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深静脉血栓的护理
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Abstract:
上肢和下肢深静脉血栓形成(DVT, deep vein thrombosis)定义为受影响四肢深静脉内的血栓。这些血栓既可以自发发生，也可以与特定的危险因素有关。无论原因如何，DVT都与显着的发病率和死亡率相关，并有可能导致致命的并发症。最显着的并发症是下肢深静脉血栓形成肺栓塞。正如研究报告的那样，超过90%的急性肺栓塞来自近端深静脉。静脉血栓栓塞还与医疗保健系统和个体患者的重大经济负担有关。在本文中，我们回顾了上肢和下肢DVT，包括危险因素、体征和症状、诊断和治疗。
Upper and lower extremity deep vein thrombosis (DVT) is defined as a blood clot in the deep veins of the affected extremities. These blood clots can either occur spontaneously or be associated with specific risk factors. Regardless of the cause, DVT is associated with significant morbidity and mortality and has the potential to lead to fatal complications. The most significant complication is deep vein thrombosis of the lower extremities and pulmonary embolism. As reported in the study, more than 90% of acute pulmonary embolisms originate from the proximal deep veins. Venous thromboembolism is also associated with a significant financial burden on the healthcare system and individual patients. In this article, we review upper and lower extremity DVT, including risk factors, signs and symptoms, diagnosis, and treatment.
| [1] | Anderson, F.A., Wheeler, H.B., Goldberg, R.J., et al. (1991) A Population-Based Perspective of the Hospital Incidence and Case-Fatality Rates of Deep Vein Thrombosis and Pulmonary Embolism. The Worcester DVT Study. Archives of Internal Medicine, 151, 933-938. https://doi.org/10.1001/archinte.1991.00400050081016 |
| [2] | Kucher, N. (2011) Deep Vein Thrombosis of the Upper Extremities. The New England Journal of Medicine, 364, 861-869. https://doi.org/10.1056/NEJMcp1008740 |
| [3] | Spyropoulous, A.C. and Lin, J. (2007) Direct Medical Costs of VTE and Subsequent Hospital Readmission Rates: An Administrative Claims Analysis from 30 Managed Care Organ-izations. Journal of Managed Care & Specialty Pharmacy, 13, 475-486. https://doi.org/10.18553/jmcp.2007.13.6.475 |
| [4] | Mousa, A.Y. and AbuRahma, A.F. (2013) May-Thurner Syn-drome: Update and Review. Annals of Vascular Surgery, 27, 984-995. https://doi.org/10.1016/j.avsg.2013.05.001 |
| [5] | Mall, N.A., Van Thiel, G.S., Heard, W.M., Paletta, G.A., Bush-Joseph, C. and Bach, B.R. (2013) Paget-Schroetter Syndrome: A Review of Effort Thrombosis of the Upper Ex-tremity from a Sports Medicine Perspective. Sports Health, 5, 353-356. https://doi.org/10.1177/1941738112470911 |
| [6] | Falck-Ytter, Y., Francis, C.W., Johanson, N.A., et al. (2012) Prevention of VTE in Orthopedic Surgery Patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed.: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 141, e278S-e325S. https://doi.org/10.1378/chest.11-2404 |
| [7] | Ridker, P.M., Hennekens, C.H., Lindpaintner, K., Stampfer, M.J., Ei-senberg, P.R. and Miletich, J.P. (1995) Mutation in the Gene Coding for Coagulation Factor V and the Risk of Myo-cardial Infarction, Stroke, and Venous Thrombosis in Apparently Healthy Men. The New England Journal of Medicine, 332, 912-917.
https://doi.org/10.1056/NEJM199504063321403 |
| [8] | Poort, S.R., Rosendaal, F.R., Reitsma, P.H. and Bertina, R.M. (1996) A Common Genetic Variation in the 3’-Untranslated Region of the Prothrombin Gene Is Associated with Elevated Plasma Prothrombin Levels and an Increase in Venous Thrombosis. Blood, 88, 3698-3703.
https://doi.org/10.1182/blood.V88.10.3698.bloodjournal88103698 |
| [9] | Schafer, A.I. (1985) The Hypercoagulable States. Annals of Internal Medicine, 102, 814-828.
https://doi.org/10.7326/0003-4819-102-6-814 |
| [10] | Rogers, J.S. (1993) Hypercoagulable States. West Virginia Medical Journal, 89, 61-63. |
| [11] | McGee, S. (2012) Evidence-Based Physical Diagnosis. Saunders, Philadelphia, 472-473.
https://doi.org/10.1016/B978-1-4377-2207-9.00001-X |
| [12] | Goodacre, S., Sutton, A.J. and Sampson, F.C. (2005) Meta-Analysis: The Value of Clinical Assessment in the Diagnosis of Deep Venous Thrombosis. Annals of Internal Medicine, 143, 129-139.
