住院患者下肢深静脉血栓形成位置与肺栓塞发生部位的特点分析  

Analysis of characteristics of the location of lower extremity deep vein thrombosis and the site of pulmonary embolism in hospitalized patients

作　　者：吴济强 王学珍 姜纹姣 李小奇 王满君 王红娟[1] 王倩[1] 陈其章[1] Wu Jiqiang;Wang Xuezhen;Jiang Wenjiao;Li Xiaoqi;Wang Manjun;Wang Hongjuan;Wang Qian;Chen Qizhang(Cadre Ward,Department of Respiratory and Critical Care Medicine,Gansu Provincial People's Hospital,Lanzhou 730000,Gansu,China)

机构地区：[1]甘肃省人民医院呼吸与危重症医学科干部病区,兰州730000

出　　处：《中华危重病急救医学》2022年第11期1148-1153,共6页Chinese Critical Care Medicine

基　　金：甘肃省兰州市科技计划项目(2020-ZD-22)。

摘　　要：目的探讨住院患者下肢深静脉血栓(DVT)形成位置与肺栓塞发生部位的特点及其潜在关联。方法回顾分析2017年12月至2021年12月通过超声诊断为下肢DVT,同时经CT肺动脉造影诊断为肺栓塞患者的临床资料。根据下肢DVT形成位置分为混合型DVT、近端DVT、远端DVT,远端DVT进一步分为胫前/后静脉和腓静脉血栓及小腿肌间静脉血栓,混合型DVT指同时存在近端和远端DVT。根据肺动脉受累部位将肺栓塞分为肺动脉主干或左/右肺动脉干栓塞、肺叶动脉栓塞和肺段动脉栓塞。观察住院患者DVT形成位置、肺栓塞发生部位、静脉血栓栓塞症(VTE)的临床表现(气短、胸闷、胸痛、咯血、咳嗽、下肢肿胀、下肢疼痛、晕厥、发热)和危险因素(骨折/创伤、肿瘤、糖尿病、高血压、心房颤动、感染、手术、自身免疫性疾病、瘫痪、妊娠),以及D-二聚体水平。结果最终共209例患者纳入分析,其中左下肢DVT 127例(占60.8%),右下肢DVT 82例(占39.2%);混合型DVT占39.2%,近端DVT占17.3%,远端DVT占43.5%(胫前/后静脉和腓静脉血栓占14.8%、小腿肌间静脉血栓占28.7%)。混合型DVT及近端DVT患者肺动脉主干或左/右肺动脉干栓塞发生率明显高于胫前/后静脉和腓静脉血栓与小腿肌间静脉血栓患者〔41.5%(34/82)、38.8%(14/36)比16.2%(5/31)、10.0%(6/60)〕,差异有统计学意义(均P<0.05)。胫前/后静脉和腓静脉血栓患者肺段动脉栓塞发生率高于混合型DVT及近端DVT患者〔41.9%(13/31)比26.8%(22/82)、30.6%(11/36)〕,但差异无统计学意义(均P>0.05);小腿肌间静脉血栓患者肺段动脉栓塞发生率明显高于混合型DVT和近端DVT患者〔66.7%(40/60)比26.8%(22/82)、30.6%(11/36)〕,差异均有统计学意义(均P<0.05)。小腿肌间静脉血栓合并肺动脉主干或左/右肺动脉干栓塞患者D-二聚体水平明显高于合并肺段动脉栓塞者(mg/L:6.08±3.12比3.66±2.66,P<0.05);而下肢其他DVT形成位置合并Objective To investigate the characteristics and relationship between the location of lower extremity deep vein thrombosis(DVT)and the site of pulmonary embolism in hospitalized patients.Methods The data of patients with lower extremity DVT diagnosed by ultrasound examination and pulmonary embolism diagnosed by CT pulmonary angiography from December 2017 to December 2021 were analyzed retrospectively.According to the location of lower extremity DVT,the patients were divided into mixed DVT,proximal DVT,and distal DVT which was further divided into anterior/posterior tibial vein or peroneal vein thrombosis and calf muscular venous thrombosis.Mixed DVT was referred to the presence of both proximal and distal DVT.According to the involved site of pulmonary artery,pulmonary embolism was divided into three types:main pulmonary artery,left or right pulmonary artery trunk embolism,lobar pulmonary artery embolism and segmental pulmonary artery embolism.The location of lower extremity DVT,the site of pulmonary embolism,the clinical manifestation(shortness of breath,chest tightness,chest pain,hemoptysis,cough,lower limb swelling,lower limb pain,syncope,fever)and risk factors(fracture/trauma,tumor,diabetes,hypertension,atrial fibrillation,infection,surgery,autoimmune diseases,paralysis,pregnancy)of venous thromboembolism(VTE),and the level of D-dimer were analyzed.Results A total of 209 patients were enrolled finally,including 127 patients with left lower extremity DVT(60.8%)and 82 with right lower extremity DVT(39.2%).Mixed DVT accounted for 39.2%,proximal DVT accounted for 17.3%,and distal DVT accounted for 43.5%(anterior/posterior tibial vein and peroneal vein thrombosis accounted for 14.8%,calf muscular venous thrombosis accounted for 28.7%).The incidences of main pulmonary artery embolism,left or right pulmonary artery trunk embolism in the mixed DVT and proximal DVT were significantly higher than those in the anterior/posterior tibial vein or peroneal vein thrombosis and calf muscular venous thrombosis[41.5%(34/82),38.

关 键 词：下肢深静脉血栓 肺栓塞 部位 

分 类 号：R563.5[医药卫生—呼吸系统] R543.6[医药卫生—内科学]