As early as 1859, Virchow, a German scholar, proposed three main factors for the formation of venous thrombosis: slow venous blood flow, venous wall damage and high blood coagulation. This is the classic venous thrombosis. Venous blood flow is slow, because the vein itself is narrow, venous outside space is occupied, peritoneal pressure is too high, sit to stand for a long time to wait, venous blood flow slows down, venous thrombosis forms easily; Venous wall injury is, because smoking, infection, tumor planting and other damage to the lining of the veins, venous thrombosis is easy to form; The high coagulation state of blood is, because dehydration, platelet function hyperfunction, leukaemia, etc., the blood coagulates easily, such as venous thrombosis is easy to form. But of the three factors mentioned above, any single factor is often not enough to cause disease, and is often a combination of various factors.
Thus, we concluded that who is at risk of deep vein thrombosis of lower limb, the old man lying in bed, obese people, smokers, tumor patients and patients after surgery, dehydration and pregnant women, patients with blood diseases, etc. This has been repeatedly demonstrated in clinical practice.
Here, we can also infer, prevention of lower extremity deep vein thrombosis, the main way to have a regular activities lower limbs, quit smoking, lose weight, pregnant time use stretch hose, a suitable amount of drinking water, especially after the surgery, tumor anticoagulant, blood disease patients more need, etc.
What are the manifestations of deep venous thrombosis in lower extremity?
Mainly conscious of acid distension, calf gastrocnemius pain when hook foot back; You can often see swelling of the lower limbs and swelling of the ankles; It can also be without any symptoms or signs, but only pulmonary infarction; In the chronic stage (30 days later), there may be the manifestations of deep venous thrombosis in the lower extremity, such as varicose veins, pigmentation, moss-like skin lesions, and even venous ulcers.
According to the composition of thrombus, there are three types of venous thrombosis:
1. Red thrombosis, the most common, is relatively uniform in composition. Platelets and white blood cells are scattered in the colloidal blocks of red blood cells and cellulose.
2. White thrombus, which is basically composed of cellulose, white blood cells and stratified platelets, has very few red blood cells.
3. Mixed thrombus, composed of white thrombus, head, lamellar red thrombus and white thrombus, body, red thrombus or lamellar thrombus, tail.
According to the site of thrombus, there are also three types of venous thrombosis in the lower extremity:
1. Peripheral type, i.e., leg muscle venous plexus thrombosis, is the most common site of deep vein thrombosis after surgery.
2. Central type, i.e. the formation of iliofemoral vein thrombosis, and Cockett syndrome is common on the left side, which may be related to the right common iliac artery crossing the left common iliac vein and the compression on the left common iliac vein. If thrombus falls off, pulmonary embolism may form.
3. Mixed type, no matter the reverse diffusion of iliofemoral vein thrombosis or the progressive expansion of the leg muscle vein thrombosis, as long as the whole lower limb deep vein system is involved, it is mixed type.
According to the time of thrombosis, there are three types of venous thrombosis in the lower extremity:
1. During the acute phase, the thrombosis occurred within 7 days;
2. During the subacute phase, thrombosis occurred within 8 to 30 days;
3. In the slow phase, the thrombosis has been occurring for more than 30 days.
According to the typical symptoms and signs, the diagnosis of deep venous thrombosis in the lower extremity is not difficult, but the clinical manifestations are often quite different, so some auxiliary examinations are needed to diagnose. Practical and convenient for lower extremity deep vein of ultrasound, it can be diagnosed with the vast majority of vein thrombosis of lower limb, and radioactive isotope inspection, electrical impedance volume eeg examination, venous pressure and determination of D - 2 polymers, etc. For some difficult cases, invasive venography is sometimes required.
The acute phase of venous thrombosis in lower extremities is caused by local distension pain, ankle edema, lower limb infection, and the most dangerous is fatal pulmonary infarction. Its late, is the sequela of the hazards, is the lower extremity deep vein valve insufficiency, performance after walking acid bilges, venous clogged dermatitis, secondary veins, recurrence of venous thrombosis, and even venous ulcer.
In treatment, the patient should first report the disease, and use postural therapy to stay in bed for 1-2 weeks to avoid activities and strenuous defecation, so as to avoid thrombus shedding. Pad the bed foot 20 ~ 25cm, make lower limb higher than the heart plane, can improve venous reflux, reduce edema and pain.
When starting to get out of bed, you should wear stretch socks or use elastic bandages. The time of use varies according to the embolization site. N venous thrombosis, no more than 6 weeks of use; Iliofemoral vein thrombosis, can be used for 3 to 6 months.
At the same time, anticoagulation therapy is needed, which, like postural therapy, is the basic treatment. Acute phase using heparin or low molecular heparin, gradually transition to warfarin coumarin derivatives, pay attention to the monitoring of blood coagulation function test, especially to monitor international standard ratio, the best guarantee is between 1.5 ~ 2.0. For starters, vitamin K antagonists should be used for at least 3 months, while for patients with primary idiopathic deep vein thrombosis, indefinite anticoagulation therapy should be considered.
It can be combined with thrombolysis and depolymerization. Urokinase is commonly used in thrombolysis. Urokinase is extracted from human urine and has less side effects than streptokinase. The first dose is 3000 ~ 4000IU/Kg, which is injected intravenously within 10 ~ 30 minutes. The duration is 2500 ~ 4000IU/Kg, and the course of treatment is generally 12 ~ 72 hours.
Pay attention to the monitoring of fibrinogen and the euglobulin dissolution time, fibrinogen if less than 2 g/L, or euglobulin dissolution time is less than 70 minutes, all need to suspend use drug 1 times, can continue application 7 ~ 10 days. Thrombolysis can also be performed with fibrinolytic enzymes (fibrinases, plasma enzymes). Depolymerization is commonly used in low - molecular dextran.
For the majority of patients with deep venous thrombosis, cava filters are not routinely used. Inferior vena cava filters are recommended only for patients with recurrent thromboembolism who are contraindicated or have complications from anticoagulant therapy, or who have sufficient anticoagulant therapy.
After getting a deep vein thrombosis, more or less will leave a sequela, there is no way to completely cure this kind of sequela. For the treatment of lower extremity deep vein thrombosis sequelae, proposal within 2 years after the deep vein thrombosis, use 30 ~ 40 ankle pressure mmHg stretch hose, and as a result of lower extremity deep venous thrombosis after syndrome in patients with severe edema, can use intermittent pressure treatment. For example, in patients with mild edema of the lower extremity caused by deep venous thrombosis syndrome, stretch socks can be used, or rutin and chestnut seed extracts can be used to alleviate symptoms.
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