脑卒中患者发生深静脉血栓危险因素的Meta分析

doi:10.3761/j.issn.0254-1769.2019.07.006

摘要/Abstract

摘要：

目的明确脑卒中患者发生深静脉血栓的危险因素,为预防脑卒中患者发生深静脉血栓提供依据。方法计算机检索Cochrane Library、PubMed、Embase、中国期刊全文数据库、万方数据库、维普数据库和中国生物医学文献数据库,搜集建库至2018年8月关于脑卒中患者发生深静脉血栓危险因素的文献,利用RevMan 5.3软件进行Meta分析。结果共纳入14篇文献,包括22项相关危险因素,有统计学意义的危险因素为年龄≥65岁（OR=1.93）、糖尿病（OR=1.63）、冠心病（OR=2.31）、心房颤动（OR=1.55）、瘫痪（OR=7.14）、深静脉穿刺（OR=3.08）、卧床（OR=7.36）、心力衰竭（OR=1.96）、感染（OR=2.48）、入院时美国国立卫生研究院脑卒中评分（OR=5.78）、下肢美国国立卫生研究院脑卒中评分≥2分（OR=2.28）。结论年龄≥65岁、糖尿病、冠心病、心房颤动、瘫痪、有深静脉穿刺史、卧床、心力衰竭、感染等是脑卒中患者深静脉血栓的危险因素。

关键词: 脑卒中, 深静脉血栓, 影响因素分析, Meta分析

Abstract:

Objective To identify risk factors of deep venous thrombosis in stroke patients,providing early warning for prevention of deep vein thrombosis in stroke patients.Methods We searched databases including The Cochrane Library,PubMed,Embase,CNKI,Wanfang Data,VIP and CBM from inception to August 2018,to collect studies on risk factors for deep venous thrombosis of stroke patients. RevMan 5.3 software was used for Meta-analysis.Results Fourteen studies were included,and 22 related risk factors were analyzed. The statistically significant risk factors were age≥65 years（OR=1.93）,diabetes（OR=1.63）,coronary heart disease（OR=2.31）,atrial fibrillation（OR=1.55）,paralysis（OR=7.14）,deep vein puncture（OR=3.08）,being bedridden（OR=7.36）,heart failure（OR=1.96）,infection（OR=2.48）,admission NIHSS score（OR=5.78） and lower limb NIHSS score≥2 points（OR=2.28）.Conclusion The risk factors of deep vein thrombosis in stroke patients include age≥65 years,diabetes,coronary heart disease,atrial fibrillation,paralysis,deep vein puncture,being bedridden,heart failure,infection,admission NIHSS score and lower limb NIHSS score≥2.

Key words: Stroke, Deep Venous Thrombosis, Root Cause Analysis, Meta-Analysis

唐文娟, 石贞仙, 张彩云, 胡喆. 脑卒中患者发生深静脉血栓危险因素的Meta分析[J]. 中华护理杂志, 2019, 54(7): 989-993.

TANG Wenjuan, SHI Zhenxian, ZHANG Caiyun, HU Zhe. Risk factors of deep venous thrombosis in stroke patients：a Meta-analysis[J]. Chinese Journal of Nursing, 2019, 54(7): 989-993.

