小腿肌间静脉血栓与肺栓塞发生相关性及小腿肌间静脉血栓形成危险因素的研究

发布时间：2018-05-24 00:30

  本文选题：肌间静脉血栓 + 肺栓塞　； 参考：《山东大学》2017年硕士论文

【摘要】：目的:探讨小腿肌间静脉从血栓形成(calf muscle venous thrombosis,CMVT)对发生肺栓塞的影响及CMVT形成的危险因素,为临床上CMVT的处理提供参考依据。方法:收集2015年9月至2016年8月于山东大学齐鲁医院住院的CMVT患者。(1)对其进行随访,观察CMVT患者合并PTE的发生率。(2)分析是否抗凝及抗凝时限差异对CMVT患者发生PTE的影响。(3)分析是否制动对CMVT患者发生PTE的影响。(4)选取CMVT患者设为血栓组,随机选择同期于我院住院的非CMVT患者设为对照组,其中CMVT均经下肢彩色多普勒超声确诊。分别比较两组患者在一般危险因素(年龄、性别、吸烟史、内科相关基础疾病)、原发疾病(手术或制动史、恶性肿瘤病史)、当期肿瘤相关治疗(化疗、放疗或内分泌治疗)、实验室指标(血小板、胆固醇、甘油三酯、低密度脂蛋白)等结果之间的差异。使用SPSS 22.0统计学软件对结果进行统计学分析,以P0.05作为差异有统计学意义。结果:2015年9月至2016年8月期间于我院住院并确诊为CMVT的患者共654例,完成随访486例,随访率为74.3%。随访时间为6～12个月。(1)随访过程中共5例患者发生PTE,发生率为1.03%。(2)所有CMVT患者中,未行抗凝治疗的患者104例,其中3例于随访过程中发生PTE,发生率为2.9%;接受抗凝治疗的患者382例,其中2例于随访过程中发生PTE,发生率为0.51%。两组之间PTE发生率存在显著性差异(P0.05)。(3)在所有接受抗凝治疗10天的CMVT患者中,抗凝时限10天～≤1月的患者131例,抗凝时限为1月～≤3月的患者150例,抗凝时限为3月～≤6月患者66例,抗凝时限6月患者33例。随访结果显示抗凝时限10天的CMVT患者均无PTE发生。(4)所有接受抗凝治疗的CMVT患者中,未制动的患者77例,其中2例于随访过程中发生PTE,发生率为2.6%;制动的患者318例,随访过程中均无PTE发生。两组之间PTE发生率存在显著性差异(P0.05)。(5)血栓组和对照组在年龄(≥60岁)、恶性肿瘤病史、肿瘤相关治疗史及手术或制动史这四个危险因素上存在显著性差异(P0.05),为CMVT形成的相关危险因素。(6)对相关危险因素进行logistic回归分析显示,年龄(≥60岁)、恶性肿瘤病史及手术或制动史是CMVT形成的独立危险因素(P0.05)。结论:1.CMVT与PTE的发生具有相关性;2.抗凝治疗可减少CMVT患者PTE的发生;不同时限抗凝治疗对阻止CMVT发生PTE疗效无显著差异;3.抗凝联合短期制动对于阻止CMVT发生PTE疗效优于其他方案;4.高龄(≥60岁)、恶性肿瘤病史及手术或制动史是CMVT形成的高危因素。
[Abstract]:Objective: to investigate the effect of calf muscle venous thromboplasms on pulmonary embolism (PE) and the risk factors of CMVT formation in calf myenteric vein, and to provide reference for the treatment of CMVT in clinic. Methods: CMVT patients hospitalized in Qilu Hospital of Shandong University from September 2015 to August 2016 were followed up. To observe the incidence of CMVT patients with PTE. (2) to analyze the effect of anticoagulant and anticoagulant duration difference on the occurrence of PTE in CMVT patients. To analyze whether the effect of immobilization on the occurrence of PTE in CMVT patients. 4) to select CMVT patients as thrombus group. Non-CMVT patients in our hospital were randomly selected as control group, in which CMVT was confirmed by lower extremity color Doppler ultrasound. Patients in the two groups were compared in general risk factors (age, sex, smoking history, basic diseases related to internal medicine), primary diseases (history of operation or immobilization, history of malignant tumor), current tumor-related therapy (chemotherapy). Differences in the results of radiotherapy or endocrine therapy, laboratory indicators (platelets, cholesterol, triglycerides, low-density lipoproteins), etc. SPSS 22. 0 statistical software was used for statistical analysis of the results, P0.05 as the difference was statistically significant. Results: from September 2015 to August 2016, a total of 654 patients with CMVT were hospitalized in our hospital, and 486 patients were followed up. The follow-up rate was 74.3%. During the follow-up period of 6 ~ 12 months, there were 5 cases of CMVT, the incidence rate was 1.033%) of all the patients, 104 cases were not treated with anticoagulant therapy, of which 3 cases (2.9%) were treated with anticoagulant therapy, and 382 cases were treated with anticoagulant therapy. PTEs occurred in 2 cases during follow-up, with an incidence of 0.51%. There was significant difference in the incidence of PTE between the two groups (P 0.05). Among all the patients receiving anticoagulant therapy for 10 days, there were 131 patients with anticoagulant duration from 10 days to 鈮，

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