下肢血栓性静脉炎的临床分析及治疗  

Clinical analysis and treatment of superficial vein thrombophlebitis of lower extremities

作　　者：乔威 刘佳莅 夏成勇 姜伟华 邵泽锋 QIAO Wei;LIU Jiali;XIA Chengyong;JIANG Weihua;SHAO Zefeng(Department of Vascular Surgery,Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing,Jiangsu 210029,China;不详)

机构地区：[1]南京中医药大学附属医院血管外科,江苏南京210029 [2]南京中医药大学附属医院介入医学科,江苏南京210029

出　　处：《中国临床研究》2025年第2期191-195,共5页Chinese Journal of Clinical Research

基　　金：江苏省干部保健科研项目(BJ14012);江苏省中医院人才引进项目(kgr0259)。

摘　　要：目的探讨下肢血栓性静脉炎(SVT)患者病因、临床特点及治疗效果。方法将南京中医药大学附属医院2022年3月至2023年12月67例急性下肢SVT患者纳入研究,分析其发病原因、临床表现特征;所有患者彩超明确诊断及血栓范围,根据临床特征将其分为轻症组42例,重症组25例。所有患者给予迈之灵口服、中药煎剂熏洗及多磺酸粘多糖外用基础治疗,轻症组给予阿司匹林缓解肿痛症状,而重症组患者给予每日1次利伐沙班10 mg抗凝治疗,治疗28 d后观察症状缓解率、静脉血栓栓塞症(VTE)发生率及出血等并发症情况,治疗后随访30 d,明确VTE发生及SVT复发情况。结果SVT发病因素多样,但以下肢静脉曲张患者居多(轻症34例,重症18例),其临床表现主要为局部红肿疼痛、皮下硬结条索改变、色素沉着等。所有急性期患者D-二聚体均明显升高,治疗后两组D-二聚体水平均明显下降(t=15.667、29.314,P<0.01)。轻症组总体疗效优于重症组(Z=2.281,P=0.023)。轻症组1例出现血栓蔓延转为重症,接受利伐沙班治疗症状缓解,无深静脉血栓/肺栓塞发生;重症组2例出现深静脉血栓形成,按深静脉血栓抗凝治疗血栓消退。轻症组无明显出血事件发生,重症组出现1例鼻出血,停药后恢复。30 d随访两组均无VTE事件发生,无SVT复发。结论SVT病因多样,血栓位置、范围及临床表现不一,根据SVT临床特点进行风险评估,采取个体化综合治疗,可以缓解症状,预防VTE形成及SVT的复发,具有良好疗效。Objective To investigate the etiologies,clinical features,and treatment outcomes of patients with superficial vein thrombophlebitis(SVT)respectively.Methods The clinical data of 67 patients with acute SVT of lower extremities in the Affiliated Hospital of Nanjing University of Chinese Medicine from March 2022 to December 2023 were collected.The etiological factors and the clinical features of SVT were analyzed.All patients were diagnosed by color Doppler ultrasound and the extent of thrombosis was determined.The patients were divided into two groups based on their clinical features:the mild group with 42 patients and the severe group with 25 patients.All patients received basic treatment with Aescuven forte,Chinese herbal fumigation and mucopolysaccharide polysulfate.The mild group received aspirin to alleviate swelling and pain,while the severe group received 10 mg of rivaroxaban every day for anticoagulation treatment.After 28-day,objective response rate,incidence of venous thromboembolism(VTE),and complications such as bleeding were monitored,and the incidences of VTE and SVT recurrence were followed up for 30 days after treatment.Results The pathogenesis of SVT of the lower extremities involved various factors,but patients with varicose veins of lower extremities were the the majority.The clinical symptoms mainly included local redness,swelling and pain,indurated subcutaneous nodules and pigmentation.The D-dimer levels in all patients in the acute stage were significantly increased,and the levels of D-dimer level in the both groups were significantly decreased after receiving treatment(t=15.667,29.314,P<0.01).The curative effect of the mild group was better than that of the severe group(Z=2.281,P=0.023).In the mild group,1 patient with the thrombosis extending to the proximal sapheno-femoral junction was treated with rivaroxaban and the symptoms were relieved without developing deep vein thrombosis or pulmonary embolism.Two patients in the severe group developed deep vein thrombosis,and the thrombosis subside

关 键 词：血栓性静脉炎 下肢 深静脉血栓形成 下肢静脉曲张 阿司匹林 利伐沙班 中药熏洗 

分 类 号：R54.5[医药卫生—心血管疾病]