为了解我国南方地区肺栓塞的现状,通过检索中国医院数字图书馆近9年(1999年～2008年)南方地区正式发表的与肺栓塞和深静脉血栓有关的论文共1288篇,进行了统计分析,发现:1、中国南方地区肺栓塞的发现数量逐年增加,且增幅明显;2、诊断水准达到一定程度的部分南方医院,诊断治疗肺栓塞的数量明显高于其他医院,并不比中国北方同类医院低;3、肺栓塞的漏诊、误诊现象依然普遍存在,提高认知和诊治水准仍然是今后工作的方向。
Inpatients after COVID-19 infection, especially those admitted to intensive care unit (ICU), may encounter a series of coagulation dysfunction, which may lead to thrombosis, such as pulmonary embolism (PE), deep vein thrombosis (DVT) or arterial thrombosis (AT). Although there are many literatures on the incidence rate, prevention and treatment of venous thromboembolism (VTE) in hospitalized patients with COVID-19 infection, there are few data on the symptomatic and subclinical incidence rate of VTE after COVID-19 infection discharge. Therefore, there are no specific recommendations or guidelines for the prevention of VTE after discharge from hospital due to COVID-19 infection, and the current guidelines are controversial. In this study, we reviewed and summarized the existing literature on the incidence rate, prevention, diagnosis and treatment of venous thromboembolism in patients with COVID-19 infection, in order to provide guidance for VTE prevention in patients with COVID-19 infection after discharge.
ObjectiveTo discuss the implantation and conversion technology of convertible inferior vena cava filter and the experience of management.MethodsThe clinical data of 115 patients with convertible inferior vena cava filter implantation admitted to our vascular surgery center from January 2018 to December 2018 was retrospectively analyzed.ResultsAmong the 115 patients with convertible inferior vena cava filter implantation, 74 were males and 41 were females. The ages ranged from 22 to 87 years, with median age 54 years. The successful rate of filter implantation was 100% without any surgical related complications. After implantation surgery, patients were followed up from 4 to 455 days with a median of 90 days and the recurrence rate of adverse events was 7.8% (9/115). The recurrence time were 16 to 104 days after conversion, with a median of 42 days. Twenty-three patients (20.0%) received filter conversion, one of them failed and all the others succeeded. The technical successful rate was 95.7% (22/23). The conversion operative time was 22.8 to 51.4 min, with median time 27.4 min. The intervals between implantation and conversion were from 4 to 455 days, with median time 159 days. Accessory techniques were used in 20 of 22 successful filter conversions and the application rate of accessory technique was 90.9%. The patients were followed-up from 30 to 180 days after conversion with a median time of 90 days and no adverse event was reported.ConclusionConvertible inferior vena cava filter is a significant choice for patients application of inferior vena cava filter due to its high safety of conversion surgery, technical success rate and possibility of conversion after long-term indwelling.
OBJECTIVE To evaluate the efficacy and safety of low molecular weight heparin(LMWH) in prophylaxis of postoperative deep vein thrombosis (DVT) following hip and knee surgery. METHODS From April 1997 to October 1998, 46 patients undergoing hip and knee orthopedic procedures were randomized into 2 groups for studying. The following eligibility criteria were applied: age over 40 years old, no recently history of venous thromboembolism (over 3 months), normal result of preoperative hemostasis test and normal result of Doppler examination of the lower extremities. One group was control group and the other group received subcutaneously a low molecular weight heparin(Fraxiparine) with anti-factor X, activity of 41 IU/kg.day for three days, then 62 IU/kg.day from the 4th day to 10th day. All patients had venegraphy performed in the operated leg at 4 to 7 days after surgery. RESULTS eight patients(34.8%) developed DVT in the control group of 23 patients and 1 patient (4.3%) in the experimental group, also of 23 patients(P lt; 0.05). Two groups had no any bleeding complications. CONCLUSION The low molecular weight heparin is safe and effective in preventing postoperative deep vein thrombosis in patients following hip and knee surgery.
