偏瘫侧肢体34例（62%），健侧肢体11例（20%），双侧肢体10例（18%）。未接受手术的偏瘫患者健侧肢体更易发生DVT（比值比（OR）0.022；95%置信区间（CI）0.001 - 0.922），无糖尿病的患者健侧肢体也更易发生DVT（OR 0.023，95% CI 0.001 - 0.853）。在发生DVT的静脉中，肌间静脉在偏瘫侧肢体占20例（45%），健侧肢体占5例（37%），双侧肢体占6例（74%）。偏瘫后DVT发生的中位时间在偏瘫侧肢体为18天（四分位数间距[IQR] 9 - 79），健侧肢体为17天（IQR 10 - 56），双侧肢体为21天（IQR 8 - 27）。术后早期有效预防DVT以及对糖尿病进行优化管理可能会降低双侧肢体DVT的风险。预防小腿静脉DVT向近端扩展很重要。DVT预防应在偏瘫发作后尽早开始，并持续至少3周。
