下肢深静脉血栓合并肺栓塞18例分析

目的探讨下肢深静脉血栓(DVT)合并肺栓塞(PE)的临床表现、诊断方法及治疗和预后。方法回顾分析我院1998年1月--2003年6月收治的18例下肢深静脉血栓患者的临床资料。结果男8例，女10例，平均年龄57．5岁。双下肢DVT3例，左下肢DVT8例，右下肢DVIv7例，12／18例双下肢不对称，膝上15cm大腿周径差。均值4．3cm，4／18例无下肢水肿，2／18例患径小于对侧。全部病例双下肢彩色多普勒检查阳性，3／18核素肺灌注示多段肺栓塞，仅1例核素双下肢深静脉扫描示有血栓，男2例未见异常，与同期B超阳性率比有差异。本组病例中，有肿瘤、长期卧床史、术后卧床、制动史12例。18例确诊病人经抗凝、溶栓治疗，5例猝死，1例因其它并发症死亡，总死亡率38．9％死亡病人多系手术科室患者。结论下肢深静脉血栓是肺栓塞的直接原因，长期卧床、尤其术后制动为DVT的直接诱因，术后DVT并肺栓塞猝死率高，双下肢彩超及时监测有助早期诊治，规范抗凝、溶栓治疗对减少死亡率有临床意义。

A study of 18 patients with deep venous thrombosis of lower limbs combinated with pulmonary embolism

Objective:To study the clinical manefestations, diagnosis, therapy and prognosis of the deep venous thrombosis (DVT) of lower limbs combinated with pulmonary embolism (PE). Methods: The clinical data of 18 patients with DVT hospitalized between 1998 and 2003 were analyzed. Results: Among the 18 patients with DVT, 3 of them DVT were found in both lower extremities, 8 in the left lower limb, 7 in the right lower limb; 12 of them were with asymmetric two lower limbs , the mean value of peri-diameter-difference 15cm above knee was 4.3cm, four of them had no edema of lower extremity. All patients were diagnosed by color Doppler. Three patients were examined by nuclein pulmonary perfusion imaging, and all of them showed PE in more than one pulmonary field, only one showed thrombosis in both lower extremities, other 2 patients showed nothing in lower extremities, so there was a difference between Doppler and nuclein pulmonary perfusion imaging examination. 12 out of 18 patients had the history of either tumor or long-term bed or lying in bed after operation or immobilization. All patients were given anti-coagulation and thrombolysis therapy ,among them 5 suffered from sudden death, 1 died from aother disease. The mortality was 38.9%. Most of the dead patients had something to do with surgical operation. Conclution: DVT is the direct reason for PE, long-term bed, especially immobilization after operation was the direct cause for DVT, DVT combinated with PE after operation has high rate of sudden death. Color Dopple examination is helpful for the early diagnosis and treatment. Formal anti-coagulation and thrombolysis therapy is of clinical significance to reduce the mortality.