超声下不同部位下肢静脉血栓与肺栓塞发生的关联性分析

目的：通过下肢静脉超声检查结果来分析不同部位下肢静脉血栓与肺栓塞之间的关系,为肺栓塞患者的病情评估以及治疗方案提供帮助。方法：回顾性分析2018年1月初至2019年12月底上海交通大学附属胸科医院心内科收治的312例患者,所有患者均行CT肺动脉造影及下肢静脉超声检查,按照检查结果分为肺栓塞组和非肺栓塞组,根据超声检查结果以及病史资料的差别作单因素和多因素相关性分析。结果：两组患者的性别构成比、年龄、肺癌合并情况、下肢静脉血栓发生率及发生部位均存在显著差异（P＜0.05）。肺栓塞组肌间静脉、股静脉、腘静脉、胫后静脉和腓静脉血栓发生率均显著高于非肺栓塞组（P＜0.05）。多因素Logistic回归分析结果表明,存在下肢静脉血栓与肺栓塞的发生存在显著关联（OR= 8.344,95%CI: 4.867- 14.304）,其中存在肌间静脉血栓（OR=2.996,95%CI: 1.630-5.509）、腘静脉血栓（OR=5.536,95%CI: 1.646-18.623）、胫后静脉血栓（OR=6.685,95%CI: 1.789-24.990）均与更高的肺栓塞发生率显著相关。结论：下肢静脉血栓患者的肺栓塞风险显著增加,存在肌间静脉血栓、腘静脉血栓、胫后静脉血栓均为肺栓塞的独立危险因素。     

脑卒中合并孤立性比目鱼肌静脉血栓治疗的回顾性研究

目的通过对不同类型脑卒中合并孤立性比目鱼肌间静脉血栓患者的超声随访结果进行回顾性分析,探讨孤立性小腿比目鱼肌间静脉血栓的管理方法。方法回顾性分析我院神经内科脑卒中患者下肢静脉超声检查结果,选取合并孤立性小腿比目鱼肌肌间静脉血栓且进行两次及以上超声检查患者共123例,其中出血性脑卒中属于抗凝绝对禁忌证为非抗凝组44例,缺血性脑卒中属于抗凝绝对适应证为抗凝组79例,通过卡方检验分析两组患者下肢静脉血栓超声检查变化是否有统计学差异。结果 (1)肺栓塞:两组中均无患者发生。(2)血栓延伸到腘静脉:抗凝组1例,非抗凝组2例,P=0.278。(3)血栓再通或部分再通:抗凝组16例,非抗凝组11例,P=0.542。结论孤立性小腿比目鱼肌间静脉血栓患者应以定期复查为主,延伸到腘静脉再进行治疗。     

下肢深静脉血栓形成的危险因素及多普勒超声诊断价值分析

目的:探讨下肢深静脉血栓形成的危险因素及多普勒超声诊断价值。方法:选取2014年5月~2017年5月我院接诊的86例疑似下肢深静脉血栓患者为研究对象,均行多普勒超声及数字减影血管造影检查,以数字减影血管造影为金标准,探讨多普勒超声检查在下肢深静脉血栓诊断中的应用价值,分析下肢深静脉血栓形成的危险因素。结果:普勒超声诊断诊断准确率为96.5%;髂静脉、股静脉、腘静脉、股静脉至筋脉累及、胫前与胫后静脉诊断灵敏度分别为75.0%、96.9%、90.0%、100.0%、100.0%;下肢深静脉血栓形成患者的脑血管病史、静脉血栓史及发热等均显著高于非下肢深静脉血栓形成患者(P<0.05)。结论:患者脑血管病史、静脉血栓史及发热是下肢深静脉血栓形成的高危因素。多普勒超声诊断下肢深静脉血栓形成操作简单、准确率高,值得临床推广应用。     

彩超对下肢骨折术前深静脉血栓筛查的意义

目的 探讨彩色多普勒超声筛查下肢骨折患者术前深静脉血栓的意义.方法 对580例单侧下肢骨折患者,术前应用彩色多普勒超声对下肢深静脉进行检测,观察有无血栓形成、累及部位、范围和活动度.结果 术前下肢深静脉血栓检出率为11.3％ (66/580),其中小腿肌间静脉血栓占40.9％ (27/66),严重的深静脉血栓(即股静脉至腘或胫后静脉、1例累及髂外静脉)占15.1％ (10/66);超声可显示血栓近端有活动度的8例.结论 下肢骨折患者易发生深静脉血栓,术前行彩色多普勒超声筛查,可早期检出下肢深静脉血栓的部位与活动度,对降低麻醉、手术风险,防止致命性肺栓塞具有重要意义.     

