本文選題：下肢深靜脈血栓形成　切入點：肺栓塞　出處：《安徽醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的評價導(dǎo)管接觸性溶栓在下肢深靜脈血栓形成并發(fā)肺動脈栓塞的臨床應(yīng)用價值方法選取我院血管外科在2014.09~2016.09收治的189例下肢深靜脈血栓形成(DVT)患者,其中80例并發(fā)肺栓塞(PE)患者作為研究對象。全組病例均由下肢深靜脈彩色多普勒超聲和/或深靜脈造影明確下肢DVT診斷,經(jīng)肺動脈CTA血管造影明確PE診斷。在80例PE患者中,采用單純抗凝治療32例(A組),采用抗凝+IVCF+導(dǎo)管溶栓(CDT)治療(B組)48例,并對18例髂靜脈受壓綜合征患者進(jìn)行介入治療,對以上患者進(jìn)行跟蹤性隨訪3~12個月。結(jié)果DVT住院患者合并發(fā)生肺栓塞的發(fā)生率為42.3%(80/189),年齡在45歲以上占91.25%,其中平均年齡為63.75±12.36歲。96.25%(77/80)患者存在致病的危險因素,其中以心血管系統(tǒng)疾病(48.9%)、吸煙(33.8%)、感染(32.4%)、臥床制動(30.6%)、手術(shù)創(chuàng)傷(16.4%)、腫瘤(13.2%)為主要致病因素。右下肢DVT患者并發(fā)PE的發(fā)生率為82.3%,高于左下肢的31.2%。在中央型(髂-股、股-乆靜脈)DVT患者中,并發(fā)肺栓塞的人數(shù)為77例,明顯高于小腿靜脈(周圍型)并發(fā)肺栓塞的人數(shù)。在治療方面,單純抗凝組再發(fā)肺動脈栓塞5例,抗凝+IVCF+導(dǎo)管溶栓(CDT)治療組再發(fā)肺動脈栓塞1例;經(jīng)導(dǎo)管接觸性溶栓治療DVT,在患肢消腫率、靜脈平均通暢率方面,近期療效較好,溶栓治療前患、健側(cè)大、小腿周徑差分別為為(4.26±2.75)cm、(3.22±1.63)cm,導(dǎo)管溶栓治療后患、健側(cè)大小腿周徑差分別為(1.0±0.90)cm、(0.90±0.80)cm。結(jié)論(1)導(dǎo)管接觸性溶栓對治療DVT患者安全可靠、簡便易行,能迅速降低患肢水腫。(2)CDT結(jié)合下腔靜脈濾器可以有效防治DVT高危人群并發(fā)PE的風(fēng)險。(3)CTPA能降低肺栓塞的漏診,是診斷肺栓塞的主要方法。
[Abstract]:Objective to evaluate the clinical value of catheter contact thrombolysis in the treatment of deep venous thrombosis complicated with pulmonary embolism. Methods 189 patients with DVT were selected from our hospital from April 09 to June 2009. Among them, 80 patients with pulmonary embolism (PE) were studied. The diagnosis of lower extremity DVT was confirmed by deep vein color Doppler ultrasound and / or deep vein angiography, and the diagnosis of PE was confirmed by pulmonary CTA angiography. 32 cases of group A were treated with anticoagulant therapy, 48 cases of group B were treated with anticoagulant IVCF catheter thrombolytic therapy, and 18 cases of iliac vein compression syndrome were treated with interventional therapy. Results the incidence of pulmonary embolism in DVT inpatients was 42.3%, and the age over 45 years was 91.25%. The mean age was 63.75 鹵12.36 years old. 96.25% of the patients had risk factors of pulmonary embolism. Among them, 48.9% of cardiovascular diseases, 33.8% of smoking, 32.4% of infection, 30.6% of bed rest, 16.442% of surgical trauma, 13.2% of tumor. The incidence of PE in patients with DVT of right lower extremity was 82.3, higher than that of 31.2in left lower extremity. Among the patients with DVT, 77 cases were complicated with pulmonary embolism, which was significantly higher than that of the shank vein (peripheral type) complicated with pulmonary embolism. In the treatment, 5 cases had recurrent pulmonary embolism in the anticoagulant group. In the anticoagulant IVCF catheter thrombolytic therapy group, there was 1 case of recurrent pulmonary embolism and 1 case was treated with transcatheter contact thrombolytic therapy, the short-term curative effect was better in terms of deswelling rate of affected limb and average patency rate of vein, and before thrombolytic therapy, the healthy side was large. The difference of leg circumference was 4.26 鹵2.75 cm ~ (-1) and 3.22 鹵1.63 cm respectively. After thrombolytic therapy with catheter, the circumference difference of normal leg was 1.0 鹵0.90 cm ~ (-1) 0.90 鹵0.80 cm 路cm ~ (-1) respectively. Conclusion the catheter contact thrombolytic thrombolysis is safe, reliable and easy to treat DVT patients. CDT combined with inferior vena cava filter can effectively prevent and treat PE in high risk population of DVT. It can reduce the missed diagnosis of pulmonary embolism and is the main method in the diagnosis of pulmonary embolism.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R543.6;R563.5

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