肺动脉栓塞合并急性下肢深静脉血栓形成的类型比例分析与解读
|
摘要
目的分析肺动脉栓塞患者合并急性下肢深静脉血栓形成的临床症状及下肢静脉顺行造影表现,归纳各种类型下肢深静脉血栓形成并发肺动脉栓塞患者的临床特点,为临床诊疗提供指导。方法对2013年10月—2016年10月蚌埠医学院第一附属医院收住的45例经影像学确诊的肺动脉栓塞患者的下肢肿胀程度及下肢静脉顺行造影征象进行归纳、分析、总结。结果表现为下肢轻微度至中度肿胀者27例(60.0%),重度肿胀者10例(22.2%),无下肢肿胀者8例(17.8%)。症状为轻中度肿胀或无肿胀为35例,重度肿胀为10例,差异有统计学意义(χ~2=9.59,P<0.05)。通过静脉顺行造影发现下肢周围型血栓,即腘静脉、股静脉及髂静脉通畅者9例(20.0%);股、腘静脉血栓形成,髂静脉通畅者19例(42.2%);髂静脉血栓形成者10例(22.2%);下腔静脉造影发现下腔静脉合并血栓形成者7例(15.6%),其中髂静脉通畅或未完全闭塞的患者为42例(93.3%)。结论下肢肿胀程度较轻的下肢深静脉血栓合并肺动脉栓塞的风险更大;下肢深静脉血栓形成患者的下肢深静脉造影类型中髂静脉通畅及合并下腔静脉血栓形成2种类型是发生肺动脉栓塞的高危因素。
Objective To analyze the clinical symptoms and lower extremity anterograde venography imaging,to sum up the clinical features of pulmonary embolism complicated with deep venous thrombosis of the lower extremities,and to provide guidance for clinical diagnosis and treatment. Methods The clinical symptoms and anterograde lower extremity venography imaging of 43 cases who were diagnosed as pulmonary embolism at the first Affiliated Hospital of Bengbu Medical College from October,2013 to October,2016 were retrospectively analyzed. Results There were 27 patients with lower extremity mild swelling,10 patients with lower extremity severe swelling,8 patients without lower extremity swelling in clinical symptoms. The percentages were 60. 0%,28. 9% and 11. 1%,respectively. The patients of calf deep vein thrombosis with popliteal vein,femoral vein and iliac vein patency was 9( 20% of the total number); the patients of popliteal vein and femoral vein thrombosis with iliac vein patency was 19( 42. 2% of the total number); the patients of iliac vein thrombosis was 10( 22. 2% of the total number) by anterograde lower extremity anterograde venography imaging. The deep venous thrombosis of lower extremity with thrombosis of inferior vena cava is 7( 15. 6% of the total number) by vena cava angiography. There are 45 cases with iliac vein patency or incomplete occlusion in all patients,most patients with mild to moderate swelling or no swelling. Conclusion The patients of lower limb swelling of the lower extremities deep vein thrombosis are more easily complicated by pulmonary embolism; iliac vein patency and thrombosis of inferior vena cava is very dangerous in the disease of venous thromboemlism through anterograde vein venography.
Objective To analyze the clinical symptoms and lower extremity anterograde venography imaging,to sum up the clinical features of pulmonary embolism complicated with deep venous thrombosis of the lower extremities,and to provide guidance for clinical diagnosis and treatment. Methods The clinical symptoms and anterograde lower extremity venography imaging of 43 cases who were diagnosed as pulmonary embolism at the first Affiliated Hospital of Bengbu Medical College from October,2013 to October,2016 were retrospectively analyzed. Results There were 27 patients with lower extremity mild swelling,10 patients with lower extremity severe swelling,8 patients without lower extremity swelling in clinical symptoms. The percentages were 60. 0%,28. 9% and 11. 1%,respectively. The patients of calf deep vein thrombosis with popliteal vein,femoral vein and iliac vein patency was 9( 20% of the total number); the patients of popliteal vein and femoral vein thrombosis with iliac vein patency was 19( 42. 2% of the total number); the patients of iliac vein thrombosis was 10( 22. 2% of the total number) by anterograde lower extremity anterograde venography imaging. The deep venous thrombosis of lower extremity with thrombosis of inferior vena cava is 7( 15. 6% of the total number) by vena cava angiography. There are 45 cases with iliac vein patency or incomplete occlusion in all patients,most patients with mild to moderate swelling or no swelling. Conclusion The patients of lower limb swelling of the lower extremities deep vein thrombosis are more easily complicated by pulmonary embolism; iliac vein patency and thrombosis of inferior vena cava is very dangerous in the disease of venous thromboemlism through anterograde vein venography.