彩色多普勒超声对脊髓损伤后并发肺动脉栓塞患者下肢静脉血栓的诊断价值

目的探讨彩色多普勒超声检查对脊髓损伤患者下肢深静脉血栓和肺栓塞的诊断价值。方法对60 例肺动脉栓塞患者(肺栓塞组)和同期35 例无肺栓塞的脊髓损伤住院患者(对照组)进行下肢静脉彩色多普勒超声检查。结果肺栓塞组中,36 例脊髓损伤患者,15 例检出下肢静脉血栓;24 例非脊髓损伤患者,9 例检出下肢静脉血栓。脊髓损伤患者与非脊髓损伤患者相比,两组肺栓塞发生率无显著性差异(P>0.05)。对照组有5 例检出下肢静脉血栓。肺栓塞组与对照组相比,下肢静脉血栓发生率有非常显著性差异(P<0.01)。肺栓塞组中,37 例急性肺栓塞患者,11 例检出下肢静脉血栓;23 例慢性肺栓塞患者,10 例检出下肢静脉血栓。两者检出率无显著性差异(P>0.05)。肺栓塞组中,31 例检出股静脉瓣反流和小腿肌肉间静脉扩张,检出率51.7%;对照组8 例检出,检出率22.9%。两组相比有非常显著性差异(P<0.01)。结论脊髓损伤后肺栓塞患者与非脊髓损伤肺栓塞患者的下肢静脉血栓检出率无明显差别,但均明显高于无肺栓塞的脊髓损伤患者。彩色多普勒超声检查下肢静脉对肺栓塞诊断具有临床价值。     

脑梗死并下肢肌间静脉血栓形成二例报告

目的探讨脑梗死并肌间静脉血栓形成的发病机制及临床特点。方法对我院收治的2例脑梗死并肌间静脉血栓形成的临床资料进行回顾性分析。结果本文2例均无下肢静脉血栓形成的典型临床表现,但下肢血管超声检查示左下肢肌间静脉血栓形成,其中例1经胸部CT检查证实肺栓塞(pulmonary emblism,PE)并下肢动脉血栓形成及对侧下肢肌间静脉血栓形成;例2住院期间发现肌间静脉血栓形成。2例皆行下腔静脉滤器植入术,术后痊愈。结论急性脑血管病患者是下肢肌间静脉血栓形成的高危人群,及时行下肢血管超声检查,可减少下肢肌间静脉血栓的漏诊。     

小腿静脉血栓的影像学诊断

目的探讨彩色多普勒超声及静脉造影对小腿静脉血栓的诊断价值.方法采用彩色多普勒超声检出219例小腿静脉血栓,其中18例行下肢静脉造影.结果彩色多普勒超声检查出小腿陈旧性或附壁血栓152例,新鲜血栓67例.与静脉造影对照,彩色多普勒超声检测小腿胫后静脉、腓静脉的敏感性分别为87.5%、90.9%,特异性分别为100%、100%,而对于小腿腓肠肌和比目鱼肌间静脉血栓,彩色多普勒超声的诊断显示率明显高于静脉造影.小腿静脉血栓发生于单侧肢体者明显多于同时发生于双侧肢体者.两侧小腿血栓分布部位的次序都是腓静脉(28%)>胫后静脉(23.0%)>肌间静脉(15.1%)>肌间静脉 腓静脉(14.6%).结论彩色多普勒超声对小腿胫后、腓、胫前静脉、腓肠肌和比目鱼肌间血栓有较高的敏感性和特异性,可以了解小腿静脉血栓的发生部位、分布、延伸和大小的变化.静脉造影可以确诊胫后、腓、胫前静脉的血栓,但对小腿肌间静脉血栓的诊断有限.     

