最后审阅: 15 三月 2021
最后更新: 29 五月 2018

小结

定义

病史和体格检查

关键诊断因素

  • 存在的危险因素
  • 既往浅静脉血栓性静脉炎(SVT)、深静脉血栓形成(DVT)或肺栓塞(PE)
  • 患处皮肤红斑/发红
  • 皮肤温度升高/发热
  • 受累静脉处发痛/压痛
  • 周围部位的肿胀/水肿
  • 可触及的条索状肿物
  • 症状的发展持续数小时至数天
  • 伴有深静脉血栓或肺动脉栓塞的体征/症状

其他诊断因素

  • 静脉曲张
  • 近期的静脉腔内器械操作(例如硬化治疗)
  • 近期的静脉置管和静脉内药物注射
  • 低热
  • 色素沉着性改变

危险因素

  • 静脉曲张
  • 易栓疾病
  • 自体免疫性疾病(例如,白塞病和血栓闭塞性脉管炎)
  • 既往 SVT 病史
  • 女性
  • 硬化疗法
  • 静脉内插管
  • 恶性肿瘤
  • 妊娠
  • 口服避孕药物和激素替代疗法的应用
  • 老年
  • 既往 VTE 病史,包括 DVT 和 PE
  • 肥胖
  • 长期制动(例如长途航空旅行)

诊断性检查

首要检查

  • 多普勒超声检查

需考虑的检查

  • 活检
  • 肺动脉 CT 血管成像
  • 通气灌注 (ventilation perfusion, VQ) 扫描
  • 选择性肺动脉造影
  • 恶性肿瘤的评估
  • 血栓形成倾向筛查

治疗流程

撰稿人

Vicky Tagalakis

Associate Professor

Department of Medicine

McGill University

Montreal

Canada

利益声明

VT has received reimbursement for consultancy work for Pzifer Canada, Sanofi Canada, Bayer, Bristol Myers Squibb, and Daiichi Sankyo. All of these companies are makers of anticoagulants. She has received an investigator-initiated grant from Sanofi Canada.

Professor Vicky Tagalakis would like to gratefully acknowledge Frédérique St-Pierre, a medical student who worked with her to update this topic. FSP declares that he has no competing interests.

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Consultant

Division of Angiology and Hemostasis

University Hospital of Geneva

Geneva

Switzerland

利益声明

FB declares that he has no competing interests.

Professor of Medicine

Section of Hematology

Director of Hematologic Malignancies

Temple University School of Medicine

Philadelphia

PA

利益声明

MB declares that he has no competing interests.

The Mary Weinfeld Professor of Clinical Research in Hemophilia

Mount Sinai School of Medicine

New York

NY

利益声明

LA declares that he has no competing interests.

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