引文
[1]Cronenwett JL,Johnston JW,Rzucidlo EM,et al.Rutherford’s Vascular Surgery[M].7thedition.Saunders/Elsevier,2013:765-784.
[2]Tapson VF.Thrombolytic therapy for acute pulmonary embolism[J].Semin Thromb Hemost,2013,39(4):452-458.
[3]祖茂衡,张庆桥,徐浩,等.静脉血栓栓塞症的血管造影诊断与留置导管溶栓治疗[J].中华介入放射学电子杂志,2013,1(1):24-30.
[4]Yang J,Radulescu A,Chen CL,et al.Heparin-binding epidermal growth factor-like growth factor improves intestinal barrier function and reduces mortality in a murine model of peritonitis[J].Surgery,2013,153(1):52-62.
[5]Stavropoulos SW,Ge BH,Mondschein JI,et al.Retrieval of tip-embedded inferior vena cava filters by using the endobronchial forceps technique:experience at a single institution[J].Radiology,2015,275(3):900-907.
[6]Kearon C,Akl EA,Ornelas J,et al.Aatithrombotic therapy for VTE disease:Chest guide line and expert panel report[J].Chest,2016,149(2):315-352.
[7]王孝高,陈世远,王晖,等.皖北地区下肢静脉曲张患者下肢深静脉的造影结果及体会[J].中国临床医学影像杂志,2014,25(2):141-143.
[8]余立权,高涌,谢胜学,等.腹部肿瘤术后并发下肢深静脉血栓形成25例分析[J].中华全科医学,2015,13(7):1081-1084.
[9]卢壬肖,刘建平,李耀平.不同下肢深静脉血栓形成患者并发肺栓塞的CT肺血管造影的评估价值[J].血栓与止血学,2016,22(3):276-278,282.
[10]田轩,王盛,刘建龙,等.下腔静脉滤器血栓形成局部置管溶栓与外周静脉溶栓治疗的比较[J].首都医科大学学报,2015,36(1):53-57.
[11]Meyer G,Vicaut E,Da Ilays T,et al.Fibrinolysis for patients with intermediate-dsk pulmonary embolism[J].N Engl J Med,2014,370(15):1402-1411.
[12]Kerbauy MN,Moraes FY,Kerbauy LN,et al.Venous thromboprophylaxis in medical patients:an application review[J].Rev Assoc Med Bras,2013,59(3):258-264.
[13]尹孝亮,高涌,聂中林,等.下肢血栓性浅静脉炎并发深静脉血栓形成21例诊疗体会[J].中国实用外科杂志,2016,36(12):1327-1328.
[14]史振宇,符伟国.深静脉血栓形成临床诊治误区[J].临床误诊误治,2014,27(3):70-72.
[15]张望德,张杨.下肢深静脉血栓溶栓治疗研究进展[J].解放军医药杂志,2013,25(12):93-95.
[16]吴华东,高涌.深静脉造影检查在下肢静脉曲张病因分析中的价值[J].华西医学,2014,29(11):2088-2091.
[17]郭洪启,李军,张鹏,等.腔内手术治疗髂静脉受压综合征49例[J].广东医学院学报,2015,33(4):466-468.