https://doi.org/10.7326/0003-4819-143-2-200507190-00012 |
| [13] | Wells, P.S., Anderson, D.R., Bormanis, J., et al. (1997) Value of Assessment of Pretest Probability of Deep-Vein Thrombosis in Clinical Management. The Lancet, 350, 1795-1798. https://doi.org/10.1016/S0140-6736(97)08140-3 |
| [14] | Wells, P.S., Anderson, D.R., Rodger, M., et al. (2003) Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis. The New England Journal of Medicine, 349:1227-1235. https://doi.org/10.1056/NEJMoa023153 |
| [15] | Bates, S.M., Kearon, C., Crowther, M., et al. (2003) A Diagnostic Strategy Involving a Quantitative Latex D-Dimer Assay Reliably Excludes Deep Venous Thrombosis. Annals of Internal Medicine, 138, 787-794.
https://doi.org/10.7326/0003-4819-138-10-200305200-00006 |
| [16] | Tapson, V.F., Carroll, B.A., Davidson, B.L., et al. (1999) The Diagnostic Approach to Acute Venous Thromboembolism. American Journal of Respiratory and Critical Care Medicine, 160, 1043-1066.
https://doi.org/10.1164/ajrccm.160.3.16030 |
| [17] | Hull, R., Hirsh, J., Sackett, D.L., et al. (1981) Clinical Validity of a Negative Venogram in Patients with Clinically Suspected Venous Thrombosis. Circulation, 64, 622-625. https://doi.org/10.1161/01.CIR.64.3.622 |
| [18] | Kearon, C., Julian, J.A., Newman, T.E. and Ginsberg, J.S. (1998) Nonin-Vasive Diagnosis of Deep Venous Thrombosis. McMas-ter Diagnostic Imaging Practice Guidelines Initiative. Annals of Internal Medicine, 128, 663-677.
https://doi.org/10.7326/0003-4819-128-8-199804150-00011 |
| [19] | Lensing, A.W. (1989) Detection of Deep-Vein Thrombosis by Real-Time B-Mode Ultrasonography. The New England Journal of Medicine, 320, 342-345. https://doi.org/10.1056/NEJM198902093200602 |
| [20] | Mattos, M.A., Londrey, G.L., Leutz, D.W., et al. (1992) Color-Flow Duplex Scanning for the Surveillance and Diagnosis of Acute Deep Venous Thrombosis. Journal of Vas-cular Surgery, 15, 336-375.
https://doi.org/10.1016/0741-5214(92)90258-A |
| [21] | Kearon, C., Akl, E.A., Comerota, A.J., et al. (2012) An-tithrombotic Therapy for VTE Disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed.: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 141, e419S-e494S. https://doi.org/10.1378/chest.11-2301 |
| [22] | White, R.H., Brunson, A., Romano, P.S., Li, Z. and Wun, T. (2016) Outcomes after Vena Cava Filter Use in Noncancer Patients with Acute Venous Thromboembolism: A Population-Based Study. Circulation, 133, 2018-2029.
https://doi.org/10.1161/CIRCULATIONAHA.115.020338 |
| [23] | Decousus, H., Leizorovicz, A., Parent, F., et al. (1998) A Clinical Trial of Vena Caval Filters in the Prevention of Pulmonary Embolism in Patients with Proximal Deep-Vein Thrombosis. Prevention du Risque d’Embolie Pulmonaire par Interruption Cave Study Group. The New England Journal of Medicine, 338, 409-415.
https://doi.org/10.1056/NEJM199802123380701 |
| [24] | Kearon, C., Akl, E.A., Ornelas, J., et al. (2016) An-tithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. Chest, 149, 315-352. https://doi.org/10.1016/j.chest.2015.11.026 |
| [25] | Einstein Investigators, Bauersachs, R., Berkowitz, S.D., Brenner, B., et al. (2010) Oral Rivaroxaban for Symptomatic Venous Thromboembolism. The New England Journal of Medicine, 363, 2499-2510.
https://doi.org/10.1056/NEJMoa1007903 |
| [26] | Kovacs, M.J., Rodger, M., Anderson, D.R., et al. (2003) Compar-ison of 10-mg and 5-mg Warfarin Initiation Nomograms Together with Low-Molecular-Weight Heparin for Outpatient Treatment of Acute Venous Thromboem-Bolism. A Randomized, Double-Blind, Controlled Trial. Annals of Internal Medicine, 138, 714-719.
https://doi.org/10.7326/0003-4819-138-9-200305060-00007 |
| [27] | Agnes, Y.Y., Lee, M.D., Mark, N., et al. (2003) Randomized Comparison of Low-Molecular-Weight Heparin versus Oral Anticoagulant Therapy for the Prevention of Recurrent Venous Thromboembolism in Patients with Cancer (CLOT) Investigators. Low-Molecular-Weight Heparin versus a Coumarin for the Prevention of Recurrent Venous Thromboembolism in Patients with Cancer. The New England Journal of Medicine, 349, 146-153.
https://doi.org/10.1056/NEJMoa025313 |