超声诊断小腿深静脉血栓及鉴别诊断

目的分析小腿深静脉血栓的超声诊断方法及其声像图特点。方法对59例67条下肢疑诊小腿深静脉血栓患者，均行超声检查。结果59例患者的67条下肢中35例患者的37条（55．2％）下肢诊为小腿深静脉血栓（8条小腿深静脉血栓伴浅静脉血栓，其中1条伴淋巴水肿；1条小腿肌间静脉血栓伴淋巴水肿），其中32条（86％）下肢为小腿肌间静脉血栓；2条（0．5％）下肢为腓静脉血栓；3条（0．8％）下肢为胫后静脉血栓，其中2条为胫后静脉血栓合并肌间静脉血栓。未见胫前静脉受累。19例患者25条（37．3％）下肢诊为淋巴水肿，5例（7．5％）诊为肌间血肿。结论超声有助于明确小腿深静脉血栓诊断，并能对类似小腿深静脉血栓疾病症状的疾病进行鉴别。     

应用彩色多普勒超声诊断小腿肌间静脉扩张及血栓形成

目的探讨彩色多普勒超声应用于小腿肌间静脉检查,在发现腓肠肌及比目鱼肌肌间静脉扩张及血栓形成中的价值。方法对腓肠肌及比目鱼肌肌间静脉均扩张的82名患者128支下肢静脉进行彩色多普勒超声检查,观测最宽内径及有无血栓形成或形成倾向。结果发现肌间静脉血栓8例(9.8%),其中4例(4.9%)并发肺栓塞;发生肌间静脉血栓的静脉内径(0.65±0.30)cm;其中并发肺栓塞的肌间静脉内径(0.62±0.29)cm;扩张的肌间静脉内具有血栓形成倾向管腔内见"泥沙流"9例(11.0%)。结论彩色多普勒超声可早期发现小腿肌间静脉扩张及血栓形成或血栓形成倾向,以辅助诊断肺栓塞的发生。     

多层螺旋CT静脉造影诊断下肢静脉血栓性病变

目的探讨多层螺旋CT静脉造影(MSCTV)对下肢静脉血栓诊断的临床应用价值.方法 MSCT下肢静脉造影检查16例,其中12例做下肢多普勒超声检查,4例做下肢静脉造影.MSCTV检查后经最大密度投影(MIP)、表面遮盖法(SSD)及容积再现法(VR)重建.结果 MSCTV显示11例存在静脉血栓.以多普勒超声作对照,MSCTV显示股腘静脉血栓的敏感性96.0%,特异性97.8%,阳性预测值96.0%,阴性预测值97.8%,准确性97.2%.MSCT尚能显示小腿、盆腔等超声检查难于显示的血栓.MSCTV较常规静脉造影更清晰显示盆腔静脉血栓.结论 MSCTV对显示股腘静脉血栓方面与超声同样敏感,MSCTV还能显示超声难于显示的髂静脉及胫腓静脉的血栓.MSCTV可作为下肢静脉血栓诊断的首选检查方法.     

超声评价高度可疑肺栓塞患者下肢深静脉血栓

目的 探讨超声检查对发现高度可疑肺栓塞(PE)患者合并有下肢深静脉血栓(DVP)的价值.方法 将161例临床及螺旋CT扫查高度可疑肺栓塞患者,按照是否有形成血栓危险因素和(或)深静脉血栓(DVT)症状分为两组.凡具有上述条件之一者为组1患者,共计118例;既无DVT症状也无危险因素者为组2,共计43例.所有患者均行超声检查.结果 超声检查发现组1有DVT者15例,其中发生在膝及膝以上者4例,发生在小腿者11例.组2无一例发现有DVT(95%可信度).组2在除外DVT的阴性预见性为100%(95%的可信度).结论 超声对发现高度可疑肺栓塞患者下肢DVT有重要价值.     

Utility of lower-extremity duplex sonography in patients with venous thromboembolism.

PURPOSE: We evaluated the utility of venous duplex ultrasonography (VDUS) of the lower extremities in patients with pulmonary embolism (PE) and studied the distribution of venous thrombi in deep vein thrombosis (DVT) patients with and without PE. METHODS: We retrospectively reviewed medical records of all inpatients with a final diagnosis of PE or DVT between 1989 and 2000. RESULTS: Venous thrombosis was detected by VDUS in 229 patients (191 without PE and 38 with PE). The left leg only was involved in 50% of patients (p < 0.05), the right leg only in 33%, and both legs in 17%. The overall distribution of veins affected by DVT was: popliteal vein, 77%; superficial femoral vein, 76%; common femoral vein, 65%; posterior tibial vein, 23%; external iliac vein, 21%; common iliac vein, 9%; great saphenous vein, 7%; and inferior vena cava, 2%. A single venous site was involved in 22% of patients. External iliac vein thrombosis was more frequent in patients with DVT only (24%) than with PE and DVT (5%) (p < 0.05). The venous obstruction was partial in 14% of patients. VDUS of the asymptomatic leg was positive in 14% of patients with unilateral symptoms of DVT, all of whom also had DVT in the symptomatic leg. VDUS was positive for DVT in 90% of patients with PE and concomitant pain or edema of the leg, compared to only 20% of PE patients with no symptoms of DVT. CONCLUSIONS: Sonography should be the first diagnostic test for patients suspected of having PE with any sign or symptom related to DVT. VDUS of the asymptomatic leg is unnecessary in the diagnosis and management of DVT. Omitting the superficial femoral vein examination would lead to some decrease in the sensitivity of VDUS.     

