r-n-jРоссийский неврологический журналRussian neurological journal2658-79472686-7192МИА10.30629/2658-7947-2022-27-5-36-44r-n-j-358Research ArticleИССЛЕДОВАНИЯ И КЛИНИЧЕСКИЕ НАБЛЮДЕНИЯCLINICAL RESEARCHES AND CASE REPORTSПредикторы развития тромбоза глубоких вен нижних конечностей в остром периоде инсультаPredictors of thrombosis development in the acute period of strokehttps://orcid.org/0000-0001-5239-744XЧазовС. А.ChazovS. A.

 Пермь 

 State Autonomous Institution of Health of Perm “City Clinical Hospital №4” 

 Perm 

https://orcid.org/0000-0001-5679-4100МехряковС. А.MekhryakovS. A.

 Пермь 

 Perm 

https://orcid.org/0000-0001-6151-6412ПавловаА. В.PavlovaA. V.

 Пермь 

 Perm 

https://orcid.org/0000-0001-6061-8118КулешА. А.KuleshA. A.

 Пермь 

 Perm 

aleksey.kulesh@gmail.comhttps://orcid.org/0000-0002-8305-1115СыромятниковаЛ. И.SyromyatnikovaL. I.

 Пермь 

 Perm 

https://orcid.org/0000-0002-7536-2060КаракуловаЮ. В.KarakulovaJ. V.

 Пермь 

 Perm 

https://orcid.org/0000-0002-6310-9316ШестаковВ. В.ShestakovV. V.

 Пермь 

 Perm 

АстанинП. А.AstaninP. A.

 Москва 

 Moscow 

ФГБОУ ВО «Пермский государственный медицинский университет им. академика Е.А. Вагнера» Минздрава РоссииРоссияAcad. E.A. Vagner Perm State Medical University, Ministry of Health of RussiaRussian FederationГАУЗ ПК «Городская клиническая больница №4»РоссияState Autonomous Institution of Health of Perm “City Clinical Hospital №4”Russian FederationФГБОУ ВО «Пермский государственный медицинский университет им. академика Е.А. Вагнера» Минздрава России; ГАУЗ ПК «Городская клиническая больница №4»РоссияAcad. E.A. Vagner Perm State Medical University, Ministry of Health of Russia; State Autonomous Institution of Health of Perm “City Clinical Hospital №4”Russian FederationФГАОУ ВО «Российский национальный исследовательский медицинский университет имени Н.И. Пирогова» Минздрава РоссииРоссияFederal State Autonomous Educational Institution of Higher Education “Russian National Research Medical University named after N.I. Pirogov” of the Ministry of Health of RussiaRussian Federation2022241120222753644Copyright © Чазов С.А., Мехряков С.А., Павлова А.В., Кулеш А.А., Сыромятникова Л.И., Каракулова Ю.В., Шестаков В.В., Астанин П.А., 20222022Чазов С.А., Мехряков С.А., Павлова А.В., Кулеш А.А., Сыромятникова Л.И., Каракулова Ю.В., Шестаков В.В., Астанин П.А.Chazov S.A., Mekhryakov S.A., Pavlova A.V., Kulesh A.A., Syromyatnikova L.I., Karakulova J.V., Shestakov V.V., Astanin P.A.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.r-n-j.com/jour/article/view/358Введение

Введение. По данным зарубежных исследований, частота бессимптомного тромбоза глубоких вен (ТГВ) в остром периоде инсульта варьирует от 10 до 75%, клинически явного — от 2 до 10%. ТГВ является жизнеугрожающим осложнением, так как может привести к развитию тромбоэмболии легочной артерии (ТЭЛА).

Цель исследования

Цель исследования: выявить предикторы развития ТГВ нижних конечностей у пациентов с инсультом по данным регистра регионального сосудистого центра (РСЦ).

Материал и методы

Материал и методы. Обследованы 100 пациентов с инсультом, которые поступили в палаты/блок интенсивной терапии РСЦ с ноября по декабрь 2021 г. Помимо стандартного обследования, всем пациентам проводилось дуплексное сканирование вен нижних конечностей при поступлении и на 7-й день стационарного лечения.

