Cifu D X, Kaelin D L, Wall B E
Department of Physical Medicine and Rehabilitation, Medical College of Virginia, Richmond, USA.
Arch Phys Med Rehabil. 1996 Nov;77(11):1182-5. doi: 10.1016/s0003-9993(96)90145-8.
To determine the incidence of deep venous thrombosis (DVT) in brain injured individuals at time of admission to a brain injury (BI) rehabilitation program.
Prospective study, sequential case series.
University tertiary care BI rehabilitation center.
Eighty-two traumatic brain injury (TBI) and 71 atraumatic brain injury (ABI) patients were consecutively admitted to our BI unit over a 12-month period and screened within 24 hours of admission for a lower extremity DVT with color flow duplex Doppler ultrasonography. All patients had been prophylaxed with either subcutaneous heparin anticoagulation therapy or intermittent compression devices, and all patients were within 2 months of the original BI.
Evidence of intrinsic venous occlusion by duplex Doppler.
DVTs were detected and treated prior to rehabilitation admission in three patients (2%), and these persisted at rehabilitation admission. New DVTs were detected at time of rehabilitation admission in 17 patients (11%). All were occult DVTs; none of the 17 patients had clinical findings indicative of acute DVT. No significant differences were noted in the TBI group when age, highest 24-hour Glasgow Coma Scale score, length of acute hospitalization, type of DVT prophylaxis, or presence of an extremity fracture were compared for individuals with and without DVT. No significant differences were noted in the ABI group when age, length of acute hospitalization, and type of DVT prophylaxis were compared for individuals with and without DVT.
The overall incidence of DVTs was 13% and the incidence of occult DVT was 11%. Individuals with TBI had an overall incidence of DVTs of 20% and an occult DVT incidence of 18%. Individuals with ABI had an overall incidence of DVT's of 6% and an occult DVT incidence of 4%. These findings indicate the importance of baseline screening for DVT in this patient population.
确定脑损伤患者在进入脑损伤（BI）康复项目时深静脉血栓形成（DVT）的发生率。
前瞻性研究，连续病例系列。
大学三级护理BI康复中心。
在12个月期间，82例创伤性脑损伤（TBI）患者和71例非创伤性脑损伤（ABI）患者连续入住我们的BI科室，并在入院后24小时内采用彩色血流双功多普勒超声对下肢DVT进行筛查。所有患者均接受了皮下肝素抗凝治疗或间歇性压迫装置预防，且所有患者均在初次脑损伤后2个月内。
双功多普勒显示的内源性静脉闭塞证据。
3例患者（2%）在康复入院前检测到并治疗了DVT，这些DVT在康复入院时持续存在。17例患者（11%）在康复入院时检测到新的DVT。所有均为隐匿性DVT；17例患者中无一例有提示急性DVT的临床表现。在TBI组中，比较有DVT和无DVT患者的年龄、最高24小时格拉斯哥昏迷量表评分、急性住院时间、DVT预防类型或肢体骨折情况，未发现显著差异。在ABI组中，比较有DVT和无DVT患者的年龄、急性住院时间和DVT预防类型，未发现显著差异。
DVT的总体发生率为13%，隐匿性DVT的发生率为11%。TBI患者DVT的总体发生率为20%，隐匿性DVT的发生率为18%。ABI患者DVT的总体发生率为6%，隐匿性DVT的发生率为4%。这些发现表明在该患者群体中进行DVT基线筛查的重要性。
