临界型下肢深静脉血栓的治疗:附23例报告

Treatment of borderline deep venous thrombosis of lower limb:a report of 23 cases

目的探讨临界型下肢深静脉血栓早期诊断及治疗的效果。方法回顾分析23例临界型下肢深静脉血栓患者的临床资料。所有患者经彩色多普勒证实下肢深静脉内"暴风雪征"阳性,并行股、腘静脉轴流及"暴风雪征"中心流速测定。比较治疗前后的血流动力学指标,分析治疗效果。结果患者均于基础抗凝、扩容治疗5～7 d后出院。治疗后患者股、腘静脉轴流流速峰增加(均P<0.01),"暴风雪征"消失或减轻。结论临界型下肢DVT的彩色多普勒筛查和早期干预有助于防止病变向固体化血栓转化,从而避免了不必要的外科手术干预(包括取栓和下腔静脉滤器的植入等)以及长期抗凝或溶栓所带来的风险和副作用。

Objective To investigate the efficacy of early detection and intervention in borderline lower-limb deep venous thrombosis（DVT）.Methods The clinical data of 23 patients with borderline lower-limb DVT were retrospectively analyzed.All the patients were confirmed having positive ＂snowstorm sign＂ in the deep veins of lower limb by duplex ultrasonography,and the central velocity of axial blood flow of femoral and popliteal veins as well as the center of snowstorm sign of the patients was measured.These hemodynamic parameters before and after treatment were compared to determine the therapeutic effect.Results All patients were discharged from hospital after basic anticoagulation,antiplatelet and volume expansion therapy for five to seven days.The peak velocity of femoral and popliteal venous axial blood flow of the patients increased after treatment（all P0.01）,and their snowstorm signs disappeared or lessened.Conclusions Duplex ultrasonography screening for early detection and intervention of borderline low-limb DVT is helpful to prevent the thrombus converting to a solid state,and it thereby avoids surgical intervention（such as thrombus and inferior vena cava filter implantation） and the risks and adverse effects of long-term anticoagulation and/or thrombolysis.