深静脉血栓DV课件

,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,*,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,*,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,*,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,*,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,2020/9/14,#,R1,主持：刘忠传 副主任,Lower extremity deep venousthrombosis,R1 Lower extremity deep veno,1,Patient,Data,Name,：,吴志强,Gender,：,M,ale,Age,：,44 years old,Admission date,：,2010.07.08,Patient DataName：吴志强,2,Chief complaint,Right lower extremity swelling 2 month.,Chief complaintRight lower ext,3,Present illness,The 44 year-old male was a,drug abuser(1.5 year).,He started using venous d,rug injection 3 month ago.(arm and femoral vein;cylinder sharing),He felt weak,right lower extremity swelling and pain 2 month ago.,Methadone maintenance treatment 2 week,.,Present illnessThe 44 year-old,4,Physical examination,T 38 P 81,次,/,分,R 20,次,/,分,BP 118/61 mmHg,Tenderness,swelling of the r,ight lower extremity,.,Right inguinal region and leg skin temperature rising.,An1X1cm right inguinal subcutaneous mass was noted,redness and swelling.,Physical examination T 38 P 8,5,ultrasonography Finding,1,、右下肢股总静脉至腘静脉广泛血栓形成,2,、右下肢小隐静脉血栓形成,3,、双下肢深动脉内膜欠光滑，未见明显血栓,ultrasonography Finding 1、右下肢,6,WBC 20.9,109/L,H,M3.9-10.6 F3.5-11,RBC 3.82 1012/L L M4.5-5.9 F4.0-5.2,Hemoglobin 102 g/L L M135-175 F120-160,Platelets 277 109/L 150-400,Segment 88.5,%,H,42-74,Band 1.0,%0-3,Albumin 21.6 g/L L,35-55,BUN 3.76 mmol/L 2.14-7.5,Creatinine 55.39 umol/L L M:56.58-112.27,Lab Data,WBC 20.9,7,检验项目 检验值 单位,H/L,参考值 改,=,P.T 14.2 sec H 10-13,Nor.plasma mean 11.3 sec,INR 1.3 (INR:,预防 治疗,1.5-3.0,静脉,血栓治疗,2-3.0,动脉疾病治疗,2.6-4.5),APTT 35.8 sec 23.3-39.3(,治疗围,1.5-2.5x,正,常血浆平均值,),Nor.plasma mean 28.8 sec,D-dimer 0.593,mg/L H 0.25,检验项目 检验值,8,Primary diagnosis,1.Right lower extremity deep venous thrombosis.,2.,Sepsis,？,Primary diagnosis 1.Right lowe,9,Differential diagnosis,1,、原发性下肢静脉曲张。,2,、原发性下肢深静脉瓣膜功能不全。,3,、动脉栓塞。,Differential diagnosis1、原发性下肢静,10,Treatment,1,、完善各项辅助检查：如血常规、凝血四项、心电图、肝肾功、,HIV,、,RPR,。,2,、安排腹部靜脉,CT,血管成像、胸部,CT,扫描。,3,、给予肝素、华法林、右旋糖酐抗凝治疗并严密监测凝血功能。,4,、每日测量双下肢周径。,5,、阿莫西林克拉维酸抗炎治疗。,Treatment1、完善各项辅助检查：如血常规、凝血四项,11,Radiology Finding,右侧股静脉、右侧髂外静脉及右侧髂总静脉静脉血栓形成伴右侧髋部软组织明显肿胀。,Radiology Finding右侧股静脉、右侧髂外静脉及,12,深静脉血栓DV课件,13,Anticoagulant therapy,右旋糖酐,40ml,静滴维持,24,小时,肝素,10,，,000IU IV,每天,2,次,华法林,2.5mg BID,口服,监测凝血功能,Q8H,Anticoagulant therapy右旋糖酐40ml,14,2010/07/11 Blood culture,细菌名称 生长状态 抹片检查,1 Staph.aureus,1/1,（金黄色葡萄球菌）,-,药敏试验,_ 1(,浓度,),Ampicillin .R ,Clindamycin .S,Erythromycin_.S _,Oxacillin .S ,Penicillin .R ,Teicoplanin_.S _,Vancomycin .S ,考虑,Sepsis-,改用,Clindamycin,抗炎治疗,2010/07/11 Blood culture细菌名,15,检验项目 检验值 单位,H/L,参考值,P.T 20.1 sec H 10-13,Nor.plasma mean 11.3 sec,INR 1.8 (INR:,预防 治疗,1.5-3.0,静脉,血栓治疗,2-3.0,动脉疾病治疗,2.6-4.5),APTT 39.7 sec H 23.3-39.3(,治疗 围,1.5-,2.5x,正常血浆平均值,),Nor.plasma mean 28.8 sec,停用肝素、右旋糖酐,改华法林,2.5mg QD,Coagulation Function,检验项目 检验值 单位,16,2010/07/12,Patient suddenly hematemesis twice.Vomitus of red and dark red blood clot.No chest pain,no,dyspnea.,Bloody stool thrice,no tarry stools.,Lips and conjunctiva paleness.Check,blood routine:,RBC:2.3910,12,/L,Platelets 36010,9,/L,Hb 65g/L Albumin:15.2g/L,。,Quickly transfusion normal saline 1000ml,VitK intramuscular injections,arrange chest X-ray,consult digestive.,Transfer to ICU,set CVP,arrange,endoscopy exploration.,2010/07/12Patient suddenly hem,17,1.,Impression:Duodenal polyp with active oozing post polypectomy,and local treatment.,2.,Suggestion:High dose PPI use and correct bleeding tendency.,1.Impression:Duodenal polyp wi,18,2010/07/12-14 treatment,1.Omeprazole intravenous infusion continuity.(3 day),2.Monitoring vital sign,blood routine,coagulation function.,3.FFP and RBC infusion.,4.07/14 transfer tocommon ward.,5.Clindamycin for anti-inflammatory therapy.,6.Arrange inferior vena cava filter implantation for prevention of risk of pulmonary embolism.,2010/07/12-14 treatment1.Omep,19,DISCUssION,DISCUssION,20,DVT EPIDEMIOLOGY,Annual incidence in urban population is 1.6 cases/1000 persons.,Approximately one third of cases caused by PE and two thirds of cases caused by DVT.,The risk of recurrent thromboembolism is higher among men than women.,The rate seems to increase sharply after age 45.,Ferris Clinical Advisor 2011,1st ed.,DVT EPIDEMIOLOGYAnnual incid,21,ETIOLOGY-DVT/VTE RISK FACTORS,Anything that places a patient at risk for:,Stasis,(reduced blood flow velocity),Hypercoaguable states,(changes in blood elements),Endothelial damage,(vein wall injury),These are the common causes of DVT known as,Virchows Triad (1856),ETIOLOGY-DVT/VTE RISK FACT,22,DVT/VTE,Risk,Factors,Risk Factor=1 Point Risk Factor=2 Points,Age 41-60 years,Bedrest,COPD,CHF(1 month),Acute MI,Pneumonia(I month),Sepsis(25),Swollen legs,Pregnancy,Oral Contraceptives,Age 60-74 years,Athroscopic surgery,Laparoscopic surgey,Malignancy(present or history),Major surgery(45 Minutes),Patient confined to bed(72 hours),Immobilizing plaster cast(75 year