肺癌合并肺血栓栓塞症和深静脉血栓形成的比较研究

目的比较肺癌合并肺血栓栓塞症(PTE)和深静脉血栓形成(DVT)的临床特点及预后。方法对2003年1月至2013年4月北京医院肺癌合并PTE和DVT的患者进行回顾性临床分析,记录年龄、性别、临床表现、病理类型、TNM分期、PS评分、化疗方案及预后等临床信息。结果 PTE组35例,年龄(67.31±9.38)岁,DVT组45例,年龄(64.62±12.48)岁。PTE组肺部基础疾病的发生率高于DVT组(9 vs 4例,P=0.043);而DVT组留置深静脉导管的患者显著多于DVT组(11 vs 1例,P=0.007)。PTE组HCT和Hb较DVT组增高(分别为36.9±4.01 vs 33.44±5.57,P=0.003;125.4±14.43 vs 113.48±21.28,P=0.006)。PTE组中有14例PTE患者为无意中发现。在两组病人中,以NSCLC为主,病理类型多为腺癌,TNM分期Ⅲ~Ⅳ期居多。肺癌合并PTE组3月、6月、9月和12个月累积发生率分别为71.4%、77.1%、82.9%和85.7%;DVT组3月、6月、9月和12个月累积发生率分别为75.6%、77.8%、82.2%和84.4%。生存分析显示,PET组和DVT组,中位生存时间无显著差异(5.0±2.1月vs 15.6±6.59月,P=0.12)。结论肺癌合并PTE和DVT患者具有相同的危险因素,但PTE组较多合并肺部疾病,而DVT组较多留置深静脉导管。两组患者中腺癌是最常见的病理类型,TNM分期多为Ⅲ~Ⅳ期。PTE或DVT多发于肺癌诊断3~6月内,并导致患者预后不佳。     

肺栓塞-深静脉血栓形成的研究现状与展望

肺栓塞（pulmonary embolism，PE）是肺循环领域中一个非常重要的医学课题。肺血栓栓塞症（pulmonary thromboembolism，PTE）为PE的最常见类型，占PE中的绝大多数（约90％以上），通常所称PE即指PTE。近年来，以PTE和深静脉血栓形成（deep venous thrombosis，DVT）为主要临床类型的静脉血栓栓塞性疾病（venous thromboembolism，VTE）的防治研究已有迅猛的发展。     

肺血栓栓塞症—深静脉血栓形成的临床流行病学

肺血栓栓塞症(PTE)与深静脉血栓形成(DVT)是一个动态发展变化的整体．共属于静脉血栓栓塞症(VTE)。VTE是以多因素参与和多基因缺陷为基础的常见病、多发病和高病死率的疾病。其获得性危险因素涉及大的普通外科手术和矫形手术、严重创伤、恶性肿瘤、心肺功能障碍、制动、高龄等多种情况。     

住院患者深静脉血栓形成的预防进展

文章针对住院患者深静脉血栓发病率呈不断上升的趋势,归纳了住院患者深静脉血栓形成研究中的关键问题,对其发病情况、形成原因、诊断方法及预防进展进行了综述,阐述了住院患者深静脉血栓形成研究的主要进展,为预防深静脉血栓的发生提供依据。     

肺血栓栓塞症-深静脉血栓形成的预防策略

肺栓塞是一种严重危害人类健康的疾病,由于其病因的复杂性、临床表现的非特征性及常规检查的非特异性,使其具有高发病率、高误漏诊率及高死亡率,已成为国际性重要的医疗保健问题。近年来,针对肺栓塞遗传流行病学、发病学、无创检查技术、药物治疗、手术及介入治疗方法等的研究,取得了显著成效。但肺栓塞在临床方面仍存在诸多问题:如高危人群的预防、诊断意识及诊断水平不足、治疗方法不规范等。本期专题对肺栓塞临床研究现状进行综述,旨在提高临床医生对本病的诊断意识及诊疗水平,降低肺栓塞的“三高”率,并推进本学科领域的深入研究。     

深静脉血栓形成的防治

采用尿激酶动脉注射,低分子肝素皮下注射及糖皮质激素、理疗等综合治疗手段治疗深静脉血栓形成8例,治愈7例,死亡1例。上述治疗对深部静脉血栓形成有治疗良好作用。     

髋部骨折患者急性下肢深静脉血栓的转归及其影响因素

目的 了解髋部骨折患者并发急性下肢深静脉血栓转化为慢性下肢深静脉血栓的发生情况,并探讨慢性DVT发生的影响因素.方法 收集经手术治疗且住院期间发生急性下肢深静脉血栓的187例髋部骨折患者的临床资料,根据出院后1个月超声复查结果,分为血栓消失组与慢性血栓组.比较两组临床资料,采用多因素logistic回归分析髋部骨折患者...     

下肢骨折术后预防深静脉血栓的护理干预措施探讨

目的 探讨下肢骨折术后预防深静脉血栓的护理干预措施.方法 将我院2009年7月-2011年7月收治的 60 例下肢骨折患者随机分为观察组和对照组,每组各30例,对照组给予常规骨科手术后护理,观察组在对照组的基础上实施有针对性的护理干预.结果 观察组无深静脉血栓形成,住院时间短,患者满意度为100%,对照组发生深静脉血栓3例,住院时间长,患者满意度为76%.结论 根据下肢骨折手术后深静脉血栓形成原因,采取有效的预防措施,可有效地降低其发生率,缩短住院时间,提高患者满意度.     

