Clinical Diagnosis And Treatment Of Venous Thromboembolism(VTE) (Report Of 196 Cases)

Objective:To investigate the incidence of pulmonary embolism thrombosis of lower extremity deep venous thrombosis after,according to the clinicalsymptoms,risk factors,laboratory monitoring,imaging examination,deep vein thrombosis of the lower extremity position,treatment and prognosis were analyzed for clinical path and constructive guidance.Method:The collection and the Department of vascular surgery of General Hospital of PLA from July 2015 to December 2016,the statistical analysis of Kunming 469 cases of lower extremity deep venous thrombosis in patients with pulmonary artery CTA(CT pulmonary angiography,CTPA)have confirmed pulmonary embolism in 196 patients,the incidence of pulmonary thromboembolism formation evaluation of lower extremity deep venous thrombosis and pulmonary embolism.Embolism patients classified as symptomatic pulmonary embolism group and asymptomatic pulmonary embolism group,statistical analysis of the clinical signs and symptoms,risk factors,test indicators,imaging examination,lower extremity deep vein thrombosis clinical stage,type,location and classification of different pulmonary embolism therapy.Results:1.July 2015 to December 2016,the PLA General Hospital of Kunming admitted to a total of about 469 cases of deep venous thrombosis of the lower extremity,with or without symptoms or signs of pulmonary thromboembolism,were treated by pulmonary artery CTA examination,pulmonary artery CTA clear pulmonary thromboembolism in patients with 196 cases,the hospital patients during the deep venous thrombosis with pulmonary thromboembolism ratio is about 41.79%.2.196 patients with pulmonary thromboembolism confirmed by pulmonary artery CTA,83 cases of symptomatic pulmonary thromboembolism,accounting for 42.4%,asymptomatic pulmonary embolism in 113 cases,accounting for 57.6%.3.Of the 196 patients,93 were deep venous thrombosis(47.4%),69 were deep vein thrombosis(35.2%),and 32(16.3%)were deep venous thrombosis.The surrounding of deep venous thrombosis in 125 cases(63.8%),15 cases of central type deep vein thrombosis(7.7%),full of limb deep vein thrombosis in 53 cases(27%),the patients with inferior vena cava thrombosis in 10 cases(5.1%),1 cases of superficial vein thrombosis(0.5%),1 cases(0.5%)without lower extremity vein found thrombus.Among the clinical stages,there were 97 cases of acute thrombosis,77 cases of subacute phase,and 2 cases of chronic stage.There was no difference between the symptom group and the asymptomatic group in the clinical stage,location and typing of the deep vein thrombosis.4.The symptoms and signs of all patients were varied,with no obvious specificity,and there was a difference in the number of tachycardia and rapid breathing between the symptomatic and asymptomatic groups.5.The ECG and chest X-ray of symptomatic PTE and asymptomatic PTE were not specific.The pulmonary artery CTA examination showed that the most common manifestations except pulmonary embolism were pleural effusion,pulmonary infection and pulmonary inflammatory disease.There were differences in the number of pulmonary infection and pleural effusion between the two groups.6.This study statistics the related risk factors of VTE,among which fracture,operation,tumor are common,and the most common diseases are hypertension.7.D-dimer and fibrinogen were the most common in all patients,and there was a difference in the number of D-dimer and fibrinogen among the symptomatic and asymptomatic groups.8.All patients were diagnosed after treated with low molecular weight heparin subcutaneous injection of 4250iu 1/12h anticoagulant therapy,a total of 130 cases(66.3%)patients received thrombolytic therapy,including catheter directed thrombolysis in 23 cases(11.7%),107 cases(54.6%)thrombolysis,jugular vein catheter thrombolysis in 23 cases(11.7%),all patients were given in raising the limb,low molecular dextran antiplatelet treatment.9.With(or without)anticoagulation and thrombolysis treatment,hospital patients with lower extremity deep venous thrombosis in the lower limb swelling,muscle tension decreased,group of patients with symptoms of symptoms,stable vital signs of pulmonary embolism in patients with asymptomatic patients without symptoms of pulmonary embolism.During the hospitalization,45 patients underwent re examination of the pulmonary artery.CTA showed that 10 cases of pulmonary embolism completely disappeared,25 cases improved,and 10 cases had no obvious change.15 patients had mild hemorrhage,1 cases with superior mesenteric artery dissection rupture death,1 cases of atrial fibrillation occurred due to cerebral infarction.Post and telephone follow-up,a total of 166 patients were followed up for 3 months,4 cases of patients with Hussein Wafa Lin dose not lead to recurrence of deep vein thrombosis,166 cases of patients with no symptoms or signs of pulmonary thromboembolism.Conclusion:1.The probability of pulmonary thromboembolism in patients with lower extremity deep vein thrombosis is 41.79%,which should be paid more attention to and avoid missed diagnosis.2.The clinical symptoms and signs of pulmonary thromboembolism are atypical.Of these,there are 113 asymptomatic pulmonary thromboembolism patients(57.6%).3.Clinical staging of deep venous thrombosis of the lower extremity,location,type and pulmonary thromboembolism in patients with symptoms has no obvious correlation between pulmonary embolism can occur in the absence of deep vein thrombosis after any formal treatment in clinical stage.4.patients with deep vein thrombosis of lower limbs appear obvious abnormalities of D two,no obvious cause of pleural effusion,pulmonary infection,syncope,should consider whether there is pulmonary embolism,need to further improve the inspection.5.The treatment of non lethal pulmonary thromboembolism with anticoagulation and thrombolysis can often achieve better clinical results.