深静脉血栓形成103例临床分析

A clinical analysis of 103 cases of deep venous thrombosis

目的 提高对深静脉血栓形成 (DVT)和肺栓塞 (PE)的认识 ,了解二者的关系。方法 对 10 3例DVT病例做一回顾性分析。结果 DVT与PE关系密切 ,DVT病例中PE的发生率为 44 7%。有危险因素者占 88 3% ,最常见的危险因素为长期卧床 (2 6 2 % )、手术 (2 3 3% )、高脂血症 (2 1 4% )、高血压 (19 4% )、恶性肿瘤 (13 6 % )、血红蛋白增多 (13 6 % )、心脏病 (12 6 % )、外伤 (9 7% )和股静脉穿刺 (9 7% ) ,且随着年龄的增长 ,危险因素的数量也增多。DVT的临床表现以下肢肿胀 (91 3% )和疼痛 (5 8 3% )最常见。DVT累及的部位以股静脉最多见 ,股静脉血栓形成也最易并发PE。DVT的诊断以无创方法为首选 ,经确诊的DVT合并PE患者 ,通过抗凝、溶栓、手术治疗 ,医院内病死率为6 5 %。结论 认识DVT的各种危险因素及临床征象 ,及早给予相应检查及治疗是防止PE的发生和降低病死率的关键。

Objective To have a better understanding of deep venous thrombosis (DVT) and pulmonary embolism (PE) as well as their relationship. Methods Review of clinical data of 103 cases with DVT treated in Peking Union Medical College Hospital from 1983 to 1999. Results Of the 103 cases with DVT,46 were diagnosed as PE (44.7%) and 88.3% of the cases had risk factors. The most common risk factors were prolonged immobilization (26.2%), surgery (23.3%), hyperlipemia (21.4%), hypertension (19.4%), malignancy (13.6%), hyperhemoglobinemia (13.6%), heart disease (12.6%), trauma (9.7%) and femoral venous puncture (9.7%). The number of risk factors increased with increase of age. The most common clinical presentations of DVT were swelling (91.3%)and pain (58.3%)of calf and thigh. The most common site of DVT was femoral vein. Femoral vein thrombosis was the most common cause leading to PE. The initial diagnostic modality for DVT should be noninvasive testing. After anticoagulant therapy or thrombolytic therapy or surgery, mortality of DVT and PE in Peking Union Medical College Hospital was 6.5%. Conclusion It is essential to identify various risk factors and clinical presentations of DVT and to select suitable examination and treatment as early as possible.It will decrease the incidence and the mortality of PE.