对深静脉血栓和急性肺栓塞诊治的初步认识

过去．急性肺栓塞在临床上诊断比较困难．被认为是一种少见疾病而未引起临床重视．常常误诊或漏诊。     

直肠癌术后下肢深静脉血栓形成的原因及其防治

回顾分析56例直肠癌术后下肢深静脉血栓形成(LDVT)患者的发生原因及治疗方法.认为直肠癌术后LDVT的发生主要与多因素引起的血流速度缓慢和血流凝固性增加有关,其防治要点是针对病因,加强围术期处理,早期诊断,及时治疗.     

Noninvasive diagnosis of deep vein thrombosis in postoperative patients

The accuracy of noninvasive testing for the diagnosis of deep vein thrombosis (DVT) generally is less in asymptomatic patients than it is in those with symptoms suggestive of thrombosis. This is because asymptomatic DVT often is confined to the distal veins and, when it involves the proximal veins, the thrombi usually are smaller than in symptomatic patients with proximal thrombosis. Because the positive predictive value of noninvasive tests for asymptomatic DVT generally is 80% or less, abnormal results should be confirmed by venography. There are two main reasons why asymptomatic DVT is sought in the postoperative period: (1) to identify the need for full-dose anticoagulant therapy to prevent symptomatic episodes of venous thromboembolism (VTE), including fatal pulmonary embolism (this represents a form of secondary prophylaxis), and (2) to use this outcome as a surrogate for episodes of clinically important VTE in studies that are designed to evaluate methods of venous thrombosis prophylaxis. In relation to the first of these indications, evidence suggests that routine surveillance of high-risk patients to detect asymptomatic postoperative DVT does not result in improved clinical outcomes in patients who received appropriate VTE prophylaxis. In relation to the second indication, there is concern that asymptomatic VTE may not be a reliable surrogate for clinically important VTE, particularly if the effectiveness of different antithrombotic agents is being compared. Coupled with the comparatively low accuracy of noninvasive testing for asymptomatic DVT, this suggests that the results of such testing are unsuitable for the evaluation of new methods of prophylaxis in clinical trials.     

卒中后深静脉血栓形成的治疗和预防

由于高龄、肢体偏瘫、脱水、血管壁损伤等自身特异性,卒中易引起静脉血栓栓塞(venous thromboembolism,VTE).VTE主要包括深静脉血栓形成(deep vein thrombosis,DVT)和肺栓塞(pulmonary embolism,PE).DVT是指血液在静脉内的非正常凝结,阻碍静脉回流,血栓脱落可形成血栓性栓塞,引起PE、心肌梗死和卒中,不仅会延长住院时间,而且可使病死率增高.文章对卒中后DVT的发病率、危险因素、治疗和预防进行了综述.     

End points in studies on the prevention of deep vein thrombosis

Clinically overt events are of obvious relevance for the outcome of patients. There is unanimous consensus of clinicians that these events should be prevented in clinical practice. In clinical trials on the prevention of deep vein thrombosis, symptomatic objectively confirmed venous thromboembolism is the most important outcome to be measured. However, because of the difficulties related to the measurement of clinically overt events, venography is the most commonly used method for end-point measurement in clinical trials on the prevention of venous thromboembolism. The limitations of venography leave a great need for the development of accurate noninvasive methods to be used as alternatives to venography. The end point must be tailored to the phase of the clinical trial. In phase I/II clinical trials, that are designed to evaluate the effectiveness of thromboprophylactic agents, it still is necessary to use the most accurate method for the diagnosis of deep vein thrombosis and to perform bilateral venography. When a new pharmacologic agent is compared with the "gold standard" agent, the use of symptomatic end points should be preferable.     

深静脉血栓症防治的几个问题

静脉血栓症（Venous thromboembolism,VTE）包括肺血栓栓塞症（pulmonary thromboembolism,VIE）和深静脉血栓形成（deep vein thrombosis,DVT）两种临床类型。由于多数DVT并非立即致命,相当数量的DVT患者没有症状,所以DVT误诊、漏诊情况非常严重。大约DVT患者中50％～60％会发生PTE,即使进行充分治疗,PTE仍然有较高的致残、致死率。     

Orgaran in the prevention of deep vein thrombosis in stroke patients.

Venous thrombo-embolism is a common complication in patients with acute ischaemic stroke. Without prophylaxis, deep vein thrombosis occurs in 60-75% of patients with dense hemiplegia, usually in the paralyzed limb, and 1-2% suffer fatal pulmonary embolism. Orgaran (Org 10172, low-molecular-weight heparinoid) has been evaluated for the prevention of deep vein thrombosis in patients with acute ischaemic stroke in two studies. In a double-blind study, 75 patients were randomized to receive Orgaran (50 patients) in a loading dose of 1,000 anti-Xa units intravenously followed by 750 anti-Xa units subcutaneously 12-hourly or placebo (25 patients). Deep vein thrombosis occurred in 2 of 50 (4%) in the Orgaran group and 7 of 25 (28%) in the placebo group (p = 0.005). The corresponding rates for proximal deep vein thrombosis were 0 and 16%, respectively (p = 0.01). There was one major haemorrhage in the treated group and one minor haemorrhage in the placebo group. In the second study, the safety and efficacy of Orgaran was compared with unfractionated heparin in the prevention of deep vein thrombosis in a double-blind randomized trial. Eighty-seven patients with marked lower limb paralysis secondary to stroke were randomized to receive Orgaran (45 patients) in a dose of 750 anti-factor Xa units subcutaneously 12-hourly or unfractionated heparin (42 patients) in a dose of 5,000 units subcutaneously 12-hourly. Venous thrombosis occurred in 4 of 45 (8.9%) of the Orgaran group and 13 of 42 (31%) in the unfractionated heparin group (2p = 0.014). The corresponding rates for proximal vein thrombosis were 4.4 and 11.9%, respectively (2p = 0.255).(ABSTRACT TRUNCATED AT 250 WORDS)