肠系膜静脉血栓形成

肠系膜静脉血栓形成(Mesenteric Ve-nous Thrombosis MVT)是一种临床罕见的肠系膜血管闭塞性疾病。许多临床医生对其了解甚少,加之本病的临床症状及体征尚无特异性表现,故很难在术前或死前明确诊断,更难做到早期诊断和治疗。由于上述原因,往往延误治疗,造成本病的死亡率过     

肠系膜静脉血栓超声表现1例

患者男 ,35岁。因转移性右下腹痛 2天 ,加重 1天入院。患者 2天前出现上腹部疼痛 ,持续性存在 ,阵发性加重 ,伴发热 ,1天前疼痛转移至右下腹 ,程度加重 ,范围扩大至全腹。查体 :体温 39.2℃ ,腹部膨隆 ,腹肌紧张 ,全腹压痛及反跳痛 ,以右下腹明显 ,肠鸣音消失。实验室检查 :白细胞 18.7× 10 9/L,中性 92 %。腹部 X光片示小肠低位梗阻。临床诊断 :急性阑尾炎穿孔 ,弥漫性腹膜炎 ,麻痹性肠梗阻。术中见阑尾坏疽、穿孔 ,腹腔内见脓液 ,量约 30 0 ml,术后给予抗感染、引流等治疗。第 6天患者排少量果冻样血便 ,左上腹腹胀、腹痛明显 ,大便潜血…     

肠系膜静脉血栓形成的临床观察和护理

目的 探讨肠系膜静脉血栓的临床观察和护理,总结经验。方法 对37例肠系膜静脉血栓形成的诊治和护理进行回顾性分析。结果 经早期诊断和积极的手术和综合治疗,37例病人均治愈出院。结论 临床护理工作者充分认识肠系膜静脉血栓形成患者病情的特点及其变化规律,护理过程中密切观察腹痛的临床表现,早期发现,早期治疗,可以降低该病的病死率和致残率。     

肠系膜静脉血栓形成5例分析

肠系膜静脉血栓形成是临床上十分难诊断的疾病,误诊率极高,常因延误手术时机,造成患者死亡。1980年以来,我们收治5例,现报告如下。1 临床资料1.1 一般资料 5例中男性3例,女性2例;年龄24-78岁。2例发病前有脾切除史,1例有脑梗死病史,3例有高血脂病史,1例患慢性白血病长期口服马利兰治疗。1.2 临床表现 全部病例均以腹痛发病,部位以脐周为主,呈阵发性绞痛或持续性阵发性加剧,伴腹胀,并日见加重。5例均有低热(T<38℃)。有呕吐,3例呕吐物为咖啡样液。少大便,腹部均有压痛,但较轻。后期全部有腹膜刺激征,肠鸣音     

急性肠系膜静脉血栓的治疗

目的 探讨急性肠系膜静脉血栓形成(AMVT)治疗方法的选择.方法 对1990年～2006年收治的18例AMVT患者的临床资料进行回顾性分析.结果 12例患者因出现小肠坏死而接受手术治疗,其中2例为单纯手术治疗,10例为手术加抗凝治疗,6例接受非手术治疗.所有患者均痊愈出院.结论 在未出现肠坏死的情况下,非手术治疗AMVT安全、有效,应为首选;接受手术者,术后抗凝治疗非常重要.     

肠系膜静脉血栓形成8例临床分析

目的 探论肠系膜静脉血栓的诊治方法.方法 回顾性分析北京医院2003～2005年收治的8例肠系膜静脉血栓病例.结果 5例患者康复出院;2例术后短肠综合征,出院后未访;1例术后死亡.结论 腹部手术史(37.5%)和肝硬化(25.0%)是肠系膜静脉血栓的明确诱因;D二聚体(D-dimer)和磁共振成像(MRI)是有效的检查手段;坏死肠段切除术后严格抗凝、祛聚治疗效果满意.     

