脳卒中患者における深部静脈血栓症の実態調査―日本リハビリテーション医学会リハビリテーション患者データベースの分析

Deep Venous Thrombosis in Stroke Patients : An Analysis of the Rehabilitation Patient Database of the Japanese Association of Rehabilitation Medicine

要旨：「日本リハビリテーション医学会リハビリテーション患者データベース」学術調査研究事業として，脳卒中患者における深部静脈血栓症（DVT）の実態を明らかにすることを目的に分析を行った．対象は，データベース「2010年12月版」より，DVTのデータがある脳卒中患者345例．345例中9例（2.6％）にDVT合併が認められた．DVT発症の関連因子と考えられる「入院時NIHSS」「入院時mRS」「入院時FIM」「発症からPT開始日数」とDVT合併の間には，いずれにおいても有意な関連は認めなかった（ロジスティック回帰分析）．急性転化率においては，DVT合併群で有意に高率であった．また自宅復帰率においてはDVT合併群で有意に低率であった．入院時の重症度やリハ開始日数の長短だけでDVT発症予測は困難であり，DVTはいずれの脳卒中患者においても起こり得る危険があることが示された．またDVTを合併した場合の急性転化率が高いことから，DVTの予防・早期診断に十分な留意が必要であると考えられる．

Abstract : As a scholarly research activity using “the Japanese Association of Rehabilitation Medicine rehabilitation patient database”, we performed an analysis with the objective of clarifying the actual conditions of DVT in stroke patients. The subjects consisted of 345 stroke patients with DVT data from the “December 2010 version” of the database. In 9 of the 345 cases (2.6％), DVT complications were observed. No significant relevance among NIHSS, mRS, or the FIM score was found at the time of admission to hospital. In addition, no association with the number of days from the onset of PT (which is believed to be a related factor) and the onset of DVT was observed. For the acute condition change rate, the DVT complication group was observed to have a significantly high rate. Moreover, for the home recovery rate, the DVT complication group was observed to have a significantly low rate. Therefore, using only the severity of the condition at the time of admission and the length of the period until the commencement of rehabilitation, it is difficult to predict the onset of DVT, and it was shown that there is a danger of DVT occurring in any stroke patient. Furthermore, the acute condition change rate when DVT occurs as a complication is high. As a result, it is therefore necessary to be vigilant in the prevention and early diagnosis of DVT.