下肢深静脉血栓形成并发肺动脉栓塞的策略探讨(1)
摘要：目的 探讨下肢深静脉血栓形成(DVT)并发肺动脉栓塞(PE)的诊断及治疗方法。方法 回顾性分析我院血管外科2014.01～2015.12诊治的189例下肢DVT患者，其中并发PE患者80例的临床资料。单纯抗凝治疗12例(A组)，下腔静脉滤器(VCF)+抗凝治疗40例(B组)，抗凝+VCF+导管溶栓(CDT)治疗28例(C组)，并对以上患者进行跟踪性随访3～12个月。结果 右下肢DVT患者并发PE的发生率为82.3%，高于左下肢的31.2%。在治疗方面，A组4位患者再发PE，B组4位患者再发PE，C组无再发PE；导管溶栓治疗前患、健侧大、小腿周径差分别为为(4.26±2.75)cm、(3.22±1.63)cm，导管溶栓治疗后患、健侧大小腿周径差分别为(1.0±0.90)cm、(0.90±0.80)cm。结论 右下肢DVT栓子脱落导致PE的发生率较左下肢高；下腔静脉滤器(VCF)+导管溶栓(CDT)能有效降低PE的复发率，并能有效改善DVT患者症状。
关键词：下肢深静脉血栓形成；肺栓塞；下腔静脉滤器；导管溶栓
, http://www.100md.com
Abstract：Objective To evaluate the diagnosis and treatment in deep vein thrombosis of lower limb complicating pulmonary embolism. Methods To analyze the clinical data of 189 cases of DVT complicating with 80 cases of PE being treated in vascular surgery of our hospital from January of 2014 to December of 2015. Only anticoagulation treatment 12 cases (group A)， Inferior vena cava filter (VCF) + anticoagulant treatment for 40 cases(group B)， Anticoagulation + VCF + catheter-directed thrombolysis (CDT) treatment of 28 cases (group C)， and traceability of follow-up in patients with more than 3 to 12 months. Results Right lower limb DVT patients complicated with the incidence of PE was 82.3%， higher than that of the left leg(31.2)%. In the treatment of PE， group A four patients with recurrence of PE， group B four patients with recurrence of PE， No recurrence of PE group C；Before catheter thrombolysis treatment， the affected side and healthy side of the thigh and calf circumferences were (4.26±4.26) cm and (3.22±1.63) cm，the affected side and healthy side of the thigh and calf circumferences were (1.0±0.90) cm， and (0.90±0.80) cm after catheter thrombolysis treatment. Conclusion Lower extremity DVT embolic loss leads to a high incidence of PE， especially those with right lower limb； Inferior vena cava filter (VCF) + catheter thrombolysis (CDT) can effectively reduce the recurrence rate of PE， and can effectively improve the symptoms of DVT patients.
