导管溶栓术治疗下肢深静脉血栓

静脉血栓栓塞性疾病(VTE)是外科多发病.2004年,Baldwin等[1]综合文献资料指出,在发展中国家每年有患者3000～6000万人,80岁男性患病率为10.7%.VTE大多为下肢深静脉血栓形成(DVT).2001年,Nicolaides等[2]报道,心脑血管意外、髋关节置换术、多发性创伤、全膝置换术和髋部骨折等,并发DVT者占40%～50%;而心肌梗死、前列腺切除术、脊柱损伤和神经外科手术等,则为20%～30%.据统计,美国每年因DVT并发肺栓塞(PE)致死者约20万人.DVT的治疗效果一直不能令人满意,经导管灌注溶栓药物的溶栓疗法(CDT),文献报道已超过600例,显著提高DVT的疗效.     

经腘静脉置管溶栓治疗下肢深静脉血栓形成

目的初步探讨经腘静脉置管溶栓治疗下肢深静脉血栓(DVT)的临床应用价值。方法67例下肢深静脉血栓形成患者,在B超引导下行经腘静脉置入溶栓导管,以输液泵经溶栓导管持续泵入溶栓药物10~14d,同时行抗凝治疗。结果所有病人均置管成功,其中3例未能通过髂静脉;治疗后临床表现均有不同程度的好转,出院前均行影像学检查,治愈11例,其中8例病程≤10d,显效42例,有效16例,有效率100%;其中5例接受髂静脉球囊扩张术,3例行髂静脉支架置入术,1例行耻骨上静脉转流术。结论经腘静脉置管溶栓术治疗下肢深静脉血栓可以延长尿激酶溶栓时间窗,减少尿激酶用量,减少出血并发症,并为后续治疗提供机会。     

人工关节置换术后下肢深静脉血栓形成

了解人工关节置换术后深静脉血栓的发生情况。方法５１例未行预防性抗凝治疗的人工关节置换患者于术后３－１３天行双侧上行性静脉造影。分析调查术后深静脉血栓的发病情况。     

下肢深静脉血栓形成手术时机的探讨

目的探讨下肢深静脉血栓形成(LEDVT)手术时机的选择。方法LEDVT47例,按照临床病程分为早期组(≤3d)23例和中期组(≤10d)18例、晚期组(>10d)6例。所有病例均采用股静脉切开取栓术。结果早中期组术后恢复良好,早期组术后患肢肿胀2d以内明显消退;中期组术后患肢肿胀于5d内消退占10/18;晚期患者术后患肢肿胀消退缓慢,术后5d仍有肿胀占5/6。早中期患者术后血栓病理多为新鲜血栓,晚期多为陈旧血栓。结论下肢深静脉血栓形成的患者在10d内应积极手术取栓治疗,10d以上不宜手术而以保守治疗为主。     

普通外科恶性肿瘤患者术后下肢深静脉血栓形成预测模型的构建

背景与目的：下肢深静脉血栓形成（LDVT）是普通外科恶性肿瘤患者术后常见的并发症之一,严重影响患者的术后康复。目前的评估工具无法对LDVT患者进行更加细致的风险分层。因此,本研究探讨普通外科恶性肿瘤患者术后发生LDVT的影响因素,并建立可靠的预测工具,从而为LDVT的诊断和防治提供帮助。方法：回顾性分析2021年1月1日—2022年10月31日中南大学湘雅医院普通外科手术治疗恶性肿瘤患者的临床资料,根据良好设计的纳入、排除标准对病例进行严格的质量控制。使用已经较明确的LDVT的影响因素和一些重要临床特征作为分析变量,单变量分析和多变量分析用以评估LDVT的影响因素以及筛选模型的预测因子。应用编程软件制作基于Logistic回归的列线图并通过受试者工作特征曲线（ROC）评估列线图的预测性能,校准曲线用以评估预测模型与数据的拟合程度。使用决策曲线分析（DCA）比较预测模型与其他单一指标临床应用价值的差异。结果：本研究共纳入342例患者,其中LDVT组167例,对照组175例。单变量分析显示,1个月内有手术创伤史、高血压史、吸烟史、饮酒史、放疗史、ICU住院时间、红细胞（RBC）、血红蛋白（...     