参考文献 44

[1]	Di Nisio M, van Es N, Büller HR . Deep vein thrombosis and pulmonary embolism[J]. Lancet, 2016,388(10063):3060-3073.
[2]	Olaf M, Cooney R . Deep venous thrombosis[J]. Emerg Med Clin North Am, 2017,35(4):743-770.
[3]	Dizon MAM, De Leon JM . Effectiveness of initiating deep vein thrombosis prophylaxis in patients with stroke:an integrative review[J]. Neurosci Nurs, 2018,50(5):308-312.
[4]	Kafeza M, Shalhoub J, Salooja N , et al. A systematic review of clinical prediction scores for deep vein thrombosis[J]. Phlebolog, 2017,32(8):516-531.
[5]	Zhang D, Li F, Li X , et al. Effect of intermittent pneumatic compression on preventing deep vein thrombosis among stroke patients:a systematic review and Meta-analysis[J]. World Views Evid Based Nurs, 2018,15(3):189-196.
[6]	Khan MT, Ikram A, Saeed O , et al. Deep vein thrombosis in acute stroke-a systemic review of the literature[J]. Cureus, 2017,9(12):e1982.
[7]	中华医学会, 全国第四届脑血管病学术会议. 脑血管疾病分类诊断要点[J]. 中华神经科杂志, 1996,29(6):376-379.
[8]	Listed N . Stroke--1989. Recommendations on stroke prevention,diagnosis,and therapy. Report of the WHO task force on stroke and other cerebrovascular disorders[J]. Stroke, 1989,20(10):1407-1431.
[9]	Wells GA, Shea B, Oconnell D . The Newcastle-Ottawa Scale(NOS)for assessing the quality of nonrandomized studies in Meta-analyses[J]. Appl Eng Agric, 2002,18(6):727-734.
[10]	陈慧, 周婷, 徐小辉 , 等. 急性脑梗死患者并发下肢深静脉血栓形成的危险因素及近期临床转归分析[J]. 浙江临床医学, 2018,20(3):426-427.
[11]	陈左然, 陈书阁, 董立平 , 等. 急性脑梗死患者下肢深静脉血栓形成的危险因素及近期预后分析[J]. 脑与神经疾病杂志, 2016,24(8):498-501.
[12]	戴晓蓉, 魏青, 王浩 , 等. 脑卒中后下肢深静脉血栓形成的危险因素探讨[J]. 中国临床神经科学, 2016,24(1):70-74,83.
[13]	甘晓英 . 脑卒中后深静脉血栓形成危险因素调查研究[J]. 中国现代医生, 2012,50(24):12-14.
[14]	娄刚, 张顺开, 易兴阳 . 老年脑卒中患者下肢深静脉血栓形成的危险因素分析[J]. 中国现代医生, 2012,50(26):26-27,30.
[15]	孙葵葵, 王辰, 庞宝森 , 等. 急性脑卒中住院患者深静脉血栓形成危险因素分析[J]. 中华流行病学杂志, 2004,25(12):1019-1023.
[16]	Kuwashiro T, Toyoda K, Oyama N , et al. High plasma D-dimer is a marker of deep vein thrombosis in acute stroke[J]. J Stroke Cerebrovasc Dis, 2012,21(3):205-209.
[17]	de Silva DA, Pey HB, Wong MC , et al. Deep vein thrombosis following ischemic stroke among Asians[J]. Cerebrovasc Dis, 2006,22(4):245-250.
[18]	Wu WX, He DR . Low vitamin D levels are associated with the development of deep venous thromboembolic events in patients with ischemic stroke[J]. Clin Appl Thromb Hemost, 2018,21(3):205-209.
[19]	Liu LP, Zheng HG, Wang DZ , et al, et al. Risk assessment of deep-vein thrombosis afteracutestroke:a prospective study using clinical factors[J]. CNS Neurosci Ther, 2014,20(5):403-410.
[20]	Yin D, Shao P, Liu Y . Elevated lipoprotein(a) levels predict deep vein thrombosis in acute ischemic stroke patients[J]. Neuroreport, 2016,27(1):39-44.
[21]	Yi X, Lin J, Han Z , et al. The incidence of venous thromboembolism following stroke and its risk factors in eastern China[J]. J Thromb Thrombolysis, 2012,34(2):269-275.
[22]	Bembenek JP, Karlinski M, Kobayashi A , et al. Deep venous thrombosis in acute stroke patients[J]. Clin Appl Thromb Hemost, 2012,18(3):258-264.
[23]	Balogun IO, Roberts LN, Patel R , et al. Clinical and laboratory predictors of deep vein thrombosis after acute stroke[J]. Thromb Res, 2016,142:33-39.