Chronic CT features in PE patients with co-existing DVT

ObjectiveClinical features may be different in patients with PE without co-existing DVT compared to those with PE with co-existing DVT. This prospective study aims to investigate the different clinical features between patients with isolated pulmonary embolism (PE) and those with PE associated with deep venous thrombosis.MethodThis is a prospective study conducted in 107 consecutive patients diagnosed with acute PE in the emergency department or other departments of Kırıkkale University Hospital. The diagnosis of PE was confirmed by computed tomography pulmonary angiography (CTPA), which was ordered on the basis of symptoms and findings. Bilateral lower extremity compression ultrasound with standard 7.5 MHz linear array probe was applied to all patients. According to compression ultrasound results, the patients were divided into two classes as with and without deep venous thrombosis. Embolism in the main or lobar pulmonary arteries were classified as central, and those found only in segmental or subsegmental arteries were classified as peripheral. Laboratory parameters and Oxygen saturation were assessed on admission.Results67 of 107 (62.6%) patients with PE were isolated pulmonary embolism, and 40 (37.4%) were PE + DVT. Patients with PE with co-existing DVT have wider pulmonary artery, higher d-dimer and pro BNP level, and lower saturation than those with isolated pulmonary embolism. Central pulmonary embolism is more common in patients with deep vein thrombus than those without it. (87.5% (35/40) vs 32.8% (22/67),p = 0.001). 38.6% of central pulmonary embolism occur without deep vein thrombosis of the lower extremities.Patients with PE with co-existing DVT have 42.5% mosaic perfusion pattern,70% chronic infarct appearance such as linear band, pleural nodüle, %15.0 thickened, small arteries and, %12.5 shrunken complete artery occlusion, suggesting the chronic background.ConclusionPE patients with co-existing DVT are clinically more serious than those who do not have a DVT. An acute picture may be present in the chronic background in a significant proportion of patients with PE with co-existing DVT. In the presence of deep vein thrombosis, pulmonary embolism is usually central, but more than one-third of central pulmonary emboli occur without lower extremity deep vein thrombosis.     

鼻内镜术后并发下肢静脉血栓及肺栓塞的分析（附5例报告）

目的 探讨鼻内镜术后下肢静脉血栓（LEVT）及肺栓塞（PE）的发生情况，旨在提高耳鼻喉科医生对术后LEVT和PE的认识和诊断水平，总结治疗经验。方法 回顾性分析2020年1月－2021年7月该院耳鼻咽喉头颈外科5例鼻内镜术后并发LEVT及PE的患者的临床资料。结果 5例患者鼻内镜术后均出现LEVT和PE，经抗凝治疗后安全出院。结论 急性PE起病急，死亡率高，鼻内镜术后并发PE的发生率较低，以往没有得到耳鼻喉科医生的足够重视，通过分析病例和回顾文献，提高耳鼻喉科医生对鼻内镜术后患者血栓的预防和重视，降低血栓发生率，并及早进行干预，提高治愈率。     

Red flag in bedside echocardiography for acute pulmonary embolism: remembering McConnell's sign

Dyspnea is a common symptom among emergency department (ED) patients. The differential diagnosis of dyspnea in ED patients is broad, and pulmonary embolism (PE) is a crucial consideration among these. Recognition of right ventricular (RV) dysfunction is critical in patients with PE. Here, we present a 76-year-old male patient with the complaint of dyspnea. Focused cardiac ultrasonography performed by the emergency physician revealed enlarged RV, hypokinetic lateral wall and hyperkinetic apex of RV (McConnell's sign). We have screened the deep venous system of the patient with the linear probe for possible deep venous thrombosis and showed that the right dilated uncompressible popliteal vein had a thrombus formation. Computed tomography angiography of the thorax revealed filling defects in both main pulmonary arteries. Our case shows that bedside ultrasonography is a valuable tool for detecting PE and decision making in PE patients.     

