13例上腔静脉滤器置入预防急性上肢深静脉血栓形成后肺栓塞的效果分

陈卢峰+蔡旭东

[摘要] 目的 探析上腔静脉滤器置入预防急性上肢深静脉血栓形成后肺栓塞的效果。方法 方便选取2012年5月—2014年5月该院收治的未置入上腔静脉滤器36例急性上肢深静脉血栓患者为此次研究对照组，选择2014年7月—2016年7月该院收治的置入上腔静脉滤器13例急性上肢深静脉血栓患者为此次研究观察组。对两组患者的肺栓塞发生情况进行对比分析。 结果 观察组患者未发生肺栓塞，对照组中4例患者发生肺栓塞，肺栓塞发生率11.11%，两组组间数据对比差异有统计学意义（P<0.05）。观察组中，所有患者滤器均未发生穿透静脉壁、心包、主动脉等恶性事件；有1例患者术后第12天因重症肺炎、心肺功能衰竭导致死亡、未取出滤器，其余患者经抗凝治疗2周后造影见滤器均未发生明显移位、且滤器均成功拔出。结论 对上肢深静脉血栓患者置入上腔静脉滤器，可有效预防血栓形成后肺栓塞发生率，提升患者的生存质量，具备积极的应用和推广价值。

[关键词] 上腔静脉滤器；上肢深静脉血栓；肺栓塞；效果

[中图分类号] R714 [文献标识码] A [文章编号] 1674-0742（2017）05（c）-0060-03

[Abstract] Objective To study the effect of superior vena cava filters placement in pulmonary embolism after the prevention of acute upper extremity deep vein thrombosis. Methods 36 cases of patients with acute upper extremity deep vein thrombosis without placement of superior vena cava filters admitted and treated in our hospital from May 2012 to May 2014 were convenient selected as the control group， 13 cases of patients with acute upper extremity deep vein thrombosis with placement of superior vena cava filters admitted and treated in our hospital from July 2014 to July 2016 were selected as the observation group， and the occurrence of pulmonary embolism was compared between the two groups. Results In the observation group， there was no case with pulmonary embolism， in the control group， there were 4 cases with pulmonary embolism and the incidence rate of pulmonary embolism was 11.11%， and the differences between the two groups were statistically significant（P<0.05）in the observation group， and the malignant events such as penetration vein wall， pericardium and aorta did not occur to all patients， and 1 case died due to severe pneumonia and cardio-pulmonary function failure in the 12th day， and there was no obvious displacement in the other patients after 2-week anticoagulant therapy. Conclusion The placement of superior vena cava filters in patients with upper extremity deep vein thrombosis can effectively prevent the incidence rate of pulmonary embolism and improve the survival quality of patients， which is of positive application and promotion value.

[Key words] Superior vena cava filters； Upper extremity deep vein thrombosis； Pulmonary embolism； Effect

近年來，上肢深静脉血栓的发病率呈现逐年上升的发展趋势，特别是随着中央静脉通路的广泛使用、恶性肿瘤患者诊疗条件的改善等原因，使得上肢静脉系统血栓的发生率、发现率明显增加，国外研究[1]表明，恶性肿瘤患者PICC相关性血栓的发生率高达27%～66%。上肢深静脉系统血栓由于多位于锁骨下静脉、颈内静脉等大静脉内，易形成大块血栓，且无静脉瓣阻挡，上肢活动度较大，重力作用、咳嗽喷嚏等胸内压变化、下腔静脉短等因素都易导致血栓脱落或造成严重的肺栓塞[2-3]。上肢DVT引发PE的风险达到5%～10%[4-5]，但风险高达28%的致死性PE已有数例报道。因此，预防急性上肢深静脉血栓形成后肺栓塞发生率是提升患者生存质量的关键。该研究以选取2012年5月—2014年5月该院收治的49例患者为研究对象，采用随机对照的研究方法，对上腔静脉滤器置入预防急性上肢深静脉血栓形成后肺栓塞的效果进行评价，并对研究结果进行进一步分析，现报道如下。……