老年肿瘤合并静脉血栓栓塞患者40例临床分析

Clinical analysis of 40 elderly patients with malignant tumor undergoing venous thromboembolism

目的 探讨老年恶性肿瘤合并静脉血栓栓塞（VTE）患者的影响因素、治疗及预防,提高对老年恶性肿瘤患者合并VTE的临床认识. 方法 回顾性分析本院近5年收治的40例合并VTE的老年恶性肿瘤患者的临床资料,对高龄肿瘤患者形成静脉血栓的风险、形成部位、时间、治疗及预防进行分析和总结. 结果 所有患者经积极治疗后,见效26例（65.0％）,未见效14例（35.0％）,具体为死亡14例,治愈7例,好转19例;本组患者除高龄和肿瘤外,又合并高血压、糖尿病、高脂血症、肺部感染、手术、放化疗等2～6项危险因素叠加,使老年肿瘤患者成为极高危人群,其发生VTE时血浆D-二聚体水平明显高于正常值;并发静脉血栓可以在肿瘤发现前或后的任何阶段,本组有1例发生在肿瘤发现前;血栓形成以下肢多见,尤其是左下肢14例（35％）,而颈内静脉和上肢静脉血栓形成大多与PICC置管有关. 结论 对具有慢性病、D-二聚体升高、放化疗等危险因素的老年肿瘤患者的VTE预防和治疗颇为重要,应引起临床医生的重视.

Objective To study the influencing factors,treatment and prevention of venous thromboembolic （VTE） in elderly patients with malignant tumor.Methods The clinical findings in forty elderly patients with malignant tumor combined with VTE from our hospital within 5 years were analyzed retrospectively.The risk,site,time,prevention and treatment of VTE in these tumor patients were analyzed and summarized.Results After active treatment,the positive efficacy response was obtained in 26 cases （65.0%）,no-response in 14 cases （35.0%）.Specifically,14 cases died,7 cases cured,and 19 cases were improved.Besides cancer and aging,the elderly tumor patients were considered as the high-risk group because of the risk factors including hypertension,diabetes,hyperlipidemia,pulmonary infection,surgery,radiation,chemotherapy and so on.D-dimer level was significantly increased in elderly malignant tumor patients with VTE.Venous thrombosis could occur at any stage.Venous thrombosis was found before tumor in 1 case.The most common site of DVT was the lower limbs,especially the left lower extremities （14 cases,35%）.Most of internal carotid vein and upper limb vein thrombosis were associated with peripherally inserted central catheter （PICC） Conclusions The elderly patients with malignant tumor is the extremely high risk groups for venous thrombosis,and their quality of life and survival will be seriously impacted.Anticoagulant therapy through the whole process of treatment in patients with VTE is beneficial.The prevention and treatment of VTE play an important role in the tumor patients with risk factors such as chronic diseases,high D dimer level,radiation and chemotherapy,which should attract the attention of clinicians.