恶性肿瘤致下肢深静脉血栓形成8例

恶性肿瘤致下肢深静脉血栓形成８例周涛刘春梅山东中医药大学附属医院（济南２５００１１）下肢深静脉血栓形成（ＬＥＤＶＴ）是临床常见的静脉回流障碍性疾病，由恶性肿瘤诱发的，我院自１９９１年１２月至１９９６年１２月收治８例，分析如下。１临床资料１．１一般资料...     

活血复元汤配合低分子肝素钠预防人工髋关节置换术后下肢深静脉血栓形成

目的：探讨人工髋关节置换术后下肢深静脉血栓（DVT）形成的中西医结合的预防方法。方法：本组112例随机分为2组：预防组52例和对照组60例。预防组联合应用活血复元汤及低分子肝素钠，对照组单纯采用低分子肝素钠进行预防。比较治疗前后两组患者DVT发生率、血液流变学、血浆活化的部分凝血活酶时间（APTT）及血浆凝血酶原时间（PT）等指标变化的差异。结果：①DVT的发生率预防组为3.85％，对照组为8．33％，两者比较无统计学差异（P〉0．05）。②预防组用药后血液流变学各项指标与术后2d比较差异有显著性意义（P〈0．01或P〈0．05），与对照组比较差异亦有显著性意义（P〈0．01或P〈0．05）。③预防组用药后APTT、和PT明显延长，与术后2d比较差异有显著性意义（P〈0．01），与对照组比较差异亦有显著性意义（P〈0．01或P〈0．05）。结论：活血复元汤配合低分子肝素钠可有效预防人工髋关节詈换术后下肢深静脉血栓形成。     

腹腔镜胆囊切除术后深静脉血栓形成17例报道

目的探讨腹腔镜胆囊切除术后静脉血栓形成的原因和治疗方法及其预防。方法回顾性分析我院2001年1月～2005年12月行腹腔镜胆囊切除术后静脉血栓形成17例的临床资料。结果浅静脉血栓14例经溶栓治疗、股深静脉血栓3例经溶栓、取栓术治疗均治愈。行抗凝治疗6个月。随访6～12个月,未见复发。结论腹腔镜胆囊切除术后静脉血栓形成与病人高危因素、CO2气腹、体位、麻醉等因素密切相关。在围手术期应积极采取措施加以治疗和预防。     

下肢骨折术后急性深静脉血栓形成的治疗

目的 探讨下肢骨折及术后急性下肢深静脉血栓形成的治疗效果显著的方法。方法 设通常静脉滴注尿激酶、低分子右旋糖酐加复方丹参注射液１３例为对照组,设经导管静脉内尿激酶溶栓１１例为治疗组,行两组治疗对比。结果 治疗组的治愈率８１．８５％,总有效率１００％;对照组治愈率２３．１％,总有效率６９．２％,两者显著差异（Ｐ〈０．０５）。结论 经导管血管内溶栓方法,用药量少,直接栓内溶栓,加之机械性破坏血栓,溶栓     

妇科肿瘤术后下肢深静脉血栓形成26例护理体会

深静脉血栓(DVT)是外科手术常见的并发症之一.国外报道,外科手术后深静脉血栓发生率30%～50%[1],而在妇科恶性肿瘤或其他妇科疾病手术后的发生率为7%～45%[2].DVT发生的Virehow三要素:活动减少、血流减慢,高凝状态及潜在静脉损伤[3].妇产科手术后的患者几乎完全符合这三要素.由于血栓形成、栓子脱落、并发肺栓塞,直接威胁患者的生命安全,因此,对妇科术后患者DVT的认真观察和精心护理,是临床护理工作中的一个重要方面.笔者对2003年1月至2008年6月我院妇科肿瘤术后并发DVT患者26例,现将临床观察情况及护理体会报告如下.     

