应用放射性核素显像对下肢深静脉病变和肺血栓栓塞症的临床观察

目的　探讨下肢深静脉血栓形成与肺动脉血栓栓塞症之间的关系。方法　病例选择为1997年 9月～ 2 0 0 1年 5月临床诊断高度怀疑肺动脉血栓栓塞症患者 140例 (男 79例 ,女 6 1例 ) ,平均年龄为 39± 18岁。所有患者均行肺灌注、肺通气显像及下肢深静脉显像。其中 2 6例患者同时进行肺动脉造影 ,11例行X线下肢静脉造影检查 ,36例行下肢血管超声检查 ,18例行下肢容积血流阻抗图检查。结果　 140例肺血栓栓塞患者中有下肢静脉病变者为 12 0例 ,占 85 7%。近端病变 113例(80 0 % )。下肢深静脉显像与X线下肢静脉造影、下肢容积阻抗图及下肢血管超声检查符合率分别为 90 9% ,72 2 % ,80 0 %。结论　研究证实下肢静脉病变和血栓形成是肺动脉血栓栓塞症的主要致病因素 ,栓子主要来源于近端静脉血栓。放射性核素肺灌注 /肺通气、下肢静脉显像是诊断肺血栓栓塞症和下肢深静脉病变的有效方法。     

肺血栓栓塞症危险因素及Caprini血栓风险评估量表的应用价值分析

目的分析肺血栓栓塞症(PTE)患者危险因素及Caprini血栓风险评估量表的应用价值。方法选取2006年1月—2016年1月广西医科大学第一附属医院收治的PTE患者585例,通过住院患者电子病案系统收集相关信息,分析PTE常见危险因素,并采用Caprini血栓风险评估量表(中文版)评估PTE危险分层。结果 585例患者中伴深静脉血栓形成者266例(占45.5%)、伴恶性肿瘤者149例(占25.5%)、卧床时间>3 d者123例(占21.0%)、近期有手术史者67例(占11.5%)、伴心脏病者61例(占10.4%)、体质指数>25 kg/m^2者52例(占8.9%)、伴骨折或创伤者43例(占7.4%)、伴脑卒中者38例(占6.5%)、伴慢性肺部疾病者36例(占6.2%)、伴肾病综合征者24例(占4.1%)、伴心房颤动者22例(占3.8%)、伴结缔组织疾病者17例(占2.9%)、伴静脉曲张者9例(占1.5%)、妊娠期或产后7例(占1.2%)。合并≥2个危险因素者473例(占80.9%),合并1个危险因素者88例(占15.0%),未合并危险因素者24例(占4.1%)。Caprini血栓风险评估量表评估的PTE危险分层:低危56例(占9.6%),中危64例(占10.9%),高危206例(占35.2%),极高危259例(占44.3%)。结论 PTE主要危险因素包括深静脉血栓形成、恶性肿瘤、卧床时间>3 d、近期手术、心脏病;Caprini血栓风险评估量表可用于PTE的风险评估。     

下肢深静脉血栓临床危险因素分析

目的分析下肢深静脉血栓(DVT)的诱因,做好早期预防DVT并积极诊治。方法对我院2016年收治的深静脉血栓患者91例进行回顾性分析,分析深静脉血栓的危险因素。所有患者均经下肢血管彩超和实验室检查确诊。结果本组患者年龄分布在19~88岁,平均年龄(61.1±15.4)岁,DVT发生年龄多在40~80岁。患者有明显病因的61例(67%)。病因主要包括外伤、外科手术、久坐、肿瘤等。结论 DVT的发病因素大部分为获得性因素,获得性因素可预防,早期预防科降低深静脉血栓的发病率,因此早期辨识危险因素和预防是防止DVT形成的关键。     

诊断和鉴别诊断

一、诊断下肢深静脉血栓形成可根据详细询问病史,认真体检,结合有关辅助检查,以及深静脉造影作出明确判断。虽然根据询问病史,了解发病诱因和临床表现,可以作出下肢深静脉血栓形成的诊断,但必须强调下肢深静脉顺行和逆行造影对诊断和鉴别     

