静脉漂浮血栓与肺栓塞

FREE-FLOATING VENOUS THROMBOSIS AND RISK OF PULMONARY EMBOLISM

连续54例经 B 型超声诊断为下肢急性近端深静脉血栓形成的患者分两组:A 组17例患者检出漂浮血栓,B 组37例为非漂浮(附壁)血栓。A 组5例(29.4%)和 B 组4例(10.8%)(P=0.12)在超声检查前已诊断肺栓塞。另4例患者在随访过程中发生经肺扫描证实的肺栓塞。肺栓塞发生率在 A 组中为42.9%(3/7例),B 组中为4.8%(1/21例)(P=0.04),其中3例 A 组患者静脉超声显象表明原漂浮血栓游离段均已消失。本文证实:(1)静脉漂浮血栓时发生肺栓塞的危险性增加,(2)在密切超声随访过程中,漂浮血栓游离段的突然消失强烈提示肺栓塞。

The risk of pulmonary embolism(PE)was evaluated in 54 consecutive patients with echographic proved acute proximal deep vein thrombosis of the lower extremities.The patient were divided into group A(n=17)if he had á free-floating thrombus or group B(n= 37)if he had an occlusive and adherent thrombus.5 patients(29.4%)in group A and 4(10.8%)in group B(P=0.12)had been diagnosed as having PE before the first venous duplex scanning.4 of the 28 patients who were not initially suspected of having PE and who were followedup for 58.5±49.8(±SD,7～165)days developed PE documented by V/Q scan.The incidence of PE was 42.9%(3/7)in group A and 4.8%(1/21)in group B(P=0.04).The proximal portion of the thrombus disappeared in all the three group A patients who developed PE.Our study confirms that:(1)patients with free-floating thrombi are at increased risk of PE,and(2)the observed loss of the proximal portion of a throm- bus by serial Duplex scans strongly suggests an embolization.