本文選題：肌間靜脈血栓 + 肺栓塞　； 參考：《山東大學(xué)》2017年碩士論文

【摘要】：目的:探討小腿肌間靜脈從血栓形成(calf muscle venous thrombosis,CMVT)對發(fā)生肺栓塞的影響及CMVT形成的危險(xiǎn)因素,為臨床上CMVT的處理提供參考依據(jù)。方法:收集2015年9月至2016年8月于山東大學(xué)齊魯醫(yī)院住院的CMVT患者。(1)對其進(jìn)行隨訪,觀察CMVT患者合并PTE的發(fā)生率。(2)分析是否抗凝及抗凝時(shí)限差異對CMVT患者發(fā)生PTE的影響。(3)分析是否制動對CMVT患者發(fā)生PTE的影響。(4)選取CMVT患者設(shè)為血栓組,隨機(jī)選擇同期于我院住院的非CMVT患者設(shè)為對照組,其中CMVT均經(jīng)下肢彩色多普勒超聲確診。分別比較兩組患者在一般危險(xiǎn)因素(年齡、性別、吸煙史、內(nèi)科相關(guān)基礎(chǔ)疾病)、原發(fā)疾病(手術(shù)或制動史、惡性腫瘤病史)、當(dāng)期腫瘤相關(guān)治療(化療、放療或內(nèi)分泌治療)、實(shí)驗(yàn)室指標(biāo)(血小板、膽固醇、甘油三酯、低密度脂蛋白)等結(jié)果之間的差異。使用SPSS 22.0統(tǒng)計(jì)學(xué)軟件對結(jié)果進(jìn)行統(tǒng)計(jì)學(xué)分析,以P0.05作為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:2015年9月至2016年8月期間于我院住院并確診為CMVT的患者共654例,完成隨訪486例,隨訪率為74.3%。隨訪時(shí)間為6～12個(gè)月。(1)隨訪過程中共5例患者發(fā)生PTE,發(fā)生率為1.03%。(2)所有CMVT患者中,未行抗凝治療的患者104例,其中3例于隨訪過程中發(fā)生PTE,發(fā)生率為2.9%;接受抗凝治療的患者382例,其中2例于隨訪過程中發(fā)生PTE,發(fā)生率為0.51%。兩組之間PTE發(fā)生率存在顯著性差異(P0.05)。(3)在所有接受抗凝治療10天的CMVT患者中,抗凝時(shí)限10天～≤1月的患者131例,抗凝時(shí)限為1月～≤3月的患者150例,抗凝時(shí)限為3月～≤6月患者66例,抗凝時(shí)限6月患者33例。隨訪結(jié)果顯示抗凝時(shí)限10天的CMVT患者均無PTE發(fā)生。(4)所有接受抗凝治療的CMVT患者中,未制動的患者77例,其中2例于隨訪過程中發(fā)生PTE,發(fā)生率為2.6%;制動的患者318例,隨訪過程中均無PTE發(fā)生。兩組之間PTE發(fā)生率存在顯著性差異(P0.05)。(5)血栓組和對照組在年齡(≥60歲)、惡性腫瘤病史、腫瘤相關(guān)治療史及手術(shù)或制動史這四個(gè)危險(xiǎn)因素上存在顯著性差異(P0.05),為CMVT形成的相關(guān)危險(xiǎn)因素。(6)對相關(guān)危險(xiǎn)因素進(jìn)行l(wèi)ogistic回歸分析顯示,年齡(≥60歲)、惡性腫瘤病史及手術(shù)或制動史是CMVT形成的獨(dú)立危險(xiǎn)因素(P0.05)。結(jié)論:1.CMVT與PTE的發(fā)生具有相關(guān)性;2.抗凝治療可減少CMVT患者PTE的發(fā)生;不同時(shí)限抗凝治療對阻止CMVT發(fā)生PTE療效無顯著差異;3.抗凝聯(lián)合短期制動對于阻止CMVT發(fā)生PTE療效優(yōu)于其他方案;4.高齡(≥60歲)、惡性腫瘤病史及手術(shù)或制動史是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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