上肢深静脉血栓研究进展复习过程.ppt

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1、上肢深静脉血栓研究进展流行病学流行病学时间作者住院病人/nUEDVT/n发生率%1998Kroger 160000 3340.21998-2006Syed Mustafa44163650.15Kroger K,Schelo C,Gocke C,et al.Colour Doppler sonographic diagnosis of upper limb venous thrombosesJ.Clin Sci(Lond),1998,94(6):657-661.Syed Mustafa,M.,et al.,upper extremity deep vein thrombosis.CHEST,20

2、03DVT中所占比例时间作者DVT/nUEDVT/n发生率%1999Spencer4836914%2004Hylton V545159211%Spencer F A E C L D.Upper Extremity Deep Vein Thrombosis A Community-BasedJ.Am J Med,2007,8(120):678-684.Hylton V.Joffe N K V F.Upper-Extremity Deep Vein Thrombosis A Prospective Registry of 592 PatientsJ.Circulation,2004,12(110)

3、:1605-1611.危险因素危险因素原发性原发性上肢深静脉血栓：遗传性血栓形成倾向：蛋白C、蛋白s或抗凝血酶、凝血因子缺乏，凝血因子VLeiden突变和凝血酶原G20210A突变解剖结构异常：Paget-Schroetter综合征 Grant,J.D.,et al.,Diagnosis and management of upper extremity deep-vein thrombosis in adults.Thromb Haemost,2012.继发性继发性上肢深静脉血栓 CVC置入：45%与CVC有关 肿瘤：38%与恶性肿瘤有关其他：起搏器、30天内手术史或制动史、个人或者家族深静

4、脉血栓栓塞史、正在接受化疗、伴随疾病（高血压、糖尿病、神经系统疾病、30内肺部感染）Munoz F J,Mismetti P,Poggio R,et al.Clinical outcome of patients with upper-extremity deep vein thrombosis:results from the RIETE RegistryJ.Chest,2008,133(1):143-148 RIETE研究多国家、多中心DVTUEDVT CVC肿瘤肿瘤例数例数n11564512228196比例比例%/4.4%45%UEDVT中比例中比例38%UEDVT中比例中比例 Muno

5、z F J,Mismetti P,Poggio R,et al.Clinical outcome of patients with upper-extremity deep vein thrombosis:results from the RIETE RegistryJ.Chest,2008,133(1):143-1482004年美国多中心研究DVTUEDVT CVC肿瘤肿瘤例数例数5451592324230比例比例%/11%55%UEDVT中比中比例例39%UEDVT中比中比例例Hylton V.Joffe N K V F.Upper-Extremity Deep Vein Thrombos

6、is A Prospective Registry of 592 PatientsJ.Circulation,2004,12(110):1605-1611临床症状和体征临床症状和体征上肢肿胀：80%患侧肢体疼痛：3050%较少出现的：患侧肢体红斑、浅表静脉曲张、肢体功能障碍、胸痛、呼吸困难、颈部肿胀无症状：约5%诊断诊断 D-二聚体超声对比静脉造影：金标准 MRI、MRVCTV van M.DI NISIO,G.L.S.,Accuracy of diagnostic tests for clinically suspected upper extremity deep vein thrombo

7、sis.Journal of Thrombosis and HaemostasisD-二聚体二聚体Merminodet al,2006,Switzerland：500ug/L 多普勒超声确诊52例怀疑UEDVT中：1.D-dimer阳性：15/52 29%2.并发肿瘤中：8/23 34.8%3.CVC：6/18 33%4.无肿瘤、CVC：4/22 18%诊断的敏感性为诊断的敏感性为100%，特异性为，特异性为14%，阳性预测价值为阳性预测价值为32%，阴性排除价值为，阴性排除价值为100%，超声超声PICC 低回声低回声 不可压缩性不可压缩性超声超声敏感性敏感性特异性特异性加压超声加压超声97

8、%96%彩色多普勒彩色多普勒84%94%Di Nisio M,Van Sluis G L,Bossuyt P M,et al.Accuracy of diagnostic tests for clinically suspected upper extremity deep vein thrombosis:a systematic reviewJ.J Thromb Haemost,2010,8(4):684-692UEDVT诊断急性期：确诊血栓后的前三个月 可以降低血栓后综合征、血栓复发的发生率。预防期：急性期治疗后的阶段 目的是控制血栓形成的危险因素 治疗治疗（参考下肢深静脉血栓形成）治疗治

9、疗（参考下肢深静脉血栓形成）拔除深静脉置管抗凝溶栓上腔静脉滤器手术取栓术 Grant,J.D.,et al.,Diagnosis and management of upper extremity deep-vein thrombosis in adults.Thromb Haemost,2012抗凝抗凝ACCP建议：同下肢深静脉血栓Kearon C,Kahn S R,Agnelli G,et al.Antithrombotic therapy for venous thromboembolic disease:American College of Chest Physicians Evid

10、ence-Based Clinical Practice Guidelines(8th Edition)J.Chest,2008,133(6 Suppl):454S-545S溶栓溶栓ACCP建议：仅用于：症状严重、血栓占据大部分锁骨下静脉和腋静脉、血栓形成14天内、肢体功能良好、预期寿命长于一年、低出血风险者Kearon C,Kahn S R,Agnelli G,et al.Antithrombotic therapy for venous thromboembolic disease:American College of Chest Physicians Evidence-Based Cl

11、inical Practice Guidelines(8th Edition)J.Chest,2008,133(6 Suppl):454S-545S上腔静脉滤器上腔静脉滤器Owens C A,Bui J T,Knuttinen M G,et al.Pulmonary embolism from upper extremity deep vein thrombosis and the role of superior vena cava filters:a review of the literatureJ.J Vasc Interv Radiol,2010,21(6):779-787上腔静脉短

12、，放置困难致死性并发症发生率为3.8%手术取栓术手术取栓术Kearon C,Kahn S R,Agnelli G,et al.Antithrombotic therapy for venous thromboembolic disease:American College of Chest Physicians Evidence-Based Clinical Practice Guidelines(8th Edition)J.Chest,2008,133(6 Suppl):454S-545S大块血栓形成影响肢体功能绝对抗凝、溶栓禁忌症治疗策略比较治疗策略比较并发症并发症肺栓塞：发生率约为5%；抗凝深静脉血栓复发：高复发、早复发血栓后综合征（Post-thrombotic Syndrome,PTS）发生率为2040%PE预防预防合理的选择CVC置入小剂量低分子肝素、小剂量华法林、维生素K拮抗剂（继发性）此课件下载可自行编辑修改，仅供参考！此课件下载可自行编辑修改，仅供参考！感谢您的支持，我们努力做得更好！谢谢感谢您的支持，我们努力做得更好！谢谢