社区医院对下肢深静脉血栓的诊疗分析

An analysis of the diagnosis and treatment of lower extremity deep venous thrombosis in community hospital

目的:探讨社区医院对下肢深静脉血栓(LEDVT)形成的诊断和治疗。方法:选取2015年4月-2017年4月我社区医院收治的30例LEDVT患者的临床资料进行回顾性分析,所有患者均由D-二聚体检测联合多普勒超声检查,确诊30例(37条患肢),其中经溶栓治疗23例共26条患肢(急性期22例25条患肢、亚急性期1例1条患肢),全身溶栓15条患肢,患肢溶栓11条患肢;未溶栓组7例(7条患肢),3例慢性期患者共计4条患肢经抬高患肢、弹力袜等综合治疗。结果:溶栓组患者的周径治疗有效率96.15%,明显高于未溶栓组71.43%;且溶栓组患者的周径缩小时间(6.08±1.16)d,明显短于未溶栓组(7.89±2.48)d;组间比较差异有统计学意义(P<0.05)。其中全身溶栓患者与患肢溶栓患者之间的治疗有效率相当,组间比较差异无统计学意义(P>0.05),但患肢溶栓患者的周径缩小时间(5.76±1.25)d,明显短于全身溶栓患者(6.56±1.73)d,组间比较差异有统计学意义(P<0.05)。溶栓组和未溶栓组患者出院后彩超检查提示,其血栓溶解有效率相当,组间比较差异无统计学意义(P>0.05)。3例慢性期患者共计4条患肢,经抬高患肢、弹力袜等综合治疗后,症状缓解率为75.0%(3/4)。结论:临床可将D-二聚体检测联合多普勒超声检查作为LEDVT诊断的首选方式。患肢静脉溶栓治疗不仅能够取得与全身静脉溶栓治疗相当的疗效,且临床症状缓解时间更短,同时还能够减少溶栓药物的使用量,临床安全性较高,值得在LEDVT的治疗中进行推广应用。

Objective:To explore the diagnosis and treatment of lower extremity deep venous thrombosis in community hospital.Methods:The clinical data of30patients with LEDVT in our community hospital from April2015to April2017were analyzed retrospectively,all patients received two D-dimer detection combined with Doppler ultrasound examination,30cases(37limbs)were diagnosed,among which thrombolytic therapy was given for23cases with26limbs(22cases of25limbs were in acute stage,1case was subacute limbs),systemic thrombolysis was given for15limbs,11limbs received thrombolysis;there were7cases(7limbs)in the nonthrombolysis group,a total of3cases of chronic patients with4limbs received raising the affected limb,stockings and other comprehensive treatment.Results:The circumference treatment effective rate of patients in the thrombolysis group was96.15%,which was significantly higher than71.43%in the non-thrombolysis group;The circumference reduction time of the thrombolysis group was(6.08±1.16)d,which was significantly shorter than(7.89±2.48)d in the non-thrombolysis group,the difference was statistically significant(P<0.05).The thrombolysis group and non-thrombolysis group received ultrasound examination after being discharged,which indicated that the thrombolytic efficiency in two groups were similar.The difference was not statistically significant(P>0.05).As for a total of3cases of chronic patients with4limbs,symptoms remission rate was75.0%(3/4)after raising the affected limb,stockings and other comprehensive treatment.Conclusion:Clinical D-two dimer detection combined with Doppler ultrasound examination could be used as the preferred way of LEDVT diagnosis.Limb venous thrombolytic therapy could achieve systemic intravenous thrombolysis equivalent efficacy,gain shorter clinical symptoms relieving time,reduce the use amount of thrombolytic drugs,with high clinical safety,and is worthy of popularization and application in the treatment of LEDVT.