下肢深静脉血栓形成的诊断和治疗—培训课件.ppt

谢 谢There is a very strong association between pulmonary embolism (PE) and deep vein thrombosis (DVT): - 90% of pulmonary emboli are the results of DVT - A recent study showed that 82% of patients with acute PE had detectable DVT at the time PE was diagnosed. - Silent PE occurs in more than 50% of patients with symptomatic proximal DVT. As the venous clot in the leg grows it extends along the vein. DVT can develop into a chronic condition in which damage to the valves in the veins results in swelling of the leg, pain and venous hypertension (known as post-thrombotic syndrome - PTS) Parts of the clot can also detach, travelling in the blood to block vessels in the lungs, subsequently causing pulmonary embolism (PE). If less than 50% of the pulmonary circulation is blocked, symptoms are generally limited to shortness of breath or are absent altogether. Very large emboli, however, can cause massive blockage of the pulmonary circulation and rapidly lead to death. 1. Pesavento R, Lusiani L, Visona A, et al. Prevalenza di embolia polmonare clinicamente silente nella trombosi venosa profonda degli arti inferiori. Minerva Cardioangiologica 1997;45:369-375. 2. Girard P, Musset D, Parent F, Maitre S, Phlippoteau C, Simmonneau G. High prevalence of detectable deep venous thrombosis in patients with acute pulmonary embolism. Chest 1999;116:903-908. ACCP 8 指南 （七） MRV （八） CTV 治 疗 保守治疗 卧床２周、抬高患肢、抗凝、溶栓、祛聚 外科治疗 静脉切开取栓、溶栓、抗凝、支持、活动 介入治疗 导管溶栓、PTA + STENT …… ● 目前对于DVT的治疗仍有很大争议，主要为保守治疗 （即单纯抗凝溶栓治疗），还是手术取栓治疗成为争议 的焦点。两者的治疗效果远非尽如人意。 ● 如何研究出更为有效的DVT治疗方法，使阻塞的静脉再通，减少PTS的 发生，提高病人生活质量是我们需要进一步研究的课题。 保守 治疗 抑制体内凝血过程中的一些环节，使凝血时间延长，阻止血栓形成； 对于已经形成的血栓不起治疗作用。对已形成的血栓只起到阻止滋长、蔓延和可预防肺栓塞及血栓再发的作用，但不能溶解和清除静脉瓣膜上的血栓物质，故不能预防PTS。 抬高患肢、急性期卧床2周，严禁患肢按摩。 一般治疗 抗 凝 溶 栓 祛 聚 UK、SK：都是纤维蛋白溶解系统的激活剂 主要是通过激活纤维蛋白原，使纤维蛋白溶酶原转化为纤维蛋白溶酶，起到溶解血栓的作用。 应用时最好是静脉尚未被血栓完全堵塞，使药液能与血栓完全接触，达到消融目的。 病程中如有侧支循环建立，疗效则明显降低。 UFH LMWH 华法令 尿激酶链激酶 rt-PA 急性期药物治疗 - 抗凝疗法 时间：高度可疑或者一旦确诊应立即开始。 UFH：