急性下肢深静脉血栓形成的急诊救治
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摘要
目的回顾性分析青岛大学附属海慈医院血管外科自2013年1月至2015年12月收治的217例急性下肢深静脉血栓形成(acute lower extremity deep venous thrombosis,ALEDVT)患者,旨在总结经验教训,进一步提高ALEDVT的急诊救治水平。方法通过基础治疗、滤器置入、股静脉切开取栓术、血管成形术及置管溶栓术等治疗方法,处理不同症状的患者。结果患者肢体肿胀、静脉通畅度、自觉症状及肢体周径等都较治疗前显著改善。结论尽可能迅速、彻底地去除血栓,减少深静脉瓣膜损害;减轻患肢肿胀和疼痛,有效减少静脉性坏疽的发生;防止致命性肺梗死是ALEDVT治疗的关键。
Objective Our department were retrospectively analyzed from March 2013 to February 2015 were treated 217 cases of ALEDVT, aimed at summing up experience and lesson, further improve ALEDVT emergency treatment level. Methods Through the base treatment, filter placement, embolectomy by femoral vein, angioplasty and catheter directed thrombolysis processing different symptoms of the patients. Results In patients with limb swelling, venous patency degree, week of self-conscious symptom and body size than before treatment significantly improved. Conclusion As quickly as possible, thoroughly remove blood clots, reduce the incidence of deep venous valvular damage;Alleviate limb swelling and pain, effectively reduce the occurrence of venous gangrene;To prevent fatal pulmonary embolism is the key of ALEDVT treatment.
Objective Our department were retrospectively analyzed from March 2013 to February 2015 were treated 217 cases of ALEDVT, aimed at summing up experience and lesson, further improve ALEDVT emergency treatment level. Methods Through the base treatment, filter placement, embolectomy by femoral vein, angioplasty and catheter directed thrombolysis processing different symptoms of the patients. Results In patients with limb swelling, venous patency degree, week of self-conscious symptom and body size than before treatment significantly improved. Conclusion As quickly as possible, thoroughly remove blood clots, reduce the incidence of deep venous valvular damage;Alleviate limb swelling and pain, effectively reduce the occurrence of venous gangrene;To prevent fatal pulmonary embolism is the key of ALEDVT treatment.
引文
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[12]叶国栋,朱明炜,李大军,等.腔静脉滤器置入对预防肺动脉栓塞的临床意义[J].中华损伤与修复杂志,2008,3(2):166-169.
[13]高涌,余朝文,周为民,等.介入联合手术取栓治疗左髂静脉受压综合征并发下肢深静脉血栓形成[J].蚌埠医学院学报,2006,31(6):583-586.
[14]Hammond CJ,Bakshi DR,Currie RJ,et al.Auditof the use of IVC filters in the UK:experience from three centres over 12 years[J].Clin Radiol,2009,64(5):502-510.
[2]Lankeit M,Konstantinides S.Mortality riskassessment and the role of thrombolysisin pulmonary embolism[J].Clin Chest Med,2010,31(4):759-769.
[3]中华医学会外科学分会血管外科学组.深静脉血栓形成的诊断和治疗指南[J].中华普通外科杂志,2008,23(3):235-238.
[4]吴庆华.努力提高下肢静脉疾病的诊治水平[J].中华普通外科杂志,2004,19(5):261-262.
[5]Einstein Investigators,Bauersachs R,Berkowitz SD,et al.Oral rivaroxaban for symptomatic venous thromboembolism[J].N Engl J Med,2010,363(26):2499-2510.
[6]Anteril JL,Sise MJ,Sack DI,et al.Retrievable Vena cava filters for preventing pulmonary embolism in trauma patients:acautionary tale[J].JTranma,2006,60(1):35-40.
[7]陈世远,高涌,聂中林,等.介入联合手术治疗下肢深静脉血栓形成[J].中华全科医学,2010,8(3):288-289.
[8]LS Jackson,XJ Wang,SJ Dudrick,et al.Catheter directed thrombolysis and/or thrombectomy with selective endovascular stenting as alte-natives to systemic anticoagulation for treatment of acute deep vein thrombosis[J].Am J Surg,2005,190(6):864-868.
[9]张柏根.下肢深静脉血栓形成治疗和预后的几个问题[J].中华普通外科杂志,2006,21(2):81-83.
[10]Jaff MR,Goldhaber SZ,Tapson VF.High utilization rate of vena cava filters in deep vein thrombosis[J].Thromb Haemost,2005,93(2):1117-1119.
[11]虞希祥,符伟国,蔡锋泉,等.髂股静脉狭窄伴血栓形成介入治疗53例临床分析[J].中华普通外科杂志,2004,19(1):21-23.
[12]叶国栋,朱明炜,李大军,等.腔静脉滤器置入对预防肺动脉栓塞的临床意义[J].中华损伤与修复杂志,2008,3(2):166-169.
[13]高涌,余朝文,周为民,等.介入联合手术取栓治疗左髂静脉受压综合征并发下肢深静脉血栓形成[J].蚌埠医学院学报,2006,31(6):583-586.
[14]Hammond CJ,Bakshi DR,Currie RJ,et al.Auditof the use of IVC filters in the UK:experience from three centres over 12 years[J].Clin Radiol,2009,64(5):502-510.