126例肺血栓栓塞的临床诊治分析

目的探讨肺血栓栓塞的危险因素、临床表现、诊断及治疗。方法回顾性分析中山大学附属第一医院2009年1月至2012年9月收治的126例肺血栓栓塞患者的临床资料。结果 126例肺血栓栓塞患者中,治愈13例,好转103例,死亡5例,放弃治疗5例。结论肺血栓栓塞患者临床表现缺乏特异性,临床不排除肺血栓栓塞时,应结合D-二聚体、心电图、心脏彩超、下肢静脉彩超、CT肺动脉造影(CTPA)等检查,明确诊断,尽早给予溶栓或抗凝治疗。     

下肢深静脉血栓形成后发生肺栓塞的危险因素分析

目的探讨下肢深静脉血栓形成后发生肺栓塞的危险因素。方法本研究采用回顾性研究方法,收集2016年1月至2018年1月就诊安徽医科大学第二附属医院确诊为下肢深静脉血栓患者的资料,其中符合纳入标准的共有142例患者,采用Logistic回归分析探寻下肢深静脉形成后发生肺栓塞的危险因素。结果 142例下肢深静脉血栓形成患者,其中有56例发生肺栓塞,通过统计分析发现:合并存在外伤手术史(OR=4.36,95%CI 1.38-13.82,P=0.01);冠心病(OR=17.41,95%CI 3.49-86.90,P0.01);高血压(OR=26.69,95%CI 6.68-106.62,P0.01);心脏瓣膜病(OR=4.00,95%CI 1.01-15.83,P=0.04);慢性肺部疾病(OR=2.57,95%CI 0.51-12.92,P=0.03);恶性肿瘤病史(OR=7.38,95%CI 0.90-60.22,P=0.04);D-D(OR=1.10,95%CI 0.99-1.11,P=0.02)与下肢深静脉血栓形成患者发生肺栓塞密切相关,通过t检验,发现Wells评分(t=-10.84,P0.01)升高会增加发生肺栓塞的风险。结论下肢深静脉血栓形成的患者合并外伤手术史、慢性心血管疾病(包括冠心病、高血压、心脏瓣膜病)、慢性肺部疾病、恶性肿瘤病史是发生肺栓塞的高危因素;D-D、Wells评分升高是会增加肺栓塞的风险。     

深静脉血栓复发危险因素分析

目的探讨深静脉血栓复发的相关的危险因素。方法通过空军总医院病案检索系统纳入2010年1月-2013年1月期间住院治疗并确诊为深静脉血栓形成(DVT)患者170例,采集患者的性别、年龄、合并疾病及复发情况等相关数据,建立数据库。对引起DVT复发可能的危险因素进行赋值,采用二分类Logistic回归分析判断DVT复发危险因素。结果 170例DVT患者中深静脉血栓复发率为52.9%。合并恶性肿瘤患者复发率为67.2%;合并肾病综合征或终末期肾病患者复发率为95.7%;合并1种及1种以上疾病患者复发率为76.5%;使用下腔静脉滤器患者复发率为25.0%;深静脉血管创伤性操作患者复发率为80.5%;骨科手术患者复发率为12.5%;肿瘤手术患者复发率为76.0%。合并肿瘤(OR=11.710,95%CI:2.302~59.553)、肾病综合征或终末期肾病(OR=73.188,95%CI:2.969~1803.904)、合并1种及1种以上疾病(OR=58.338,95%CI:11.519~295.458)是深静脉血栓复发的独立危险因素。结论深静脉血栓形成患者合并肿瘤、肾病综合征或终末期肾病及合并1种或1种以上疾病时要注意深静脉血栓复发的预防。     

