介入治疗烧伤后下肢深静脉血栓形成13例
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摘要
目的探讨烧伤后下肢深静脉血栓形成(DVT)患者介入治疗效果及其特殊性。方法回顾性分析13例烧伤并发下肢DVT患者临床资料。其中男7例,女6例;年龄37~67岁,中位年龄46.1岁;火焰伤9例,电击伤2例,热液伤2例;烧伤面积为1%~88%,平均(37.08±30.60)%;11例伴发下肢烧伤,其中8例双下肢烧伤;5例伴发吸入性损伤;烧伤后13~72 d发现DVT,平均(38.69±16.83)d。所有患者均接受介入治疗并观察疗效。结果介入手术技术均获成功(13/13)。3例经右侧颈内静脉入路,10例经健侧股静脉入路分别接受下腔静脉滤器(IVCF)置入及抗凝治疗;7例留置溶栓导管接受接触溶栓,4例静脉溶栓,2例未溶栓治疗。未发生有症状的肺栓塞。介入治疗有效率为84.6%(11/13)。结论介入治疗烧伤后DVT安全、可靠,但在穿刺点选择、是否留置溶栓导管方面有其特殊性。
Objective To discuss the curative effect and specificity of interventional therapy for deep venous thrombosis(DVT) of lower limb in burned patients. Methods The clinical data of 13 patients with lower limb DVT after burn, including 7 males and 6 females with a median age of 46.1 years(37-67 years),were retrospectively analyzed. The causes of burn included flame burn(n =9), electric injury(n =2) and hydrothermal burn(n=2). The burned area was 1%-88% of the total body surface, with a mean of(37.08±30.60) %. Lower limb DVT complicated by lower limb burn was observed in 11 patients, among them burn of both lower limbs was seen in 8 patients. Lower limb DVT associated with inhalation injury was found in 5patients. Clinically, lower limb DVT was usually detected in 13-72 days after burn, with a mean of(38.69±16.83) days. Interventional treatment was carried out in all 13 patients, and the curative effect was assessed.Results Technical success of interventional treatment was obtained in all 13 patients. Both inferior vena cava filter placement via right internal jugular vein approach(n =3) or via unaffected-side femoral vein approach(n=10) and anticoagulant therapy were conducted. Catheter-directed thrombolysis was employed in 7patients, intravenous thrombolysis was adopted in 4 patients, and no thrombolysis therapy was used in 2patients. No pulmonary embolism occurred. The curative effect rate of interventional treatment was 84.6%(11/13). Conclusion For the treatment of lower limb DVT after burn, interventional therapy is safe and reliable, but the selection of puncture site and the use or not use of indwelling catheter for thrombolysis should be carefully taken into consideration.
Objective To discuss the curative effect and specificity of interventional therapy for deep venous thrombosis(DVT) of lower limb in burned patients. Methods The clinical data of 13 patients with lower limb DVT after burn, including 7 males and 6 females with a median age of 46.1 years(37-67 years),were retrospectively analyzed. The causes of burn included flame burn(n =9), electric injury(n =2) and hydrothermal burn(n=2). The burned area was 1%-88% of the total body surface, with a mean of(37.08±30.60) %. Lower limb DVT complicated by lower limb burn was observed in 11 patients, among them burn of both lower limbs was seen in 8 patients. Lower limb DVT associated with inhalation injury was found in 5patients. Clinically, lower limb DVT was usually detected in 13-72 days after burn, with a mean of(38.69±16.83) days. Interventional treatment was carried out in all 13 patients, and the curative effect was assessed.Results Technical success of interventional treatment was obtained in all 13 patients. Both inferior vena cava filter placement via right internal jugular vein approach(n =3) or via unaffected-side femoral vein approach(n=10) and anticoagulant therapy were conducted. Catheter-directed thrombolysis was employed in 7patients, intravenous thrombolysis was adopted in 4 patients, and no thrombolysis therapy was used in 2patients. No pulmonary embolism occurred. The curative effect rate of interventional treatment was 84.6%(11/13). Conclusion For the treatment of lower limb DVT after burn, interventional therapy is safe and reliable, but the selection of puncture site and the use or not use of indwelling catheter for thrombolysis should be carefully taken into consideration.
引文
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[5]中华医学会放射学分会介入学组.下腔静脉滤器置入术和取出术规范的专家共识[J].介入放射学杂志,2011,20:340-344.
[6]Sebastian R,Ghanem O,Di Roma F,et al.Pulmonary embolism in burns,is there an evidence based prophylactic recommendation?Case report and review of literature[J].Burns,2015,41:e4-e7.
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[9]Pannucci CJ,Osborne NH,Wahl WL.Creation and validation of a simple venous thromboembolism risk scoring tool for thermally injured patients:analysis of the National Burn Repository[J].J Burn Care Res,2012,33:20-25.
[10]Kearon C,Akl EA,Comerota AJ,et al.Antithrombotic therapy for VTE disease:antithrombotic therapy and prevention of thrombosis,9th ed:American College of Chest Physicians Evidence-Based Clinical Practice Guidelines[J].Chest,2012,141(2 Suppl):e419S-e494S.
[11]Wahl WL,Brandt MM,Ahrns KS,et al.Venous thrombosis incidence in burn patients:preliminary results of a prospective study[J].J Burn Care Rehabil,2002,23:97-102.
