Introduction
Deep vein thrombosisIt means that the blood is abnormally condensed in the deep vein and belongs to the venous return disorder of the lower extremity. Most thrombosis occurs in a state of braking (especially major orthopedic surgery). The pathogenic factors are three factors: slow blood flow, vein wall damage and hypercoagulability. After thrombosis, except for a few who can self-ablate or confine the site of occurrence, most of the deep vein trunks that will spread to the entire limb. If not diagnosed and treated in time, most will evolve into thrombosis sequelae, which will affect the quality of life of patients for a long time. There are also some patients who may have pulmonary embolism, with extremely serious consequences.
Cause
Clinically, only 10% to 17% of patients with DVT have obvious symptoms. Including swelling of the lower extremities, local deep tenderness and dorsiflexion. The most serious clinical features and signs of DVT development are pulmonary embolism, with mortality rates as high as 9% to 50%, and the vast majority of deaths die within minutes to hours. Symptoms and signs of DVT are more common in patients with postoperative, traumatic, advanced cancer, coma, and prolonged bed rest. Dealing with DVT is important in prevention. All primary surgery for lower extremity should be treated first. Prophylactic measures for acute lower extremity venous thrombosis include: avoiding postoperative hamstring under the calf, affecting deep venous return of the calf; encouraging patients to actively move their feet and toes and licking them Take more deep breathing and coughing exercises; let the patient get out of bed as soon as possible, wearing medical elastic stockings if necessary. More attention should be paid to the elderly or heart disease patients after surgery.
symptom
The so-called deep vein thrombosis of the lower extremity, the English name is DVT (deep venous thrombosis), refers to the formation of blood clots in the venous lumen for various reasons. The typical clinical manifestations of deep venous thrombosis of the lower extremities are often swelling and pain in the unilateral lower extremities (more common in the left lower extremity). But there is no obvious symptom in the early stage of thrombosis, which is one of the reasons why venous thrombosis is easily overlooked.
diagnosis
Early diagnosis and importance of deep venous thrombosis of lower extremities
Deep vein thrombosis of the lower extremities is called DVT in European and American countries, and it began to attract attention in the 1960s. Many ordinary people also know some knowledge about DVT. China's real attention to DVT is still a matter of recent years. At present, the domestic standard treatment for deep vein thrombosis is excellent. It is the Oriental Hospital affiliated to Shanghai Tongji University. Their vascular surgery leader Smile (Zhang Qiang) is the first to pay attention to this. One of several experts in the disease. In the past, due to the occlusion of information and some misunderstandings in the medical community, the proportion of missed diagnosis and misdiagnosis of deep venous thrombosis of the lower extremities was high. Each medical institution has different levels of understanding of lower extremity deep venous thrombosis and different conceptual differences, resulting in different treatment options.
The first is the judgment of the onset time. Due to the large number of collateral circulation in the venous system, early thrombosis does not prevent the smooth return of venous blood. Only when the thrombus spreads to a certain length and blocks the proximal branch opening near the distal end, it shows clinical swelling of the lower limb. Therefore, in general, cases in which the lower extremity is swollen in the clinic are diagnosed, and the onset time has often exceeded several days.
The guiding significance of the judgment of the onset time on the treatment plan
Venous thrombosis is like cement and can be washed away early, but once dissolved, it cannot dissolve. Although this metaphor is not appropriate, it is a fact that venous thrombosis began to be partially machined after several decades of formation. Mechanized venous thrombosis is difficult to solve by thrombolysis. Surgical thrombectomy is also unsuitable. Because the mechanical thrombus is tightly attached to the wall of the vein, forcible thrombolysis can cause a greater range of thrombosis in the vein wall. Therefore, early diagnosis is very important.
How to early diagnosis of deep venous thrombosis of lower extremities
Although there are no obvious symptoms of early deep vein thrombosis, for experienced doctors, some clues can be found through careful physical examination. For example, pain in the deep part of the calf often suggests a calf vein thrombosis (medically known as the Homan sign). This is because of the aseptic inflammation of the surrounding tissue during venous thrombosis. Similarly, tenderness in the thigh root often suggests femoral vein thrombosis. Of course, once there is a suspected deep vein thrombosis, blood D2 is detected as early as possible, and B-ultrasound is used to detect the deep vein to confirm the diagnosis. In this way, most cases of deep vein thrombosis can be diagnosed early.
treatment
Thrombolytic
The issue of thrombolysis has been controversial in the medical community. In China, many people have great expectations when they hear the tempting word “thrombolysis”. In fact, the word "thrombolysis" refers more to the mechanism of the drug than to the inevitable treatment. The latest international ACCP thrombotherapy guidelines do not recommend thrombolytic therapy as the first choice for deep venous thrombosis of the lower extremities. There are three reasons for this: one is that the clinical manifestations of venous thrombosis are lagging, the thrombolytic drugs are ineffective for mechanized thrombosis; the second is thrombolytic drugs. The risk of bleeding is very high, especially in elderly patients, which may cause fatal cerebral hemorrhage. Third, a large number of comparative studies have shown that the therapeutic effect of thrombolysis is not superior to anticoagulant therapy. Of course, with the development of interventional techniques, whether the development of catheter thrombolysis can reduce complications and improve treatment effects is still further accumulated in experience. The current clinical results are still relatively optimistic. But it is necessary to strictly control the testimony.
Anticoagulation
Anticoagulant therapy is generally preferred as long as the patient does not have bleeding or coagulation problems. The role of anticoagulant therapy is to prevent the thrombus from spreading or forming a new thrombus, and to strive for conditions for the open relief symptoms of the collateral circulation.
prevention
Venous thromboembolism (VTE) is a serious life-threatening condition. Clinical includes deep vein thrombosis and pulmonary thromboembolism. Pulmonary thromboembolism refers to a disease caused by a thrombus obstructing the pulmonary artery or its branches from the venous system or the right heart, which is commonly referred to as pulmonary embolism. Both are two different stages of the disease course of the same disease. In Western countries such as the United States, the incidence of VTE ranks third in cardiovascular disease. Data shows that 10% of hospital deaths are caused by VTE. In Europe, more than 500,000 people die each year from VTE, which exceeds the combined death toll from AIDS, prostate cancer, breast cancer and highway accidents.
At the 19th Great Wall International Cardiology Conference, Professor Hu Dayi said that VTE is not only common in Western countries, but also common in China and Asian countries. A significant number of high-risk patients with VTE develop VTE after discharge because of inadequate precautions, and sudden death in severe cases.
In the first patients with VTE, 50-75% had a clear risk factor. Risk factors for VTE include: surgery, trauma, bed rest, oncology (hormone, chemotherapy or radiotherapy), advanced age, heart or respiratory failure, nephrotic syndrome, obesity, smoking, varicose veins, hereditary or acquired thrombotic tendency, etc. These risk factors usually coexist.
In fact, VTE is preventable. After prevention, its incidence will be greatly reduced. Common preventive measures such as: routinely give small doses of anticoagulant drugs in orthopedics and major thoracic surgery; patients after major surgery should turn over and beat the lower limbs, massage the lower limbs, and patients with minor surgery should get out of bed early, such as sudden orders The swelling of the side limbs should go to the hospital in time and so on. In fact, it is also crucial to spread the knowledge of thrombosis to the masses and grassroots medical staff.
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