疑诊肺栓塞患者337例中合并下肢深静脉血栓的发生率

目的 评价疑诊肺栓塞患者中合并下肢深静脉血栓的发生率.方法 顺序收集2004年1月至2006年6月在北京首都医科大学附属朝阳医院和宁夏医学院附属医院内疑诊肺栓塞的患者,进行CT肺动脉造影(CTPA)联合下肢CT静脉造影检查(CTV)或CTPA联合下肢静脉超声检查.分析肺栓塞患者中合并下肢深静脉血栓的发生率以及下肢深静脉血栓的发生部位有无不同.采用SPSS 11.5统计软件进行数据分析,描述性结果采用频数分析法,组间比较采用卡方检验.结果 共337例患者纳入研究,男189例,女148例,中位年龄62岁,范围19～84岁.CTPA诊断肺栓塞者144例,CTV和下肢超声检查诊断下肢深静脉血栓患者100例.肺栓塞患者合并下肢深静脉血栓的发生率为44%(63/144),其中76%(48/63)发生于近端深静脉内;而下肢深静脉血栓形成患者中合并肺栓塞的发生率为63%(63/100).结论 无论肺栓塞患者合并下肢深静脉血栓,还是下肢深静脉血栓患者合并肺栓塞的发生率均很高,有必要同时进行肺动脉和下肢深静脉检查.     

急性肺栓塞合并深静脉血栓患者不同治疗方案临床分析

目的 通过分析急性中危肺血栓栓塞症合并下肢深静脉血栓形成患者的临床资料,分析不同治疗方案的治疗效果,探讨对该类人群合理的治疗方案.方法 采用回顾性研究方法,收集2006年1月至2011年5月于我院连续收治、临床疑诊肺栓塞并经CT肺动脉造影及心脏彩超、下肢血管超声或CT血管造影确诊为急性中危肺栓塞合并下肢深静脉血栓患者的临床资科.根据治疗方案的不同分为单纯抗凝组和溶栓联合抗凝组.结果 73例急性中危肺栓塞合并下肢深静脉血栓患者最主要的危险因素是外伤手术(50.7％),其次是下肢静脉曲张(35.6％);最常见的临床表现是呼吸困难(95.9％),最常见的体征是双下肢不对称肿胀(79.5％);治疗前两组患者年龄、性别及临床表现分布差异无统计学意义(P＞0.05);两组D-二聚体及心超估测肺动脉收缩压(PASP)明显升高,动脉血氧分压(PaO2)明显下降(P＜0.05),但两组之间指标差异无统计学意义(P＞0.05);治疗后两组D-二聚体及PaO2较治疗前均有明显改善,但溶栓联合抗凝组PASP明显低于单纯抗凝组(P＜0.05).所有患者治疗后未出现重要部位出血.结论 溶栓联合抗凝治疗能够明显改善患者肺动脉收缩压,进而改善患者右心功能和临床症状,疗效显著优于单纯抗凝治疗.     

妊娠合并Ⅱ型糖尿病与下肢深静脉血栓的关系

目的：研究妊娠合并Ⅱ型糖尿病患下肢深静脉血栓(DVT)的发病率及原因。方法：随机选择1998年1月至2003年1月在本院治疗的100例妊娠合并Ⅱ型糖尿病患为研究对象。患入院后3～13d内行双下肢深静脉顺行造影检查，分析其下肢深静脉发生血栓的原因及发病率。结果：本组病人中，下肢深静脉血栓的发生率为18％，未见症状性肺栓塞。年龄的增加，危险因素数量的增多，卧床时间长，血小板增多，血栓疾病多等是下肢DVT的主要危险因素。结论：对妊娠合并Ⅱ型糖尿病患，尤其是有潜在高凝因素的孕妇，要高度警惕下肢深静血栓的形成。     

