Effect Of Rehabilitation Training Combined With Low Molecular Weight Heparin On Blood Hypercoagulability In Patients With Stroke Dyskinesia

BackgroundStroke is a group of cerebrovascular diseases characterized by sudden onset,rapid localization or diffuse brain dysfunction,including hemorrhagic and ischemic stroke.The incidence and recurrence rate of the disease,Disability rate and mortality rate remain high.At present,there are about 13 million stroke patients in my country,of which about 50%-70%suffer from speech disorder,cognitive disorder,swallowing disorder,motor dysfunction,severe disability,which seriously affects the patients’ability of daily living and prolongs their return to family and society Time damages the mental health of patients.In stroke patients with dyskinesia,the balance between coagulation and fibrinolysis is an important part of the disease.The core elements of the pathogenesis are the activation of platelets and the formation of thrombus.A number of clinical studies have also shown that 40%-50%of stroke patients will develop deep venous thrombosis of the lower extremity(LDVT),and the incidence of severe motor dysfunction is as high as 60%-70%.In addition,high blood pressure,hyperlipidemia,diabetes,dehydration,and infection are also important risk factors for hypercoagulability.At present,the commonly accepted methods for reducing the hypercoagulable state of the blood include drug therapy and non-drug therapy.Antiplatelet or anticoagulation therapy is an effective method for reducing hyperfibrinolysis in clinical practice.The 2016 American Heart Association(AHA)/American Stroke Association(ASA)guidelines believe that for stroke patients who suffer from motor dysfunction during rehabilitation and hospitalization,it is recommended to give a preventive dose of low-molecular weight heparin(LMWH)Get treatment.LMWH has been widely used clinically because of its long plasma half-life,high low-dose bioavailability and predictable dose response compared to UFH.At present,there are many kinds of LMWHs in clinical practice,and the most abundant research evidence is enoxaparin sodium.There are guidelines that point out the application of low-molecular-weight heparin in patients with acute stroke and the evaluation of bleeding risk,but there is no scientific guidance on the dosage,use period,and adverse reactions of patients with residual movement disorders after stroke,and long-term use of low-molecular-weight heparin treatment There are few reports on whether there is any effect on the coagulation and fibrinolytic system of patients.Research on non-pharmacological treatments is not complete.Studies have shown that aerobic training can effectively reduce the fibrinolytic index of patients with cerebral infarction,thereby improving blood hypercoagulability,reducing the risk of recurring cerebral infarction,preventing DVT,and improving the prognosis of patients.improve the quality of life.With the vigorous development of rehabilitation,rehabilitation training,as a healthy long-term,easy-to-develop treatment method,needs to tap its huge development potential.However,there is a lack of relevant research on whether rehabilitation training can improve blood hypercoagulability in clinical work.In this study,through retrospective analysis of 150 patients with stroke dyskinesia in our hospital,group intervention and comparison,observation of long-term use of low molecular weight heparin and rehabilitation training on the blood coagulation and fibrinolysis indicators of stroke dyskinesia patients,record whether there are any adverse effects The occurrence of the incident,and then clarify the effect of the combined use of the two,provide a reference for the formulation of clinical rehabilitation training programs,and provide a reference for the early prevention of DVT.ObjectiveClinical observation of rehabilitation training combined with low-molecular-weight heparin on blood hypercoagulability in patients with stroke dyskinesia.MethodsA retrospective analysis of 150 patients with stroke dyskinesia(disease duration>6 months)who were hospitalized in the southern district of the Second Hospital of Shandong University and met the inclusion criteria were divided into treatment group 87 cases and control group 63 cases according to whether they received rehabilitation training;according to whether low molecular heparin treatment is given or not,the treatment groups are divided into 50 cases in the rehabilitation group and 37 cases in the rehabilitation heparin group;the control group is divided into general care group 47 cases and heparin group 16 cases.Compare the changes of the initial coagulation and fibrinolysis index levels of patients in each group after 2 weeks and 4 weeks of treatment;compare the differences in coagulation and fibrinolysis related indexes of patients between the 4 groups after 2 weeks and 4 weeks of treatment.Results1.Baseline data such as age,gender,hypertension,diabetes,coronary heart disease,CRP,HCT,and the initial coagulation and fibrinolysis indexes of each subgroup(DD,FIB,INR,PT,TT,APTT)of the treatment group and the control group,the difference was not statistically significant(P>0.05).2.The comparison within the treatment group found that APTT,FIB,D-D,TT were statistically significant;the comparison within the control group found that the difference in FIB was statistically significant(P<0.05).3.The comparison within the rehabilitation group found that the difference in FIB was statistically significant(P<0.05);the comparison within the rehabilitation heparin group found that D-D,FIB,INR,PT,TT,APTT were all statistically significant(P<0.05).4.The comparison within the general care group found that the difference in FIB,APTT,and D-D was statistically significant(P<0.05);the comparison within the heparin group found that there was no statistical difference(P>0.05).5.The comparison between the treatment group and the control group found that the difference in PT,APTT,D-D in the second week and the D-D in the fourth week was statistically significant(P<0.05);the comparison between the rehabilitation group and the rehabilitation heparin group found that the difference in D-D in the second week was statistically significant Scientific significance(P<0.05);there is no statistical difference between the general nursing group and the heparin group(P>0.05).6.The incidence of lower extremity venous thrombosis during hospitalization in the treatment group was lower than that in the control group,but the difference was not statistically significant(P>0.05).ConclusionsIn summary,according to the results of the study,rehabilitation training can improve the blood hypercoagulability of patients with stroke dyskinesia,and help reduce the risk of DVT and PE;in addition,long-term use of LMWH has no special effect on the blood hypercoagulability of patients,But did not increase the occurrence of adverse events,indicating that it may be safer to use LMWH for a long time.Through research,we speculate that rehabilitation training combined with low-molecular-weight heparin is safer for patients with stroke dyskinesia and can better improve the hypercoagulable state of the patient’s blood.