Retrievable inferior vena cava filter to prevent pulmonary embolism in patients with fractures and deep venous thrombosis of lower extremities: a single-center experience

ObjectiveTo evaluate the effectiveness of inserting a retrievable inferior vena cava filter (IVCF) to prevent pulmonary embolism (PE) in patients with bone fractures and acute deep venous thrombosis (DVT) before major orthopedic surgery.MethodsClinical data of patients with fractures and acute DVT who underwent IVCF insertion were analyzed. The patients were divided into above-knee DVT (AKDVT), popliteal vein thrombosis (PVT), and below-knee DVT (BKDVT) groups.ResultsAn IVCF was successfully implanted in 964 patients, among whom 929 were followed up (335, 470, and 124 in AKDVT, PVT, and BKDVT groups, respectively). There was no significant difference in the incidence of filter thrombosis among the groups (11.04%, 11.70%, and 8.06%, respectively). No symptomatic PE occurred during follow-up. The mean filter indwelling time was 18.4 ± 4.3 days, and the total filter removal rate was 76.87%. There was no significant difference in the rate of filter implantation, retrieval, complications, or mortality among the groups.ConclusionsRetrievable filters can effectively prevent PE before orthopedic surgery in patients with fractures and acute DVT of the lower limbs. AKDVT more readily forms a ≥1-cm thrombus in the IVCF than does BKDVT, and PVT more readily forms a <1-cm thrombus than does AKDVT.     

彩色多普勒超声与数字减影血管造影对比评价不同节段下肢深静脉血栓的诊断价值

目的 探讨彩色多普勒超声对不同节段深静脉血栓形成(DVT)的诊断价值.方法 临床疑为DVT患者58例,应用彩色多普勒超声探测患肢各节段血管,检查结果 与DSA对照,按照四格表分析,评价彩色多普勒超卢诊断不同节段DVT的灵敏性、特异性、准确性等指标.结果 共检测150条不同节段静脉.进行四格表统计分析彩色多普勒超声对各节段血管的检出率:髂总静脉血栓检查灵敏性82.6%,特异性66.7%;髂外静脉血栓灵敏性83.3%,特异性80.0%;髂内静脉血栓灵敏性80.0%,特异性66.7%;胴静脉血栓灵敏性92.6%,特异性92.2%;股静脉血栓灵敏性96.2%,特异性93.8%;胫前静脉血栓灵敏性71.4%,特异性75.0%;胫后静脉血栓灵敏性72.7%,特异性75.0%.结论 彩色多普勒超声作为DVT的首选检查方法 ,对不同节段静脉血栓有不同的诊断价值,对股、胭及髂外静脉灵敏性较高,胫前、胫后静脉血栓检出的灵敏性较低.     

Merino wool graduated compression stocking increases lower limb venous blood flow: A randomized controlled trial

Introduction  

Graduated compression stockings represent a nonpharmacological approach to reduce the risk of deep vein thrombosis (DVT) and pulmonary embolism (PE) due to prolonged immobility through reducing lower limb venous stasis. A novel merino wool, double-layer, below-knee graduated compression stocking has been developed to reduce the risk of air travel-related DVT and PE.     

骨科围手术期下肢深静脉血栓形成的预防及护理进展

为了提高护理人员对骨科手术病人并发下肢深静脉血栓形成(DVT)的认识 ,加强对骨科高危人群的预防和护理 ,降低DVT和肺栓塞(PE)的发生率。回顾性分析了骨科病人并发下肢DVT的发病原因、高危因素 ,重点综述了DVT的预防和护理进展。     

Endovascular therapy for floating thrombus in the inferior vena cava

ObjectiveWe aimed to summarize the clinical characteristics of floating thrombus in the inferior vena cava (IVC).MethodsFrom January 2014 to June 2019, four patients with floating thrombus in the IVC were admitted to our hospital and underwent intracavitary therapy. Diagnosis, therapy, and clinical characteristics of floating thrombus were summarized.ResultsThree patients presented with pulmonary embolism. Three of the patients had a floating thrombus discovered by inferior venacavography and one was found by contrast-enhanced computed tomography. Two patients had deep venous thrombosis in the lower extremities. One patient had a double IVC, one had left iliac vein compression syndrome, and one had right renal phlebothrombosis. The four patients underwent implantation of a temporary IVC filter and were treated with anti-coagulation, debulking, and thrombolysis. All four patients achieved satisfactory results.ConclusionsFloating thrombus in the IVC is often caused by spread of branch vein thrombosis, and is more likely to lead to pulmonary embolism. Anti-coagulant therapy and debulking under the protection of filters can achieve satisfactory clinical results.