静脉吸毒的艾滋病病人下肢血管病变彩色多普勒超声检查的表现

目的探讨静脉吸毒的艾滋病(Acquired immunodeficiency syndrome,AIDS)病人下肢血管彩色多普勒超声检查的表现及图像特征,重点分析形成下肢深静脉血栓的原因。方法对65例静脉吸毒AIDS病人下肢血管的二维及彩色多普勒(Color doppler flow imaging,CDFI)图像特征进行分析与总结。所有病例均行磁共振(Magneto-impurity resonance,MIR)及X线静脉造影检查证实。结果发现股动脉硬化斑块28例,下肢静脉血栓形成51例;患肢左侧多于右侧。结论对静脉吸毒的AIDS病人下肢血管彩超检查,可发现下肢动脉及相伴静脉的病变部位及病变类型,对AIDS病人下肢血管病变的诊断具有可靠的参考价值。     

Superficial venous thrombosis of the lower limbs: prospective analysis in 100 patients

OBJECTIVES: Our objectives were first to estimate the potential gravity of superficial venous thrombosis (SVT) of the lower limbs by determining the frequency of associated deep venous thrombosis (DVT), pulmonary embolism (PE) and extensions of the junction or a perforating vein and second to identify factors of risk (neoplasia, thrombophilia, connective tissue disease, thromboembolic events). METHOD: We conducted a prospective study in 100 cases of SVT in 88 patients with varicose veins (VV) and 12 patients without varicose veins (NVV). RESULTS: Superficial venous thrombosis was identified in 32 cases (32%): muscle vein in 23 (gastrocnemius, solesu), popliteo-femoro-iliac system in 5, and posterior tibial or fibular vein in 4. In 17 cases (17) the SVT extended to deep veins at distant localizations in 15 (15%). Pulmonary embolism was suspected clinically in 10 cases (10%) and confirmed in 3 (3%). An extension to the saphenous junction was observed in 17 cases (17%) and the thrombus migrated into a deep vein in 7. There were 6 cases of a unique extension to a perforating vein. Search for etiology was conducted in 86 cases: 64 were negative (74.4%), there was a neoplasia context in 5 (6%) and a hemostasis disorder in 17 (19.8%) including 6/12 (50%) in the NVV group and 11/74 (15%) in the VV group. CONCLUSION: Superficial venous thrombosis is often considered to be benign although severe situations can occur in patients with a hemostatis disorder. Consideration of these different factors (risk factors, presence of a deep venous thrombus or pulmonary embolism) should be helpful in determining the etiology and for a better choice of a therapeutic option (medical/surgical) depending on the different subpopulations identified.     

山东地区剖宫产术后肺栓塞的危险因素分析

目的探讨山东地区剖宫产术后肺栓塞的危险因素。方法选取在我院行剖宫产术的560患者资料进行分析,对其肺栓塞进行危险因素分析。结果高龄产妇(>35岁)、有多种合并症(≥2种)、手术时间长(>1.5 h)、卧床制动、孕周长(>40周)、激动、输血过度,下肢深静脉血栓形成、未使用活血抗凝药物肥胖是剖宫产术后肺栓塞的危险因素(P<0.05),而与产次数、血型、麻醉方式、焦虑、紧张、恐惧、下地时间无关(P>0.05);其中,下肢深静脉血栓形成、卧床制动、输血情况、使用活血抗凝药物是肺栓塞的高危险因素。结论剖宫产术后肺栓塞的危险因素有下肢深静脉血栓形成、卧床制动。     

