彩色多普勒血流显像对PICC术后上肢静脉血栓溶栓疗效的评估作用

目的：探讨彩色多普勒血流显像对经外周静脉穿刺中心静脉置管（Peripherally inserted central cather,PICC）术后,上肢静脉血栓形成溶栓治疗中评估疗效及预后的价值.方法：利用彩色多普勒超声对2012年3月-2013年5月的12例PICC术后,上肢静脉血栓形成溶栓治疗的患者,进行随访观察并总结分析.结果：12例患者,7例导管位于右上肢,5例位于左上肢.男8例,女4例.胃肠道恶性肿瘤4例,肺部恶性肿瘤3例,乳腺恶性肿瘤3例,均为女性患者,腹部恶性肿瘤2例.11例患者上肢静脉血栓经溶栓治疗均消失,1例患者出现双上肢静脉广泛栓塞,临床上怀疑合并肺血栓栓塞.彩色多普勒超声能短时间内准确的判断上肢静脉血栓溶栓治疗过程中,血栓大小、形态及范围的变化,反应血流再通的情况,清楚的显示导管的位置以及状态,很大程度帮助临床判定溶栓治疗的效果及指导治疗方案.结论：彩色多普勒超声能对PICC术后,上肢静脉血栓形成溶栓治疗过程中血栓范围、大小、导管的位置以及状态及其作出准确的判断,对临床PICC术后血栓形成溶栓效果评估及治疗方案选择具有重要作用.

The value of color Doppler flow imaging in upper extremity venous thrombosis after PICC

Objective： To explore the value of color Doppler ultrasound （CDUS） in the thrombolytic therapy for the patient with upper extremity venous thrombosis after peripherally inserted central venous catheter （PICC）. Method： Follow-up observa- tion and analysis of 12 patients who underwent PICC due to upper extremity venous thrombosis and received thrombolytic therapy later under CDUS monitoring. Results： In all the 12 patients, 8 patients were male, 4 were female. Seven cases of catheter located in the right upper extremity, 5 cases in the left upper extremity, 4 cases due to gastrointestinal cancer, 3 cases of lung cancer and breast cancer respectively, 2 cases of abdominal malignancies. All the patients with breast cancer were female. In 11 patients the upper extremity venous thrombosis disappeared after thrombolytic therapy. One patient devel- oped extensive upper limb venous thrombosis, and had been suspected clinically to have pulmonary thromboembolism, but ex- cluded later. CDUS can observe the size, shape, scope of the venous thrombosis, also can monitor the situation of flow re- canalization, and show the position and the state of the catheter clearly during the whole process of thrombolytic therapy. It would help clinicians to assess the effect of thrombolytic therapy and so as to guide the treatment plan in an large extent. Conclusions： CDUS can accurately observe the location, scope, status of the patients with upper venous thrombosis after PICC and monitor the therapeutic treatment during the whole process. CDFI plays an important role in the assessment of throm- bolytic effect for the patients with upper venous thrombosis after PICC and to guide treatment plan.