下肢深静脉血栓形成并发肺动脉栓塞策略探析.doc

下肢深静脉血栓形成并发肺动脉栓塞策略探析 　　摘要：目的 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，其中并发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）能有效降低PE的复发率，并能有效改善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：Objective To evaluate the diagnosis and treatment in deep vein thrombosis of lower limb complicating pulmonary embolism. Methods To analyze the clinical data of 189 cases of DVT complicating with 80 cases of PE being treated in vascular surgery of our hospital from January of 2014 to December of 2015. Only anticoagulation treatment 12 cases （group A）， Inferior vena cava filter （VCF） + anticoagulant treatment for 40 cases（group B）， Anticoagulation + VCF + catheter-directed thrombolysis （CDT） treatment of 28 cases （group C）， and traceability of follow-up in patients with more than 3 to 12 months. Results Right lower limb DVT patients complicated with the incidence of PE was 82.3%， higher than that of the left leg（31.2）%. In the treatment of PE， group A four patients with recurrence of PE， group B four patients with recurrence of PE， No recurrence of PE group C；Before catheter thrombolysis treatment， the affected side and healthy side of the thigh and calf circumferences were （4.26±4.26） cm and （3.22±1.63） cm，the affected side and healthy side of the thigh and calf circumferences were （1.0±0.90） cm， and （0.90±0.80） cm after catheter thrombolysis treatment. Conclusion Lower extremity DVT embolic loss leads to a high incidence of PE， especially those with right lower limb； Inferior vena cava filter （VCF） + catheter thrombolysis （CDT） can effectively reduce the recurrence rate of PE， and can effectively improve the symptoms of DVT patients. Key words：Deep vein thrombosis； Pulmona