静脉血栓栓塞症D-二聚体水平诊断决定限的建立

目的建立适用于静脉血栓栓塞症(VTE)的D-二聚体诊断决定限,评价该决定限对VTE的诊断价值。方法 2015年4月至2016年9月牡丹江医学院附属红旗医院符合纳入、排除标准的就诊患者237例及体检健康者236例,定期检测D-二聚体,比较不同年龄及疾病人群D-二聚体水平,用ROC曲线分析不同人群用于VTE诊断的D-二聚体水平决定限。结果≥60岁VTE患者D-二聚体水平决定限为9.69μg/m L,敏感性和特异性分别为82.3%和53.8%,60岁患者D-二聚体水平决定限为3.64μg/m L,敏感性为92.5%,特异性为43.3%。结论建立了适用于VTE诊断的D-二聚体水平的决定限,可进一步提高D-二聚体的诊断效能。     

肠系膜静脉血栓形成误诊7例分析

我院1998-01～2004-10共收治肠系膜静脉血栓形成（MVT）患者7例，现结合有关文献分析如下。     

孕期D-二聚体监测预防孕妇静脉血栓的临床效果

选择于我院妇产科诊治的患者390例。其中双胎妊娠的孕妇20例分为双胎组;单胎孕妇250例分为单胎组;非怀孕的患者120例为对照组。所有患者抽取空腹静脉血,采用免疫比浊法检测血浆D-二聚体水平。采用彩色多普勒超声对所有患者的双下肢静脉进行检查,对有深静脉血栓形成的患者进行症状评分。对比分析三组患者的血浆D-二聚体水平、深静脉血栓(DVT)发生率和症状积分。结果双胎组的血浆D-二聚体水平较单胎组和对照组的高(P0.05);单胎组的血浆D-二聚体水平较对照组的高(P0.05);对照组无1例有DVT形成,而双胎组的DVT发生率为5.0%,比单胎组的1.2%高(P0.05);双胎组的DVT症状积分也比单胎组的高(P0.05)。检测孕妇的血浆D-二聚体水平对于了解其机体凝血功能和纤溶功能有较好反映作用,对于增高幅度大的孕妇可以提示妇产科医师注意做好预防措施,值得在临床合理推广应用。     

D-二聚体测定对下肢深部静脉血栓疾病的临床价值

目的研究D-二聚体测定对下肢深部静脉血栓疾病的诊断价值及疗效监测效能。方法选取2012年1月至2013年12月贵州航天医院下肢深部静脉血栓住院患者81例,作为实验组;健康体检人群50例作为对照组,分别在实验组治疗前、治疗后1、3、5、7、14及20d空腹采集上述人群枸橼酸钠抗凝血1.8mL,运用法国MINI-VIDAS全自动免疫荧光分析仪测定其血浆D-二聚体浓度,并对两组数据进行比较,以确定血浆D-二聚体含量对下肢深部静脉栓塞疾病的诊断价值及疗效判断效能。结果81例下肢深部静脉栓塞患者治疗前D-二聚体水平均值为(1 450±136)μg/L,对照组D-二聚体含量均值为(168±10.4)μg/L,两者比较,差异有统计学意义(P0.05),溶栓治疗后D-二聚体水平显著上升,峰值出现时间平均为3d;治疗7d后D-二聚体水平维持相对稳定的高水平,14d后降至溶栓前状态,20d后回归正常范围。结论 D-二聚体对下肢深部静脉血栓疾病有较高诊断效能,动态观测患者D-二聚体水平,可以作为患者溶栓治疗的疗效评价及判断预后的有效指标。     

建立新西兰白兔深静脉血栓模型的实验研究

目的探索兔深静脉血栓的建模方法。方法采用暂时阻断血流、损伤血管内皮、注入凝血酶及术后肢体固定的方法制作动物模型。于造模后48h进行彩色多普勒超声及病理检测。结果 8只兔均存活,彩色多普勒超声检查示双侧股静脉管腔均为无回声;探头加压,实验侧股静脉不能被压瘪,对照侧可被压瘪;实验侧静脉管腔内无血流及频谱信号,对照侧可见充盈管腔的血流信号及随呼吸变化的血流频谱;病理检测示实验侧股静脉可见血栓充满管腔,且与管壁无粘连,对侧股静脉没有血栓形成。结论建立了兔深静脉血栓动物模型。     