, http://www.100md.com
Key words：Deep vein thrombosis； Pulmonary embolism； Inferior vena cava filter； Catheter-directed thrombolysis
肺栓塞(PE)是一种严重危害患者生命的一组疾病或临床综合症的总称，主要发病原因是肺动脉或其分支被各种栓子阻塞，作为DVT的一个严重并发症，主要是由深静脉血栓脱落导致[1]。PE发病率较高，美国每年有60万人发生PE[2]，在我国PE发病率为0.1%，虽低于西方国家，但也呈逐年上升趋势[3]，而且易发生漏诊和误诊。一项国外研究显示PE死亡率占住院总死亡人数的1%[4]。经过诊治的PE患者死亡率可以降至10%以下，未经治疗的PE患者死亡率高达25%～30%[5]。
1资料与方法
1.1一般資料 本组189例下肢DVT患者，合并PE80例，双下肢DVT14例合并PE8例，左下肢DVT141例合并PE44例，右下肢DVT34例合并PE28例。DVT患者表现为患肢肿胀、发热、疼痛、浅表静脉曲张，以及"股青肿"等症状，部分患者出现下肢活动障碍。PE患者的临床症状不典型，主要表现为咳嗽15例、呼吸困难23例、胸前区疼痛12例、咯血4例， "肺梗死三联征" 2例，无任何症状24例。全组下肢DVT病例经下肢深静脉彩色多普勒超声或深静脉造影明确诊断，PE病例经CTPA明确诊断。病程5 h～100 d，平均8.31 d。80例PE患者，单纯抗凝12例(A组)，VCF+抗凝治疗40例(B组)，抗凝+VCF+CDT治疗28例(C组)。, http://www.100md.com(余浩 万圣云 孔令尚 程云生)
关键词：下肢深静脉血栓形成；肺栓塞；下腔静脉滤器；导管溶栓
, http://www.100md.com
Abstract：Objective To evaluate the diagnosis and treatment in deep vein thrombosis of lower limb complicating pulmonary embolism. Methods To analyze the clinical data of 189 cases of DVT complicating with 80 cases of PE being treated in vascular surgery of our hospital from January of 2014 to December of 2015. Only anticoagulation treatment 12 cases (group A)， Inferior vena cava filter (VCF) + anticoagulant treatment for 40 cases(group B)， Anticoagulation + VCF + catheter-directed thrombolysis (CDT) treatment of 28 cases (group C)， and traceability of follow-up in patients with more than 3 to 12 months. Results Right lower limb DVT patients complicated with the incidence of PE was 82.3%， higher than that of the left leg(31.2)%. In the treatment of PE， group A four patients with recurrence of PE， group B four patients with recurrence of PE， No recurrence of PE group C；Before catheter thrombolysis treatment， the affected side and healthy side of the thigh and calf circumferences were (4.26±4.26) cm and (3.22±1.63) cm，the affected side and healthy side of the thigh and calf circumferences were (1.0±0.90) cm， and (0.90±0.80) cm after catheter thrombolysis treatment. Conclusion Lower extremity DVT embolic loss leads to a high incidence of PE， especially those with right lower limb； Inferior vena cava filter (VCF) + catheter thrombolysis (CDT) can effectively reduce the recurrence rate of PE， and can effectively improve the symptoms of DVT patients.
, http://www.100md.com
Key words：Deep vein thrombosis； Pulmonary embolism； Inferior vena cava filter； Catheter-directed thrombolysis
肺栓塞(PE)是一种严重危害患者生命的一组疾病或临床综合症的总称，主要发病原因是肺动脉或其分支被各种栓子阻塞，作为DVT的一个严重并发症，主要是由深静脉血栓脱落导致[1]。PE发病率较高，美国每年有60万人发生PE[2]，在我国PE发病率为0.1%，虽低于西方国家，但也呈逐年上升趋势[3]，而且易发生漏诊和误诊。一项国外研究显示PE死亡率占住院总死亡人数的1%[4]。经过诊治的PE患者死亡率可以降至10%以下，未经治疗的PE患者死亡率高达25%～30%[5]。
1资料与方法
1.1一般資料 本组189例下肢DVT患者，合并PE80例，双下肢DVT14例合并PE8例，左下肢DVT141例合并PE44例，右下肢DVT34例合并PE28例。DVT患者表现为患肢肿胀、发热、疼痛、浅表静脉曲张，以及"股青肿"等症状，部分患者出现下肢活动障碍。PE患者的临床症状不典型，主要表现为咳嗽15例、呼吸困难23例、胸前区疼痛12例、咯血4例， "肺梗死三联征" 2例，无任何症状24例。全组下肢DVT病例经下肢深静脉彩色多普勒超声或深静脉造影明确诊断，PE病例经CTPA明确诊断。病程5 h～100 d，平均8.31 d。80例PE患者，单纯抗凝12例(A组)，VCF+抗凝治疗40例(B组)，抗凝+VCF+CDT治疗28例(C组)。, http://www.100md.com(余浩 万圣云 孔令尚 程云生)
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