Prevention and treatment of deep venous thrombosis

Postoperative venous thromboembolism (VTE) is a common cause of preventable patient morbidity and mortality. Hospitalized patients have multiple risk factors for VTE, which can exert a cumulative effect on the individual patient. Although effective thromboprophylactic measures are currently available, they are not commonly used for a number of reasons, in addition to heightened concern about increasing bleeding risk. Limited data are available characterizing the incidence of symptomatic VTE following major vascular surgery in the absence of thromboprophylactic therapy. Reported rates vary according to the type of surgery, type of prophylaxis used, and diagnostic modalities used for deep venous thrombosis (DVT) and pulmonary embolism (PE). Hospital-acquired DVT in the absence of thromboprophylaxis can occur in up to 40% of patients, occurring primarily in the proximal deep veins, which elevates the risk of PE. Risk factors for VTE in vascular surgery include limb ischemia, prolonged surgery duration, localized intraoperative trauma, and atherosclerosis. Advanced patient age is also a risk factor for VTE; however, the relationship between age and risk of VTE after surgery is complex and dependent on both the type of surgery and the underlying disease process. Evidence-based guidelines for venous thrombo-prophylaxis are now available; however, adoption of and compliance with these guidelines have lagged. Effective thrombo-prophylactic strategies exist and include both pharmacologic and nonpharmacologic approaches. For those surgical patients who develop a VTE, antithrombotic therapy remains the treatment of choice.     

髋部骨折患者术前静脉血栓栓塞症的预防与治疗

目的 分析髋部骨折患者深静脉血栓形成(DVT)的影响因素,探讨髋部骨折患者术前静脉血栓栓塞症的预防与治疗.方法 选取2008年6月至2010年6月间收治的531例髋部单发骨折患者,男242例,女289例;平均年龄59.2岁(28～93岁).股骨颈骨折336例,股骨转子间骨折183例,股骨转子下骨折12例.分析不同骨折类型、D-二聚体浓度、性别、年龄及术前制动时间与DVT发生率的关系.对于出现DVT的患者,给予放置下腔静脉滤器同时行骨折内固定术. 结果所有531例髋部骨折患者中,股骨颈骨折患者中21例发生DVT,股骨转子间骨折患者中34例发生DVT,股骨转子下骨折患者中无一例发生DVT.55例患者DVT均发生于术前,发生率为10.4%(55/531).髋部骨折患者年龄、性别对DVT的发生率无影响,差异无统计学意义(P值分别为0.347、0.376).D-二聚体浓度、骨折类型和术前制动时间对DVT的发生率有影响,差异有统计学意义(P值分别为0.002、0.017、0.037).55例发生DVT的患者均顺利完成手术. 结论对于髋部骨折患者,年龄、性别对DVT的发生不具有临床意义,D-二聚体浓度、骨折类型和术前制动时间对DVT的发生有临床意义.放置下腔静脉滤器可确保骨折内固定手术及术后康复安全顺利进行.     

Prevention of postoperative deep venous thrombosis and pulmonary emboli with combined modalities

Worldwide statistics reveal that 25 to 40 per cent of patients who are over the age of 40 years and operated on for 1 or more hours will develop a deep venous thrombosis (DVT). The studies reviewed in this paper were performed to evaluate several modalities and compare their effectiveness in preventing DVT in postoperative patients. In the first study, five modalities plus a control group were evaluated in 562 patients from five surgical specialties. The incidence of DVT in the control group was 35 per cent. Though most of the pharmacologic agents were effective in reducing the incidence of DVT, the antistasis devices (gradient elastic stockings and intermittent pneumatic compression) were most effective. The purpose of the second study was to evaluate the effectiveness of combining a pharmacologic drug with an antistasis modality. Deep venous thrombosis was virtually eliminated in this group of 328 patients. There was only a 1.5 per cent incidence of DVT in the treated population as compared to a 26.8 per cent incidence in the control group. Thus, it seems that combining one antistasis and one pharmacologic agent greatly reduces the incidence of lower extremity thrombi. I-125 fibrinogen scanning was the most sensitive test in detecting DVT and had an accuracy of 97 per cent.     