Результаты

Результаты. Частота встречаемости ТГВ составила 13%. В сравнении с пациентами без ТГВ, пациентыс тромбозом характеризовались более высокими медианными значениями показателей возраста (77 vs 67 лет, p = 0,015), времени от развития инсульта до поступления в стационар (24 vs 5 часов, p = 0,026), тяжести инсульта по шкале NIHSS при поступлении (16 vs 5 баллов, p = 0,006) и завершении первого этапа лечения (10 vs 3 баллов, p = 0,010), двигательных нарушений в ноге по шкале Medical Research Council (4 vs 1 баллов, p = 0,011) и шкалы IMPROVE-VTE (4 vs 2 баллов, p < 0,001). У половины пациентов с ТГВ тромбоз имел место уже при поступлении в стационар, у остальных возник в процессе лечения. У четверти пациентов тромбоз вовлекал проксимальные вены и осложнился у одного пациента развитием ТЭЛА, у остальных наблюдался дистальный ТГВ. Во всех случаях ТГВ развился в паретичной конечности. У всех пациентов тромбоз изначально расценен как бессимптомный и диагностирован только при дуплексном сканировании вен. К наиболее значимым факторам риска развития ТГВ в остром периоде инсульта отнесены возраст от 64 лет и выше (ОШ = 8,1), тяжесть инсульта по шкале NIHSS при поступлении от 6 баллов и выше (ОШ = 5,6), время до поступления от 10 часов и выше (ОШ = 3,8), сила в ноге не более 3 баллов (ОШ = 4,5) и результат шкалы IMPROVE-VTE от 3 баллов и выше (ОШ = 9,5). При построении логистической регрессионной модели с использованием выявленных факторов риска получены значения точности, равные 83% и 85% для обучающей и тестовой выборок соответственно.

Заключение

Заключение. ТГВ наблюдается у 13% пациентов в остром периоде инсульта и ассоциирован с возрастом пациентов, тяжестью инсульта и двигательных нарушений, временем от развития симптомов до поступления в стационар и риском венозных тромбоэмболических осложнений по шкале IMPROVE-VTE.

Introduction

Introduction. According to foreign studies, the frequency of asymptomatic deep vein thrombosis (DVT) in the acute period of stroke varies from 10 to 75%, clinically obvious — from 2 to 10%. DVT is a life-threatening complication as it can lead to the development of pulmonary embolism (PE).

Purpose of the study

Purpose of the study: to identify predictors of DVT development in the lower extremities in patients with stroke according to the registry of the Regional Vascular Center (RVC).

Materials and methods

Materials and methods. 100 patients with stroke who were admitted to the wards/intensive care unit of the RVC from November to December 2021 were examined. In addition to the standard examination, all patients underwent duplex scanning of the veins of the lower extremities upon admission and on the 7th day of inpatient treatment.

Results

Results. The incidence of DVT was 13%. Compared with patients without DVT, patients with thrombosis were characterized by higher median values of age (77 vs 67 years, p = 0.015), time from stroke to hospital admission (24 vs 5 hours, p = 0.026), stroke severity by NIHSS score at admission (16 vs 5 points, p = 0.006) and completion of the first stage of treatment (10 vs 3 points, p = 0.010), movement disorders in the leg according to the Medical Research Council scale (4 vs 1 points, p = 0.011) and IMPROVE-VTE scales (4 vs 2 points, p < 0.001). In half of patients with DVT, thrombosis occurred already at admission to the hospital, in the rest it occurred during treatment. In a quarter of patients, thrombosis involved the proximal veins and was complicated by the development of PE in one patient, the rest had distal DVT. In all cases, DVT developed in the paretic limb. In all patients, thrombosis was initially regarded as asymptomatic and was diagnosed only by duplex scanning of the veins. The most significant risk factors for developing DVT in the acute period of stroke were age 64 years and over (OR = 8.1), stroke severity on the NIHSS scale at admission of 6 points and above (OR = 5.6), time to admission from 10 hours or more (OR = 3.8), leg strength not more than 3 points (OR = 4.5) and an IMPROVE-VTE score of 3 points or more (OR = 9.5). When building a logistic regression model using the identified risk factors, accuracy values were obtained equal to 83% and 85% for the training and test samples, respectively.

Conclusion

Conclusion. DVT is observed in 13% of patients in the acute period of stroke and is associated with the age of patients, the severity of stroke and movement disorders, the time from the development of symptoms to hospital admission, and the risk of venous thromboembolic complications according to the IMPROVE-VTE scale.

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The authors declare that there are no conflicts of interest present.