[18]Ageno W,Agnelli G,Imberti D,et al.Prevalence of risk factors for venous thromboembolism in Italian population:results of a cross-sectional study from the Master Registry[J].Intern Emerg Med,2013,8(7):575-580.
[19]Konstantinides SV.2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism[J].Eur Heart J,2014,35(45):3145.
[20]尹孝亮,高涌,聂中林,等.腔内综合治疗髂股静脉血栓形成[J].中国普通外科杂志,2016,25(6):887-891.
[2]Tapson VF.Thrombolytic therapy for acute pulmonary embolism[J].Semin Thromb Hemost,2013,39(4):452-458.
[3]祖茂衡,张庆桥,徐浩,等.静脉血栓栓塞症的血管造影诊断与留置导管溶栓治疗[J].中华介入放射学电子杂志,2013,1(1):24-30.
[4]Yang J,Radulescu A,Chen CL,et al.Heparin-binding epidermal growth factor-like growth factor improves intestinal barrier function and reduces mortality in a murine model of peritonitis[J].Surgery,2013,153(1):52-62.
[5]Stavropoulos SW,Ge BH,Mondschein JI,et al.Retrieval of tip-embedded inferior vena cava filters by using the endobronchial forceps technique:experience at a single institution[J].Radiology,2015,275(3):900-907.
[6]Kearon C,Akl EA,Ornelas J,et al.Aatithrombotic therapy for VTE disease:Chest guide line and expert panel report[J].Chest,2016,149(2):315-352.
[7]王孝高,陈世远,王晖,等.皖北地区下肢静脉曲张患者下肢深静脉的造影结果及体会[J].中国临床医学影像杂志,2014,25(2):141-143.
[8]余立权,高涌,谢胜学,等.腹部肿瘤术后并发下肢深静脉血栓形成25例分析[J].中华全科医学,2015,13(7):1081-1084.
[9]卢壬肖,刘建平,李耀平.不同下肢深静脉血栓形成患者并发肺栓塞的CT肺血管造影的评估价值[J].血栓与止血学,2016,22(3):276-278,282.
[10]田轩,王盛,刘建龙,等.下腔静脉滤器血栓形成局部置管溶栓与外周静脉溶栓治疗的比较[J].首都医科大学学报,2015,36(1):53-57.
[11]Meyer G,Vicaut E,Da Ilays T,et al.Fibrinolysis for patients with intermediate-dsk pulmonary embolism[J].N Engl J Med,2014,370(15):1402-1411.
[12]Kerbauy MN,Moraes FY,Kerbauy LN,et al.Venous thromboprophylaxis in medical patients:an application review[J].Rev Assoc Med Bras,2013,59(3):258-264.
[13]尹孝亮,高涌,聂中林,等.下肢血栓性浅静脉炎并发深静脉血栓形成21例诊疗体会[J].中国实用外科杂志,2016,36(12):1327-1328.
[14]史振宇,符伟国.深静脉血栓形成临床诊治误区[J].临床误诊误治,2014,27(3):70-72.
[15]张望德,张杨.下肢深静脉血栓溶栓治疗研究进展[J].解放军医药杂志,2013,25(12):93-95.
[16]吴华东,高涌.深静脉造影检查在下肢静脉曲张病因分析中的价值[J].华西医学,2014,29(11):2088-2091.
[17]郭洪启,李军,张鹏,等.腔内手术治疗髂静脉受压综合征49例[J].广东医学院学报,2015,33(4):466-468.
[18]Ageno W,Agnelli G,Imberti D,et al.Prevalence of risk factors for venous thromboembolism in Italian population:results of a cross-sectional study from the Master Registry[J].Intern Emerg Med,2013,8(7):575-580.
[19]Konstantinides SV.2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism[J].Eur Heart J,2014,35(45):3145.
[20]尹孝亮,高涌,聂中林,等.腔内综合治疗髂股静脉血栓形成[J].中国普通外科杂志,2016,25(6):887-891.