下肢深静脉血栓形成并发肺动脉栓塞的策略探讨

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1、下肢深静脉血栓形成并发肺动脉栓塞的策略探讨摘要：0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，其屮并发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

2、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）能冇效降低PE的复发率，并能冇效改善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Abstract：ObjectiveToevaluatethediagnosisandtreatmentindeepveinthrombosisoflowerlimbcomplicat

3、ingpulmonaryembolism.MethodsToanalyzetheclinicaldataof189casesofDVTcomplicatingwith80casesofPEbeingtreatedinvascularsurgeryofourhospitalfromJanuaryof2014toDecemberof2015.Onlyanticoagulationtreatment12cases(groupA),Inferiorvenacavafilter(VCF)+anticoagulanttreatmentfor40cases(groupB),An

4、ticoagulation+VCF+catheter-directedthrombolysis(CDT)treatmentof28cases(groupC),andtraceabilityoffollow-upinpatientswithmorethan3to12months.ResultsRightlowerlimbDVTpatientscomplicatedwiththeincidenceofPEwas82.3%,higherthanthatoftheleftlcg(31.2)%.InthetreatmentofPE,groupAfourpatientswit

5、hrecurrenceofPE,groupBfourpatientswithrecurrenceofPE,NorecurrenceofPEgroupC；Beforecatheterthrombolysistreatment,theaffectedsideandhealthysideofthethighandcalfcircumferenceswere(4.26±4.26)cmand(3.22+1.63)cm,theaffectedsideandhealthysideofthethighandcalfcircumferenceswere(1.0±0.90)cm,an

6、d(0.90±0.80)cmaftercatheterthrombolysistreatment.ConclusionLowerextremityDVTemboliclossleadstoahighincidenceofPE,especiallythosewithrightlowerlimb；Inferiorvenacavafilter(VCF)+catheterthrombolysis(CDT)caneffectivelyreducetherecurrencerateofPE,andcaneffectivelyimprovethesymptomsofDVTpat

7、ients.Keywords：Deepveinthrombosis；Pulmonaryembolism；Inferiorvenacavafilter；Catheter-directedthrombolysis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%,里低于西方国家，但也呈逐年上升趋势[3],而且易发生漏诊和误诊。一项国外研宂显示PE死亡率占住院总死亡人数的1%

8、[4]。经