Risk factors of thrombosis in abdominal veins

AIM： To estimate the prevalence of inherited and acquired thrombophilic risk factors in patients with abdominal venous thrombosis and to compare the risk factor profiles between Budd-Chiari syndromes （BCS） and splanchnic vein thrombosis （SVT）.
METHODS： In this retrospective study, 36 patients with abdominal venous thrombosis were studied. The patients were divided into Budd-Chiari group （hepatic vein, IVC thrombosis） and splanchnic venous thrombosis group （portal, splenic, superior mesenteric veins） based on the veins involved. Hereditary and acquired thrombophilic risk factors were evaluated in all patients.
RESULTS： Twenty patients had SVT, 14 had BCS, and 2 had mixed venous thrombosis. Ten patients （28%） had hereditary and 10 patients （28%） acquired thrombophilic risk factors. The acquired risk factors were significantly more common in the SVT group （SVT vs BCS： 45% vs 7%, χ^2= 5.7, P = 0.02） while hereditary risk factors did not show significant differences between the two groups （SVT vs BCS： 25% vs 36%, χ^2 = 0.46, P = 0.7）. Multiple risk factors were present in one （7%） patient with BCS and in 3 patients （15%） with SVT. No risk factors were identified in 57% of patients with BCS and in 45% of patients with SVT.
CONCLUSION： Hereditary and acquired risk factors play an important role in the etiopathogenesis of abdominal venous thrombosis. Acquired risk factors are significantly more common in SVT patients while hereditary factors are similar in both groups.     

Splanchnic vein thrombosis in candidates for liver transplantation: usefulness of screening and anticoagulation

BACKGROUND AND AIMS: Splanchnic vein thrombosis is a significant source of complications in candidates for liver transplantation. The aims of this study were: (a) to determine the prevalence of and risk factors for splanchnic vein thrombosis in cirrhotic patients awaiting transplantation and (b) to assess the usefulness of anticoagulation. METHODS: A total of 251 cirrhotic patients listed for transplantation were analysed. All underwent systematic screening for thrombosis with Doppler ultrasonography. During the second period of the study, all patients with thrombosis received anticoagulation up to transplantation while during the first period none had received anticoagulation. RESULTS: The incidence of splanchnic vein thrombosis at evaluation was 8.4%. Seventeen additional patients (7.4%) developed de novo thrombosis after evaluation. Independent risk factors for thrombosis were low platelet count (77.4 (36.3) v 111.6 (69.2) 10(9)/l; p = 0.001), a past history of variceal bleeding (47.4% v 29.1%; p = 0.003), and a prolonged interval from listing to transplantation (8.5 (6.8) v 4.8 (4.4) months; p = 0.002). The proportion of partial or complete recanalisation was significantly higher in those who received (8/19) than in those who did not receive (0/10, p = 0.002) anticoagulation. Survival was significantly lower in those who had complete portal vein thrombosis at the time of surgery (p = 0.04). CONCLUSION: These results support a systematic screening for splanchnic vein thrombosis in patients awaiting transplantation. They suggest that in these patients, anticoagulation is safe and has a significant impact on recanalisation as well as prevention of extension of thrombosis.     

基于Caprini模型风险评估的个体化DVT干预对重症心肌梗死患者深静脉血栓的发生率及凝血功能的影响

摘要：目的 考察基于Caprini模型风险评估的个体化DVT干预对重症心肌梗死患者深静脉血栓的发生率及凝血功能的影响。方法 于2019年1月至2019年12月期间收治的118例重症心肌梗死患者作为研究对象,按照随机数字表法分为对照组和观察组,各59例。对照组采用常规干预,观察组患者在对照组患者的基础上采用基于Caprini模型风险评估的个体化DVT干预。干预前及干预1个月后测量两组患者的血流动力学指标,髂静脉、股静脉、腘静脉的血流速度（Q）和血流量（V）,以及凝血功能指标,凝血酶时间（APTT）、凝血酶原时间（PT）,凝血酶时间（TT）、纤维蛋白原（FIB）,干预期间记录两组患者的下肢深静脉血栓（DVT）、肢体疼痛、肢体肿胀及主要不良心血管事件（MACE）发生率,记录两组患者全球急性冠状动脉事件注册评分（GRACE）,并考察各危险等级与DVT发生率的关系。结果 干预1个月后,观察组患者髂静脉、股静脉和腘静脉的左、右侧Q和V均有显著升高（P<0.05）,对照组各项指标显著下降（P<0.05）;观察组患者的APTT、PT、TT水平明显高于对照组（P<0.05）,FIB水平更低（P<0.05）;观察组患者DVT、肢体疼痛、肢体肿胀和MACE的发生率分别为1.69%、3.39%,、1.69%、6.78%,显著低于对照组患者（P<0.05）,对照组分别为11.86%、10.17%、10.17%、23.73%,差异具有统计学意义（P<0.05）;干预后,观察组的GRACE评分明显低于对照组患者（P<0.05）,GRACE评分危险等级和DVT发生风险呈正相关（r=0.06,P<0.01）。结论 采用基于Caprini模型风险评估的个体化DVT干预能显著预防患者DVT的发生,改善不良预后,提高凝血功能,促进血运,该种护理策略具有重要临床应用价值。     

