上肢深静脉血栓研究进展课件.pptVIP

?腋静脉、锁骨下静脉、桡静脉、尺静脉、肱静脉、颈内静脉、头臂干静脉?最常见：腋静脉、锁骨下静脉?原发性：约占20%?继发性：指存在危险因素的深静脉血栓形成，约占80%CucMai,M.D.H.M.,UpperextremityDeepVenous

住院病人UEDVTKroger1998-SyedMustafaSyedMustafa,M.,etal.,upperextremitydeepveinthrombosis.CHEST,2003

作者HyltonV.JoffeNKVF.Upper-ExtremityDeepVeinThrombosisAProspectiveRegistryof592Patients[J].Circulation,2004,12(110):1605-1611.

?遗传性血栓形成倾向：蛋白C、蛋白s或抗凝血酶、凝血因子Ⅲ缺乏，凝血因子VLeiden突变和凝血酶原G20210A突变?解剖结构异常：Paget-Schroetter综合征Grant,J.D.,etal.,Diagnosisandmanagementofupperextremitydeep-veinthrombosisinadults.ThrombHaemost,2012.

?CVC置入：45%与CVC有关?肿瘤：38%与恶性肿瘤有关?其他：起搏器、30天内手术史或制动史、个人或者家族深静脉血栓栓塞史、正在接受化疗、伴随疾病（高血压、糖尿病、神经系统疾病、30内肺部感染）MunozFJ,MismettiP,PoggioR,etal.Clinicaloutcomeofpatientswithupper-extremitydeepveinthrombosis:resultsfromtheRIETERegistry[J].Chest,2008,133(1):143-148

例数n11564512228196比例%/4.4%45%38%UEDVT中比例UEDVT中比例MunozFJ,MismettiP,PoggioR,etal.Clinicaloutcomeofpatientswithupper-extremitydeepveinthrombosis:resultsfromtheRIETERegistry[J].Chest,2008,133(1):143-148

比例%/11%55%39%UEDVT中比UEDVT中比HyltonV.JoffeNKVF.Upper-ExtremityDeepVeinThrombosisAProspectiveRegistryof592Patients[J].Circulation,2004,12(110):1605-1611

?上肢肿胀：80%?患侧肢体疼痛：30—50%?较少出现的：患侧肢体红斑、浅表静脉曲张、肢体功能障碍、胸痛、呼吸困难、颈部肿胀

vanM.DINISIO,G.L.S.,Accuracyofdiagnostictestsfor

?52例怀疑UEDVT中：4.无肿瘤、CVC：4/2218%诊断的敏感性为100%，特异性为14%，阳性预测价值为32%，阴性排除价值为100%，

PICC

低回声不可压缩性

治疗（参考下肢深静脉血栓形成）?急性期：确诊血栓后的前三个月可以降低血栓后综合征、血栓复发的发生率。?预防期：急性期治疗后的阶段

治疗（参考下肢深静脉血栓形成）?上腔静脉滤器?手术取栓术Grant,J.D.,etal.,Diagnosisandmanagementofupperextremitydeep-veinthrombosisinadults.ThrombHaemost,2012

KearonC,KahnSR,AgnelliG,etal.Antithrombotictherapyforvenousthromboembolicdisease:AmericanCollegeofChestPhysiciansEvidence-BasedClinicalPracticeGuidelines(8thEdition)[J].Chest,2008,133(6Suppl):454S-545S

ACCP建议：仅用于：症状严重、血栓占据大部分锁骨下静脉和腋静脉、血栓形成14天内、肢体功能良好、预期寿命长于一年、低出血风险者KearonC,KahnSR,