[24]	彭南海, 马嫦娥, 陈月英 . 老年腹部创伤患者术后深静脉血栓高危风险的筛查及护理[J]. 中华护理杂志, 2013,48(6):494-496.
[25]	Jiang Y, Du H, Liu J , et al. Aspirin combined with mechanical measures to prevent venous thromboembolism after total knee arthroplasty:a randomized controlled trial[J]. Chin Med J(Engl), 2014,127(12):2201-2205.
[26]	Wang C, Wang L, Zhang Y , et al. A novel approach for assessing the progression of deep venous thrombosis by area of venous thrombus in ultrasonic elastography[J]. Clin Appl Thromb Hemost, 2014,20(3):311-317.
[27]	Stein PD, Matta F, Sabra MJ . Pulmonary embolism and deep venous thrombosis following laparoscopic cholecystectomy[J]. Clin Appl Thromb Hemost, 2014,20(3):233-237.
[28]	Rinde LB, Småbrekke B, Mathiesen EB , et al. Ischemic stroke and risk of venous thromboembolism in the general population:the tromsø study[J]. J Am Heart Assoc. 2016,5(11):e004311.
[29]	华珊珊, 李闺臣, 彩虹 , 等. 运动疗法对糖尿病周围神经病变影响的研究进展[J]. 中华护理杂志, 2017,52(10):1252-1256.
[30]	Chung WS, Lin CL, Kao CH . Diabetes increases the risk of deep-vein thrombosis and pulmonary embolism. A population-based cohort study[J]. Thromb Haemost, 2015,114(4):812-818.
[31]	Markovic DL, Zivkovic K, Lesic A , et al. Risk factors and distribution of symptomatic venous thromboembolism in total hip and knee replacements:prospective study[J]. Int Orthop, 2012,36(6):1299-1305.
[32]	Sundbøll J, Hováth-Puhó E, Adelborg K , et al. Risk of arterial and venous thromboembolism in patients with atrial fibrillation or flutter:a nationwide population-based cohort study[J]. Int J Cardiol, 2017,241(1):182-187.
[33]	Lip GY, Shantsila E . Thrombotic complications in heart failure:an underappreciated challenge[J]. Circulation, 2014,130(5):387-389.
[34]	Matsuo H, Matsumura M, Nakajima Y , et al. Frequency of deep vein thrombosis among hospitalized non-surgical Japanese patients with congestive heart failure[J]. Cardiol, 2014,64(6):430-434.
[35]	Guo F, Shashikiran T, Chen X , et al. Clinical features and risk factor analysis for lower extremity deep venous thrombosis in Chinese neurosurgical patients[J]. J Neurosci Rural Pract, 2015,6(4):471-476.
[36]	Branchford BR, Carpenter SL . The role of inflammation in venous thromboembolism[J]. Front Pediatr, 2018(6):142.
[37]	常红, 刘淑珍, 岳鹏 , 等. 间歇式充气压力泵预防缺血性脑卒中后下肢深静脉血栓形成的护理[J]. 中华护理杂志, 2011,46(7):714-715.
[38]	穆景颂, 倪朝民, 吴鸣 , 等. 脑出血患者下肢深静脉血栓形成的危险因素分析[J]. 中华物理医学与康复杂志, 2018,40(12):906-909.
[39]	Engbers MJ, Blom JW, Cushman M , et al. The contribution of immobility risk factors to the incidence of venous thrombosis in an older population[J]. J Thromb Haemost, 2014,12(3):290-296.
[40]	张啸飞, 程显声, 何建国 , 等. 心力衰竭、脑卒中、肿瘤及骨伤病下肢深静脉血栓形成及肺栓塞发生率的临床流行病学调查[J]. 中国慢性病预防与控制, 2001,9(5):206-208.
[41]	de Freitas GR, Nagayama M . Deep venous thrombosis after intracerebral hemorrhage,gender and ethnicity:a challenge for therapeutic approaches[J]. Cerebrovasc Dis, 2009,27(4):320-321.
[42]	巩忠, 郑典刚, 李东华 , 等. 脑卒中后偏瘫患者症状性下肢深静脉血栓形成的临床特点[J]. 中西医结合心脑血管病杂志, 2012,10(7):820-821.
[43]	杨国强 . 急性脑卒中后深静脉血栓形成危险因素分析[D]. 乌鲁木齐:新疆医科大学, 2015: 1-39.
[44]	张银萍, 崔焱, 钱志慧 , 等. 肺癌化疗患者PICC相关上肢深静脉血栓的危险因素分析[J]. 中华护理杂志, 2016,51(4):434-437.