[12]周彪,巴特,王凌峰,等.下腔静脉滤器置入术联合溶栓治疗严重烧伤并发下肢深静脉血栓一例[J].中华烧伤杂志,2014,30:187-188.
[13]Mullins F,Mian MA,Jenkins D,et al.Thromboembolic complications in burn patients and associated risk factors[J].J Burn Care Res,2013,34:355-360.
[14]Friedman BC,Mian MA,Mullins RF,et al.Five-lumen antibioticimpregnated femoral central venous catheters in severely burned patients:an investigation of device utility and catheter-related bloodstream infection rates[J].J Burn Care Res,2015,36:493-499.
[15]杜猛,张锦生.介入治疗急性深静脉血栓的临床观察[J].介入放射学杂志,2011,20:858-861.
[16]张文广,李震,韩新巍,等.经导管接触性溶栓与单纯静脉药物溶栓治疗下肢深静脉血栓的对比研究[J].中国普外基础与临床杂志,2012,19:1171-1174.
[17]Austin RE,Shahrokhi S,Bolourani S,et al.Peripherally inserted central venous catheter safety in burn care:a single-center retrospective cohort review[J].J Burn Care Res,2015,36:111-117.
[18]Bushuev LL,Vazina IR,Sosin EL.Complications in the heart and vessels from the prolonged venous catheterization of burn patients[J].Vestn Khir Im I I Grek,1980,124:96-100.
[19]Still J,Friedman B,Furman S,et al.Experience with the insertion of vena caval filters in acutely burned patients[J].Am Surg,2000,66:277-279.
[2]Ferguson RE,Critchfield A,Leclaire A,et al.Current practice of thromboprophylaxis in the burn population:a survey study of84 US burn centers[J].Burns,2005,31:964-966.
[3]Faucher LD,Conlon KM.Practice guidelines for deep venous thrombosis prophylaxis in burns[J].J Burn Care Res,2007,28:661-663.
[4]中华医学会放射学分会介入学组.下肢深静脉血栓形成介入治疗规范的专家共识[J].介入放射学杂志,2011,20:505-510.
[5]中华医学会放射学分会介入学组.下腔静脉滤器置入术和取出术规范的专家共识[J].介入放射学杂志,2011,20:340-344.
[6]Sebastian R,Ghanem O,Di Roma F,et al.Pulmonary embolism in burns,is there an evidence based prophylactic recommendation?Case report and review of literature[J].Burns,2015,41:e4-e7.
[7]Barret JP,Dziewulski PG.Complications of the hypercoagulable status in burn injury[J].Burns,2006,32:1005-1008.
[8]Wibbenmeyer LA,Hoballah JJ,Amelon MJ,et al.The prevalence of venous thromboembolism of the lower extremity among thermally injured patients determined by duplex sonography[J].J Trauma,2003,55:1162-1167.
[9]Pannucci CJ,Osborne NH,Wahl WL.Creation and validation of a simple venous thromboembolism risk scoring tool for thermally injured patients:analysis of the National Burn Repository[J].J Burn Care Res,2012,33:20-25.
[10]Kearon C,Akl EA,Comerota AJ,et al.Antithrombotic therapy for VTE disease:antithrombotic therapy and prevention of thrombosis,9th ed:American College of Chest Physicians Evidence-Based Clinical Practice Guidelines[J].Chest,2012,141(2 Suppl):e419S-e494S.
[11]Wahl WL,Brandt MM,Ahrns KS,et al.Venous thrombosis incidence in burn patients:preliminary results of a prospective study[J].J Burn Care Rehabil,2002,23:97-102.
[12]周彪,巴特,王凌峰,等.下腔静脉滤器置入术联合溶栓治疗严重烧伤并发下肢深静脉血栓一例[J].中华烧伤杂志,2014,30:187-188.
[13]Mullins F,Mian MA,Jenkins D,et al.Thromboembolic complications in burn patients and associated risk factors[J].J Burn Care Res,2013,34:355-360.
[14]Friedman BC,Mian MA,Mullins RF,et al.Five-lumen antibioticimpregnated femoral central venous catheters in severely burned patients:an investigation of device utility and catheter-related bloodstream infection rates[J].J Burn Care Res,2015,36:493-499.
[15]杜猛,张锦生.介入治疗急性深静脉血栓的临床观察[J].介入放射学杂志,2011,20:858-861.
[16]张文广,李震,韩新巍,等.经导管接触性溶栓与单纯静脉药物溶栓治疗下肢深静脉血栓的对比研究[J].中国普外基础与临床杂志,2012,19:1171-1174.
[17]Austin RE,Shahrokhi S,Bolourani S,et al.Peripherally inserted central venous catheter safety in burn care:a single-center retrospective cohort review[J].J Burn Care Res,2015,36:111-117.
[18]Bushuev LL,Vazina IR,Sosin EL.Complications in the heart and vessels from the prolonged venous catheterization of burn patients[J].Vestn Khir Im I I Grek,1980,124:96-100.
[19]Still J,Friedman B,Furman S,et al.Experience with the insertion of vena caval filters in acutely burned patients[J].Am Surg,2000,66:277-279.