| Background:Stroke has become the leading cause of disability and death in our country.Cerebral infarction is the most common type of stroke,which refers to the ischemic softening or necrosis of localized brain tissue caused by hypoxia and ischemia due to disturbance of blood circulation in the brain.Lower extremity deep venous thrombosis is one of the more common and serious complications in patients with cerebral infarction.The further development of lower extremity deep venous thrombosis in patients with cerebral infarction can cause pulmonary embolism,which seriously threatens the life of patients with cerebral infarction.At present,the prevention,diagnosis and treatment of cerebral infarction complicated with lower extremity deep vein thrombosis are faced with many difficulties.Analyzing and finding the risk factors of cerebral infarction complicated with deep venous thrombosis and controlling them,looking for the risk assessment scale that can effectively predict cerebral infarction complicated with lower extremity deep venous thrombosis,and formulating the best scientific prevention and treatment plan are of positive significance to improve the prognosis of patients with cerebral infarction complicated with lower extremity deep venous thrombosis.Purposes:To investigate the incidence and mortality of lower extremity DVT in patients with acute cerebral infarction;to analyze the related risk factors that may affect cerebral infarction with lower extremity DVT;to explore the predictive value of Padua score and D-dimer in cerebral infarction complicated with lower extremity DVT;to explore the treatment and prognosis of cerebral infarction with lower extremity DVT.Improve clinicians’ awareness of lower extremity DVT and the importance of early intervention,and further improve the prognosis and quality of life of patients.Methods:The relevant clinical data of inpatients with cerebral infarction in the Department of Neurology,Second Hospital of Jilin University who met the inclusion criteria from January 2020 to August 2021 were retrospectively collected and analyzed.Record the general clinical data of the patients（age,gender,weight,etc.）,neurological symptoms and signs（level of consciousness,muscle strength,etc.）,clinical symptoms and signs of lower extremity deep venous thrombosis（extremity swelling,pain,cyanosis,varicose veins,etc.）,past medical history（hypertension,diabetes,tumor,infection,etc.）,laboratory indicators（D-dimer,blood lipids,blood homocysteine,etc.）,Padua prediction score,treatment（whether antiplatelet aggregation drugs,anticoagulants,,etc.）,whether combined with pulmonary embolism,follow-up,and other related information.According to the occurrence of lower extremity deep vein thrombosis during hospitalization,they were divided into DVT group and non-DVT group.Using SPSS25.0 software,the differences in clinical data of the two groups were compared by univariate analysis,and multivariate Logistic regression analysis was used to screen independent patients with acute cerebral infarction complicated by DVT risk factors.A receiver operating characteristic curve was constructed to compare the predictive performance of Padua predictive score,D-dimer and their combination in cerebral infarction complicated with lower extremity DVT.All results were statistically significant at P<0.05.Results:（1）Occurrence of lower extremity DVT: There were a total of 540 eligible cerebral infarction patients,of which 99 were diagnosed with lower extremity DVT.According to the data of this group,the incidence of lower extremity DVT in patients with cerebral infarction was 18.3%.DVT involved the left lower extremity in 39 cases,the right lower extremity in 38 cases,and the bilateral lower extremities in 22 cases.DVT occurred in 121 lower extremities,99 DVT occurred on the paralyzed side,and 22 occurred on the non-paralyzed side.There were11 cases of symptomatic DVT,including 5 cases of pain,6 cases of swelling,and 88 cases of asymptomatic DVT.According to the results of lower extremity color Doppler ultrasound,there were 1 case of central DVT and 98 cases of peripheral DVT,of which 85 cases occurred in the intermuscular vein,which was the most common involved site.The average age of patients with cerebral infarction complicated with lower extremity DVT was 68.83±9.21 years old,accounting for the largest proportion from 61 to 70 years old,a total of39 cases（39.4%）.The discovery time of lower extremity DVT patients after cerebral infarction,of which 64 cases（64.6%）occurred within 7days after onset,21 cases（21.2%）occurred within 7～14 days after onset,and 14 cases（14.1%）occurred 2 weeks after onset.（2）Univariate analysis showed that there were significant differences in gender,infection history,tumor-related medical history,paralysis,disturbance of consciousness,antiplatelet aggregation drugs,D-dimer,and age between the cerebral infarction with lower extremity DVT group and the group without DVT（P<0.05）.（3）Multivariate Logistic regression analysis showed that increased D-dimer and gender were independent risk factors（P<0.05）.（4）A total of 540 patients with cerebral infarction were grouped according to the Padua Prediction Scale.There were 362 patients in the low-risk group,of which 16 patients（4.4%）were diagnosed with DVT;178 patients in the high-risk group,of which 83 patients（46.6%）were diagnosed with DVT.The Padua scale had the ability to predict cerebral infarction complicated with DVT（P<0.001）.The area under the curve of Padua scale was 0.837,the area under the curve of D-dimer was0.844,and the area under the curve of Padua scale combined with D-dimer was 0.877.（5）Treatment,prognosis and related follow-up outcomes:Treatment: A total of 41 patients were treated with anticoagulants,of which 1 patient developed non-fatal cerebral hemorrhage after anticoagulation.58 cases did not receive anticoagulation,of which 13 cases had normal D-dimer and were given regular review;15 cases were temporarily unable to anticoagulate due to high risk of bleeding;17 cases were temporarily unable to anticoagulate with massive cerebral infarction,and 13 cases were refused anticoagulation by patients or their families.Follow-up and prognosis: 99 patients were followed up,a total of81 patients were followed up,and 18 were lost to follow-up.Thirty-seven patients were regularly reviewed,and 44 patients were not regularly reviewed.There were 6 cases of post-thrombotic syndrome.There were 2 cases of pulmonary embolism.There were 20 deaths.Death situation: 7 patients died of anticoagulation,all of them died after stopping the use of anticoagulant drugs;13 patients died in the non-anticoagulation group.Conclusions:（1）The incidence rate of acute cerebral infarction complicated with lower extremity deep venous thrombosis with movement disorder was18.3%,and asymptomatic patients accounted for 88.9%.Early prevention and screening are very important.（2）Multivariate Logistic regression analysis showed that D-dimer and female gender were independent risk factors for lower extremity deep vein thrombosis in patients with acute cerebral infarction.（3）Padua scale combined with D-dimer was more valuable in predicting cerebral infarction complicated with DVT.（4）Anticoagulation is safe in patients with cerebral infarction complicated by lower extremity DVT without contraindications and with a low risk of bleeding. |
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