下肢深静脉血栓形成并发肺动脉栓塞的临床诊治分析

发布时间：2018-08-03 16:03

【摘要】：目的探讨下肢深静脉血栓形成并发肺动脉栓塞的诊断和治疗。 方法回顾性分析我院血管外科2011.01—2012.12诊治的45例下肢DVT（49条肢体）并发PTE患者的临床资料。全组病例均由下肢深静脉彩色多普勒超声或深静脉造影明确下肢DVT诊断，经肺动脉CT血管造影明确PTE诊断，确诊45例。其中经抗凝+乆静脉置管溶栓治疗29例（30条肢体），抗凝+系统溶栓治疗6例（8条肢体）,单纯抗凝治疗10例（11条肢体）。 结果本组资料中，男性21例，女性24例，年龄25-83岁，平均59.71±14.16岁，其中以40岁以上为主，占93.3%。有97.8%患者存在着致病的危险因素，其中以左髂静脉压迫综合症、外科手术、创伤为主要致病因素。PTE的主要症状表现为咳嗽、呼吸困难、胸闷、发热，而具有“肺梗塞三联征”较少，占8.8%。CTPA表现为肺动脉血管内不同程度的造影缺损，以双侧肺动脉栓塞多见，右侧多于左侧。右下肢DVT患者并发PTE的发生率为87.5%，高于左下肢的39.1%。PTE治疗方面，单纯抗凝组治疗的临床有效率为80.0%，溶栓治疗组总的临床有效率为94.3%，两者相比无统计学差异。经乆静脉导管溶栓治疗DVT，在患肢消肿率、静脉平均通畅率方面，近期疗效较好。41例患者行下腔静脉滤器置入术后，无再发严重肺动脉栓塞，拦截脱落血栓6例，9例留置下腔静脉滤器的患者获得随访，，随访时间3-28个月，平均（11.71±5.72）个月，无症状性PTE发生，复查造影未见滤器明显移位、变形、穿孔等。 结论多种获得性因素可导致VTE，其中以左髂静脉压迫综合症、外科手术、创伤为主要致病因素。下肢DVT栓子脱落导致PTE的发生率很高，特别是右下肢患者。PTE的临床症状缺乏特异性，容易漏诊，CTPA可以作为诊断PTE的首要检查方法。只要及时诊断和治疗，大多数VTE者经抗凝、溶栓等治疗达到较满意的治疗效果。导管溶栓治疗下肢DVT近期疗效效好，单纯抗凝在PTE治疗方面，可以得到很好的临床疗效，而对于大面积的PTE的患者，推荐使用溶栓治疗。下腔静脉滤器置入能有效防止脱落的血栓并再次加重PTE，降低病死率。
[Abstract]:Objective to investigate the diagnosis and treatment of deep venous thrombosis complicated with pulmonary embolism. Methods the clinical data of 45 patients with DVT (49 limbs) complicated with PTE in vascular surgery from January 2011 to December 2012 in our hospital were retrospectively analyzed. The diagnosis of lower extremity DVT was confirmed by deep vein color Doppler ultrasound or deep vein angiography in all patients, and 45 cases were diagnosed by pulmonary CT angiography (PTE). Among them, 29 cases (30 limbs) were treated with anticoagulant system, 6 cases (8 limbs) were treated with anticoagulant system, and 10 cases (11 limbs) were treated with anticoagulation alone. Results there were 21 males and 24 females, aged 25-83 years, with an average age of 59.71 卤14.16 years. The majority of them were over 40 years old (93.3%). 97.8% of the patients had the risk factors of the disease. The main symptoms of PTE were cough, dyspnea, chest tightness, fever, and left iliac vein compression syndrome, surgery and trauma. However, there were less triple signs of pulmonary infarction, which showed different degree of angiography defect in pulmonary artery on 8.8%.CTPA. Bilateral pulmonary embolism was more common in the right side than in the left. The incidence of PTE in patients with DVT in right lower extremity was 87.5, which was higher than that in 39.1%.PTE treatment of left lower extremity. The clinical effective rate of anticoagulant group was 80.0.The total effective rate of thrombolytic treatment group was 94.3. There was no significant difference between the two groups. DVT was treated by thrombolytic therapy with intravascular catheter. In terms of deswelling rate and average patency rate of affected limbs, 41 patients received inferior vena cava filter implantation, and no serious pulmonary embolism occurred. Six cases of thrombus were intercepted and 9 cases were followed up with inferior vena cava filter. The follow-up time was 3-28 months (mean (11.71 卤5.72) months). Asymptomatic PTE occurred. No obvious shift, deformation and perforation of filter were observed in the reexamination. Conclusion VTEs can be caused by various acquired factors, including left iliac vein compression syndrome, surgery and trauma. The incidence of PTE is very high due to the exfoliation of lower limb DVT embolus, especially the lack of specificity of clinical symptoms in patients with right lower extremity. As long as timely diagnosis and treatment, most patients with VTE through anticoagulant, thrombolysis and other treatment to achieve satisfactory results. Catheter thrombolytic therapy for lower extremity DVT is effective in the short term. Anticoagulant therapy alone can obtain a good clinical effect in the treatment of PTE. For patients with large area of PTE, thrombolytic therapy is recommended. Inferior vena cava filter (IVC) implantation can effectively prevent shedding thrombus and aggravate PTEs and reduce mortality.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R654.4;R563.5

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