老年下肢深静脉血栓形成患者临床特征分析

Clinical Features of Lower Extremity Deep Venous Thrombosis in Elder Patients

目的分析总结老年下肢深静脉血栓形成(lower extremity deep venous thrombosis,LDVT)患者的临床特征。方法回顾性分析2012年6月—2017年6月山西医科大学附属山西大医院收治的469例老年LDVT患者的人口学和临床资料,分析所有患者的临床特征,比较<80岁组患者和≥80岁组患者临床特征的差异。结果 469例LDVT男女比例大致相当,中位年龄74岁,≥80岁者104例(22.2%);有85例(18.2%)合并肺栓塞;以左下肢LDVT最为多见(51.0%),分期以急性期(70.2%)为主,分型以混合型(46.5%)和周围型(42.9%)为主,较多累及股静脉、肌间静脉、腘静脉;主要症状和体征为患肢肿胀和疼痛。77.6%的患者存在血栓形成的危险因素,其中17.9%的患者有≥3个危险因素,前6位危险因素分别是高血压病、手术与制动、损伤与骨折、糖尿病、脑卒中/瘫痪/长期卧床、恶性肿瘤。≥80岁组与<80岁组患者相比,双下肢LDVT构成比更高,危险因素中高血压病和损伤与骨折更为多见。结论识别老年LDVT的病变特点和临床特征对于其治疗和管理至关重要。高龄患者更易累及双侧下肢,高危因素以高血压病和损伤与骨折更为多见;老年LDVT的筛查和防治时应同时关注双侧肢体,尤其注意高血压病患者和骨折损伤后血栓形成的筛查。

Objective To analyze the clinical characteristics of lower extremity deep venous thrombosis(LDVT)in elderly patients,treatment and management of elderly patients with LDVT.Methods The demographic and clinical data of 469 elderly patients with LDVT admitted to Department of Vascular Surgery of our hospital during the period from June 2012 to June 2017 were collected and analyzed retrospectively,and the clinical characteristics of all patients were analyzed.The differences in clinical characteristics of LDVT in patients<80 years old and≥80 years old were compared.Results The ratio of male to female was approximately the same in 469 patients,with a median age of 74 years,including 104 cases(22.2%)aged≥80 years,and 85 cases(18.2%)of pulmonary embolism(PE).DVT was most commonly found in left lower limb was the most common(51.0%),mainly in acute phase(70.2%)and predominantly involving mixed type(46.5%)and peripheral type(42.9%).Femoral vein,intermuscular vein,popliteal vein were mostly involved.The main symptoms and signs of patients were swelling and pain of the affected limbs.In addition,77.6%of the patients had risk factors for thrombosis,17.9%of whom had more than 3 risk factors.The top six risk factors were hypertension,surgical immobility,fracture injury,diabetes mellitus,stroke/paralysis/long-term bed rest,and malignant tumor.The proportion of LDVT in the bilateral lower limbs was higher and hypertension and fracture injuries were more common in the≥80-year-old group,compared to the<80-year-old group.Conclusion Identification of pathological and clinical characteristics in elderly patients with LDVT is essential for their treatment and management.Older patients are more likely to be affected in bilateral lower limbs,and hypertension and fracture injuries are more common in all risk factors.Therefore,in the screening,prevention and treatment of elderly people,attention should be paid to both limbs in meantime.Moreover,it is also important to put a high value on screening for thrombosis in elder patients with hypertension and after fracture injury.