Objective To investigate the incidence and management of CTEPH in the Department of Pulmonary and Critical Care Medicine in Xijing Hospital to enrich the epidemiological data of chronic thromboembolic pulmonary hypertension (CTEPH) in China.Methods We conducted a retrospective study to investigate the incidence and management of CTEPH in the Department of Pulmonary and Critical Care Medicine in Xijing Hospital from 2008 to 2012. Results The incidence of CTEPH was 5.24% . About 62.90% of venous thromboembolism/pulmonary embolism (VTE/PE) patients were unprovoked, and about 53.85% of CTEPH patients was unprovoked. About 38% of CTEPH patients had no history of VTE, and 62% of CTEPH patients had no history of acute pulmonary embolism. None of the CTEPH patients was treated by pulmonary thromboendarterctom (PTE) , and about 53.85% of patients were only given anticoagulant monotherapy. Conclusions The incidence of CTEPH is higher in our hospital than reported. This phenomenon may be related to the lack of awareness of risk factors of CTEPH and the insufficient thrombolytic and anticoagulant therapy to acute pulmonary embolism. It’s very urgent to standardize the diagnosis and management of CTEPH in pulmonologists.
ObjectiveTo explore the value of recombinant inferior vena cava filter (IVCF) in the prevention of perioperative pulmonary embolism in patients with lower limb or pelvic fracture combined with deep venous thrombosis (DVT).MethodsThe clinical data of 168 patients with lower limb or pelvic fracture combined with DVT were analyzed retrospectively.ResultsThe filters were successfully implanted in 168 patients, and the recoverable filters were removed after (48.3±4.8) d (14–97 d). The filters were removed successfully in 159 cases, and the removal rate was 94.6%. Sixty-one cases were found to have thrombus on the filter after contrast examination or removal of vena cava filter, that is, the thrombus interception rate was 36.3%.ConclusionFor patients with lower limb or pelvic fracture combined with DVT, the rechargeable vena cava filter can effectively stop thrombosis and avoid pulmonary embolism.
目的探讨低分子肝素预防下肢静脉曲张术后深静脉血栓形成的临床效果。 方法将2011年1月至2013年12月期间于笔者所在医院行大隐静脉高位结扎＋分段剥脱术＋腔内激光闭合术的513例下肢静脉曲张患者随机分为2组：低分子肝素组238例，下肢静脉曲张术后采用低分子肝素预防性治疗；对照组275例，术后不采用任何抗凝药物。比较2组患者深静脉血栓形成和并发症发生情况。 结果低分子肝素组发生浸透敷料的出血14例（5.9%），切口出血或皮下血肿25例（10.5%），血小板减少1例（0.4%），肝功能异常2例（0.8%），无深静脉血栓形成发生；对照组发生浸透敷料的出血19例（6.9%），切口出血或皮下血肿27例（9.8%），肝功能异常2例（0.7%），深静脉血栓形成7例（2.5%），无血小板减少发生。2组患者浸透敷料的出血、切口出血或皮下血肿、血小板减少及肝功能异常发生率比较差异均无统计学意义（P＞0.05），但低分子肝素组深静脉血栓形成的发生率低于对照组（P＜0.05）。术后获访487例，随访时间为4～12个月，平均10个月。其中低分子肝素组获访225例，对照组获访262例。获访患者随访期间发生下肢静脉曲张复发9例（低分子肝素组4例，对照组5例），隐神经损伤11例（低分子肝素组5例，对照组6例），无远期下肢深静脉血栓形成病例。2组患者的下肢静脉曲张复发率和隐神经损伤发生率比较差异均无统计学意义（P＞0.05）。 结论采用低分子肝素预防下肢静脉曲张术后下肢深静脉血栓形成具有良好的临床效果和安全性，值得临床推广应用。
目的探讨急性下肢深静脉血栓形成的治疗方法。 方法对我院1999年2月至2002年8月收治的20例急性下肢深静脉血栓形成患者的临床资料进行回顾性分析，并结合文献加以讨论。 结果采用手术取栓配合超声消融及区域性溶栓的综合治疗方法，20例中1例死亡，1例股浅静脉小段狭窄，1例遗留深静脉瓣膜功能不全，其余均获满意疗效，术后症状消失，肢体肿胀明显改善。结论手术取栓配合超声消融等微创技术是治疗急性下肢深静脉血栓形成的最佳选择。