脑梗死合并下肢深静脉血栓形成的病因探讨

目的探讨脑梗死合并下肢深静脉血栓形成(LDVT)的主要发病原因。方法分析50例脑梗死合并LDVT患者(脑梗死合并LDVT组)的临床特点及血液凝血、抗凝和纤溶系统分子标记物指标的变化,另选50例健康体检者为对照组。结果50例脑梗死合并LDVT组患者中,卧床2~4周的发病率最高;伴发疾病中以高血压、血脂异常最常见;与对照组比较,脑梗死合并LDVT组患者的血管性血友病因子、血小板表面α颗粒膜蛋白、凝血酶原片断1+2含量、纤溶酶原激活物抑制剂-1活性均明显升高,而抗凝血酶活性、总蛋白S含量、蛋白C活性、纤溶酶原活性均明显降低,差异有显著性意义。结论长期卧床及血液的高凝状态是LDVT发生的主要原因。     

Progress of local symptoms of superficial vein thrombosis vs. duplex findings

BACKGROUND: Risk of subsequent deep vein thrombosis (DVT) following superficial vein thrombosis (SVT) is not fully appreciated. Mechanisms, time relations and risk factors for DVT arising upon earlier SVT remain unclear. The aim of this study was to analyze time relations between local symptoms of lower limb superficial vein thrombosis, duplex findings and onset of deep vein thrombosis during clinically evident course of SVT. PATIENTS AND METHODS: 46 patients with early (onset less than 72 hours prior to inclusion) clinical diagnosis of SVT, confirmed ultrasonographically were included in this prospective, multicenter study. Progress of pain, erythema and swelling in relation to subsequent ultrasound changes in size and localization of thrombus at 0, 7, 14 and 21 day of study has been recorded. RESULTS: Local symptoms subsided completely during 3 weeks. At that time thrombus disappeared completely only in 26% of cases, in remaining cases decreased in size from average 117.5 mm to 43.0 mm. Thrombus regression was similar to venous blood outflow direction--proximal to femoral area. Thrombus propagation was observed following regression of local symptoms of SVT. 4 cases of DVT (8.7%) were diagnosed at 2-11 days. CONCLUSIONS: Local, clinically detectable symptoms of SVT regress incomparably quicker than thrombus in affected veins. Risk of further thrombus propagation extends well beyond the period of intensive local symptoms of SVT. Regression of thrombus in femoral area requires significantly more time than in popliteal or calf segment. Thrombus propagation is directed with blood flow towards femoral segment.     

Thromboprophylaxis in patients with lower limb immobilisation – review of current status

The risk for venous thromboembolism (VTE) associated with lower limb immobilisation is unclear, owing to of a lack of evidence from studies in this patient group. However, six small, randomised control trials (RCTs), totalling 1536 patients, compared low molecular weight heparin (LMWH) with controls and showed a significant reduction in asymptomatic deep vein thrombosis (DVT) from 17·1% to 9·8%, with very low bleeding rates. This is likely to be an underestimate of the real risk reduction as most trials excluded high-risk patients from randomisation. There have been no other controlled trials in cast-immobilised patients using alternative prophylactic measures. Together with the RCTs, other cohort studies have identified risk factors that increase the risk for VTE in lower limb immobilisation. In summary, patients in lower limb cast (or brace) immobilisation should be risk assessed and those deemed high risk for VTE should receive prophylactic LMWH for at least the duration of cast immobilisation.