深静脉血栓形成患者个案管理模式的建立与实践

目的 建立并实践院内发生深静脉血栓形成患者的个案管理模式。方法 选拔并培训深静脉血栓个案管理师,成立个案管理多学科团队,建立院内发生深静脉血栓形成上报流程,制定入案标准并筛选个案管理对象,编制深静脉血栓健康指导手册及个案管理档案,以及实施院内发生深静脉血栓形成患者的个案管理流程。结果 2019年1—6月顺利结案20例,均未出现深静脉血栓形成相关的临床症状,19例患者抗凝治疗依从性好,1例鼻腔出血,经个案管理师指导,复查凝血指标,与多学科团队沟通,减少了抗凝药物剂量,避免了严重出血事件的发生。持续随访率为100%。结论 通过探索并实施院内发生深静脉血栓形成患者的个案管理模式,可确保为患者提供科学、精准、专业化的护理服务,加强患者的自我管理,促使静脉血栓护理专科向前发展。     

肠系膜上静脉血栓形成:切勿贻误诊治时机

目的探讨肠系膜上静脉血栓形成(superior mesenteric venous thrombosis,SMVT)的早期诊断方法及最佳诊治时机和策略。方法回顾分析我院2010年3月—2013年10月收治的42例SMVT的临床资料,按病程分为急性组19例和慢性组23例,分析两组临床表现、诊治经过及治疗效果。结果 42例均以腹痛为主要表现,急性组表现为上腹部、脐周及全腹部绞痛或胀痛,慢性组表现为腹部及脐周胀痛,且急性组血白细胞、体温显著高于慢性组(P均0.001)。两组均经计算机断层X线血管造影(CTA)检查确诊,根据病情分别行小肠切除术、经肠系膜上动脉置管溶栓术及药物抗凝治疗等,急性组治疗有效率为94.8%,病死率为5.2%,慢性组治疗有效率为95.7%,病死率为4.3%。结论 CTA是确诊SMVT的首选手段,并能明确剖腹探查术的适应证。通过有效措施促进侧支循环建立,防止远期血栓复发及门静脉高压相关并发症,是SMVT的主要治疗策略。     

Deep Venous Thrombosis

This article will review the acute and chronic complications of deep venous thrombosis (DVT) for radiology nurses. DVT is one of the most common causes of in-hospital morbidity. In its acute form, it can lead to development of pulmonary embolism, which can be life threatening. In its chronic form, DVT may progress to postthrombotic syndrome. This review includes a brief overview of modalities used for DVT prevention and treatment. It outlines the importance of understanding the anatomic location of DVT as patients with iliofemoral DVTs have a better prognosis if treated with aggressive interventional or surgical treatment modalities.     

超声显象诊断下肢急性深静脉血栓形成

用超声静脉显象检查连续308临床怀疑下肢急性深静脉血栓形成（DVT）的患者，282例（91．6％）作出明确诊断，其中97例（34．4％），为DVT。97例DVT患者，19例（19．6％）血栓累及双侧下肢，43例（44．3％）血栓局限于远端静脉，超声检查由5名血管专科医师施行。     

Validation of the Canadian Clinical Probability Model for Acute Venous Thrombosis