骨折术后深静脉血栓的防治

目的 探讨骨折术后合并深静脉血栓的临床特点和防治措施。方法 抗凝治疗下肢深静脉血栓5例。结果 5例经及时诊断和抗凝治疗后均获得好转。结论 深静脉血栓具有隐蔽性临床征象，容易延误早期治疗。对高危患者应重点预防。围手术期采用3种预防方法能够显著减少深静脉血栓的发生率。     

Prevention of postoperative deep venous thrombosis. Low-dose heparin versus graded pressure stockings

In a prospective, controlled clinical study prevention of postoperative deep venous thrombosis by low-dose heparin (Heparin Leo 5 000 I.U. subcutaneously twice daily) was compared with graded compression stockings (TED stockings, Kendall Co.). One hundred and twelve patients, admitted during a period of one year for elective major surgery, were allocated to one of the two treatment groups. In order to detect deep venous thrombosis the 99mTc-plasmin test was performed before the operative procedure and again 5 days later. Ninety-seven patients completed the study (45 patients in the heparin group and 52 patients in the stocking group). Venous thromboembolism was detected in 4 patients (8.9%) in the heparin group and in 3 patients (5.8%) in the stocking group (p greater than 0.05). In 6 patients the plasmin test was positive and one patient in the heparin group died following pulmonary embolism. It is concluded that graded compression stockings can be used as an alternative to low-dose heparin for prophylaxis against deep venous thrombosis in elective general surgery.     

凝血功能监测预防腹部创伤术后深静脉血栓的护理研究

目的探讨在血栓弹力图指导下腹部创伤患者术后深静脉血栓的预防方法,降低其发生率。方法对接受大手术的创伤患者121例,在手术后2h内采用深静脉血栓风险因素评估表和血栓弹力图检测。筛查出高危患者108例,中危患者13例。患者均采取主动和被动物理干预措施,由专人负责监督完成,高危组患者使用下肢压力梯度治疗仪,中危组患者穿弹力袜,且两组患者采取不同的物理运动治疗量,包括踝关节背伸、跖屈活动、双下肢足泵运动,床上活动使用卧床患者功能锻炼器进行活动,同时进行适当的药物干预。结果高危组干预前后患者72h、1周、2周的血栓弹力图参数R值、MA值比较,差异有统计学意义(均P<0.05);中危组患者在干预后2周与干预前比较,差异有统计学意义(P<0.05);干预72h、1周、2周后高凝患者显著减少(均P<0.05);10例患者发生深静脉血栓,发生率为8.26%。结论采用检测血栓弹力图对腹部创伤术后患者筛查具有积极指导作用,采取积极有效的护理和药物干预方法,可有效改善凝血功能和降低术后深静脉血栓的发生。     

全髋关节置换术后深静脉血栓形成

目的：探讨全髋关节置换术后下肢深静脉血栓形成（DVT）的发生情况及预防治疗措施。方法：对220例（244髋）全髋关节置换患者围手术期皮下注射低分子肝素来预防治疗下肢深静脉血栓形成。术后第7天行彩色多普勒超声检查。结果：58例发生下肢深静脉血栓，其中远端血栓33例，近端血栓14例，全静脉血栓11例，DVT发生率26．4％，未发生1例肺栓塞。结论：围手术期低分子肝素应用可降低全髋关节置换术后DVT发生率，且安全可靠。     

Prevention of deep venous thrombosis in ambulatory or discharged orthopaedic patients

In recent years the problem of deep venous thrombosis (DVT) in outpatients and discharged patients has grown into a medical and juridical problem. In traumatology certain recommendations and statistical material exist: similar recommendations were made by the Berufsverband der Ärzte für Orthopädie, Germany, pointing out the lack of sufficient statistical material. With the present study we tried to evalaute the actual management of DVT in discharged patients or outpatients in leading orthopaedic hospitals. The results from December 1993 reveal an inhomogenous procedure which does not precisely follow the above recommendations. However, most orthopaedic surgeons agree that either general or individual means to prevent DVT should be available for ambulatory and discharged patients with plaster immobilisation of the leg according to presently accepted standards, i.e. low-dose heparin or low-molecular-weight heparins. Reduced weight-bearing, in contrast, is considered not to require preventive heparinisation to any great extent.