摘要
目的总结急性上肢深静脉血栓形成（ULDVT）的诊断治疗经验、分析影响其预后的因素。方法回顾性研究了1988至2009年期间中国医科大学附属第一医院接收诊治的急性ULDVT患者。以10年为界分为两组，前10年为Ⅰ组、后10年为Ⅱ组，对两组患者的临床特点、治疗结果及预后进行了分析比较。结果本组共28例患者，Ⅰ组9例，Ⅱ组19例。急性ULDVT占同期下肢深静脉血栓形成的8．1％。其中男患者14例，女患者14例，平均46．1岁，17例发生于左上肢，11例发生于右上肢。8例（28．6％）为上肢深静脉穿刺置管后发生，13例（46．4％）为肿瘤患者。两组病例在原发病以及危险因素方面存在明显差异，Ⅱ组中的由于恶性肿瘤或其他因素导致的ULDVT的发生的概率明显高于Ⅰ组，并且相对于Ⅰ组患者预后较差。本组病例7例PT值延长，9例HB值升高。本组患者均经彩超检查后确诊，确诊后予以溶栓、抗凝、祛聚治疗，1例为介入置管溶栓治疗，其余均经外周静脉给药。急性期治疗后改用口服华法林治疗维持6个月。所有患者均病情改善良好，症状明显缓解出院。平均随访2．2年，复发2例，1例肺梗塞，6例死亡。结论上肢深静脉血栓发生率远低于下肢深静脉血栓形成。以血液高凝状态如肿瘤、静脉置管等为形成诱因。临床表现结合彩超检查是确诊的重要依据。及时的进行溶栓、抗凝、祛聚治疗效果明显，后续的口服抗凝可预防复发。
Objective To conclude the experience of diagnosis and therapy , the effect analysis and the prognosis factors of acute upper limbs deep venous thrombosis （ULDVT）. Methods We retrospectively analyzed the etiological factor, clinical manifestation, diagnosis, therapy and prognosis of 28 patients treated for acute ULDVT admitted in our hospital between 1988 and 2009. The patients were divided into two groups according to the time of admission and management in hospital. Group Ⅰ , from 1988 to 1998, and group Ⅱ , from 1999 to 2009. Results There were 28 patients diagnosed as acute ULDVT, which was 8. 1% of lower limbs deep venous thrombosis in synchronization. There were 14 men and 14 women, and the mean age was 46. 1 years. 17 patients developed in left upper limbs, and 11 patients developed in right upper limbs. There were 9 patients in group Ⅰ and 19 in group Ⅱ. A significant difference was observed between two groups in their risk factors, primary and secondary cause. 8 patients （28.6%） were relevant to venepuncture catheterization, and 13 patients （46. 4% ） have tumors. There is clear difference between the two groups in the way of primary disease and risk Factors , which means that the probability of ULDVT caused by malignant tumors or other factors in group Ⅱ is apparently higher than group Ⅰ , and the prognosis of group Ⅱ is worse compared with group Ⅰ. All the patients in the group were made a definite diagnosis by ultrasound, after that our policy were thrombolysis and anticoagnlation followed by Warfarin oral administration for 6 months. All the conditions of the patients were well improved, and the symptoms were relieved obviously and discharged . The mean follow-up duration was 2.2 years. 2 recurred , 1 was pulmonary infarction , and 6 was died. Conclusion The incidence of ULDVT is much lower than LLDVT. The motivations are blood hypercoagulabale state , such as tumor , vein catheterization etc. The final diagnosis is mostly based on clinical manifestation combined with ultrasound. Thrombolysis , antieoagulation in time have an obvious therapy effect. After that the anticoagulation therapy through oral administration can prevent recurrence.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2010年第1期38-41,共4页
National Medical Journal of China
关键词
上肢
静脉
血栓
Vein
Thrombosis
Upper limb