OBJECTIVE: To validate the predictive value of the Canadian clinical probability model for acute venous thrombosis, which, to the best of the authors' knowledge, has not been done in emergency department (ED) settings outside of Canada. METHODS: Demographic and clinical information, rapid D-dimer testing, and venous ultrasound imaging were obtained among patients presenting with clinically suspected venous thrombosis at a university-affiliated ED. A diagnosis of deep venous thrombosis (DVT) was made based on venous ultrasound test results or objectively documented venous thromboembolism during a 12-week follow-up period. The probability of venous thrombosis was calculated using the Canadian clinical probability model. RESULTS: Among 102 patients, 17 (17%) were diagnosed as having venous thrombosis initially or during the three-month follow-up period. The frequency of venous thrombosis among patients categorized as having high probability was 10 of 17 [59%, 95% confidence interval (95% CI) = 35% to 82%], 6 of 44 (14%, 95% CI = 4% to 24%) with intermediate probability, and 1 of 41 (2%, 95% CI = 0.1% to 11%) with low probability. This compares with respective values of 49%, 14%, and 3%, reported by Canadian researchers in an ED study. Forty-one of 102 (40%) patients had an alternate diagnosis as likely or more likely than venous thrombosis, but only three (7%, 95% CI = 2% to 18%) of these had venous thrombosis. CONCLUSIONS: Use of the Canadian probability model for DVT in this ED resulted in effective risk stratification, comparable to previously published results.     

肠系膜上静脉-门静脉血栓形成患者介入溶栓治疗的护理

总结25例经桡动脉行肠系膜上动脉置管,持续溶栓治疗肠系膜上静脉-门静脉血栓形成患者的护理.术前准确评估患者的心理状况及症状、体征,尤其是各项凝血指标、腹痛程度及肠鸣音次数;术中注意预防桡动脉穿刺点出血和桡动脉痉挛;术后留置导管期间做好导管和鞘管的固定、冲洗以及APTT监测和腹部症状体征的观察,防止出血等并发症发生.本组24例患者成功进行溶栓治疗,1例出现肠坏死转外科手术治疗后康复出院.     

实验性兔膝骨关节炎模型的建立

目的为兔膝骨关节炎的研究提供实验性的动物模型。方法36只体重2—3kg的日本大耳兔,分别通过前交叉韧带切断（ACLT法）与制动法制模,分别于4周、8周观察软骨退变情况及病理变化,并检测关节液白介素一1的含量,比较ACLT模型与制动法在不同造模时间关节损害的差异。结果ACLT法模型建立时间较短,4周即可达到制动8周的病理表现。结论与制动法比较,ACLT法更适合进行兔膝骨性关节炎实验。     

Cerebral Venous Thrombosis in Spontaneous Intracranial Hypotension

Background and Objective.— The occurrence of cerebral venous thrombosis has been reported among patients with spontaneous intracranial hypotension, but a causal relationship has not been clearly established. We reviewed our experience with spontaneous intracranial hypotension and cerebral venous thrombosis and we reviewed the relevant literature to evaluate the relationship between these 2 entities. Methods.— We reviewed the medical records and imaging studies of a consecutive group of patients with spontaneous intracranial hypotension evaluated at a tertiary care center between 1/1/2001 and 12/31/2007. The main search strategy was a systemic review of journal articles in MEDLINE (1966 to January 2008). Results.— Among 141 patients with spontaneous intracranial hypotension, 3 (2.1%) were also diagnosed with cerebral venous thrombosis. Among these 3 patients and the 17 reported in the literature there were 11 men and 9 women with a mean age of 39.5 years. Radiographic or clinical evidence for spontaneous intracranial hypotension preceding cerebral venous thrombosis was found in most patients, while there was no evidence for cerebral venous thrombosis preceding spontaneous intracranial hypotension in any patient. Eight (40%) of the 20 patients were found to have a change in their headache pattern believed to be due to the development of cerebral venous thrombosis. Complications of cerebral venous thrombosis, eg, cerebral venous infarction, occurred in 8 patients (40%). Conclusions.— Spontaneous intracranial hypotension is a risk factor for cerebral venous thrombosis, but cerebral venous thrombosis is found in only about 2% of patients with spontaneous intracranial hypotension. A change in headache pattern is not a reliable predictor of the development of cerebral venous thrombosis in patients with spontaneous intracranial hypotension.