上肢深静脉血栓研究进展VIP免费

上肢深静脉血栓upperextremitydeepvenousthrombosisUEDVT定义•腋静脉、锁骨下静脉、桡静脉、尺静脉、肱静脉、颈内静脉、头臂干静脉•最常见：腋静脉、锁骨下静脉•原发性：约占20%•继发性：指存在危险因素的深静脉血栓形成，约占80%CucMai,M.D.H.M.,UpperextremityDeepVenousThrombosisAReview.TheAmericanJournalofMedicine,2011.流行病学时间作者住院病人/nUEDVT/n发生率%1998Kroger1600003340.21998-2006SyedMustafa44163650.15KrogerK,ScheloC,GockeC,etal.ColourDopplersonographicdiagnosisofupperlimbvenousthromboses[J].ClinSci(Lond),1998,94(6):657-661.SyedMustafa,M.,etal.,upperextremitydeepveinthrombosis.CHEST,2003DVT中所占比例时间作者DVT/nUEDVT/n发生率%1999Spencer4836914%2004HyltonV545159211%SpencerFAECLD.UpperExtremityDeepVeinThrombosisACommunity-Based[J].AmJMed,2007,8(120):678-684.HyltonV.JoffeNKVF.Upper-ExtremityDeepVeinThrombosisAProspectiveRegistryof592Patients[J].Circulation,2004,12(110):1605-1611.危险因素原发性上肢深静脉血栓：•遗传性血栓形成倾向：蛋白C、蛋白s或抗凝血酶、凝血因子Ⅲ缺乏，凝血因子VLeiden突变和凝血酶原G20210A突变•解剖结构异常：Paget-Schroetter综合征Grant,J.D.,etal.,Diagnosisandmanagementofupperextremitydeep-veinthrombosisinadults.ThrombHaemost,2012.继发性上肢深静脉血栓•CVC置入：45%与CVC有关•肿瘤：38%与恶性肿瘤有关•其他：起搏器、30天内手术史或制动史、个人或者家族深静脉血栓栓塞史、正在接受化疗、伴随疾病（高血压、糖尿病、神经系统疾病、30内肺部感染）MunozFJ,MismettiP,PoggioR,etal.Clinicaloutcomeofpatientswithupper-extremitydeepveinthrombosis:resultsfromtheRIETERegistry[J].Chest,2008,133(1):143-148RIETE研究多国家、多中心DVTUEDVTCVC肿瘤例数n11564512228196比例%/4.4%45%UEDVT中比例38%UEDVT中比例MunozFJ,MismettiP,PoggioR,etal.Clinicaloutcomeofpatientswithupper-extremitydeepveinthrombosis:resultsfromtheRIETERegistry[J].Chest,2008,133(1):143-1482004年美国多中心研究DVTUEDVTCVC肿瘤例数5451592324230比例%/11%55%UEDVT中比例39%UEDVT中比例HyltonV.JoffeNKVF.Upper-ExtremityDeepVeinThrombosisAProspectiveRegistryof592Patients[J].Circulation,2004,12(110):1605-1611临床症状和体征•上肢肿胀：80%•患侧肢体疼痛：30—50%•较少出现的：患侧肢体红斑、浅表静脉曲张、肢体功能障碍、胸痛、呼吸困难、颈部肿胀•无症状：约5%诊断•D-二聚体•超声•对比静脉造影：金标准•MRI、MRV•CTV……vanM.DINISIO,G.L.S.,Accuracyofdiagnostictestsforclinicallysuspectedupperextremitydeepveinthrombosis.JournalofThrombosisandHaemostasisD-二聚体•Merminodetal,2006,Switzerland：•500ug/L多普勒超声确诊•52例怀疑UEDVT中：1.D-dimer阳性：15/5229%2.并发肿瘤中：8/2334.8%3.CVC：6/1833%4.无肿瘤、CVC：4/2218%诊断的敏感性为100%，特异性为14%，阳性预测价值为32%，阴性排除价值为100%，超声PICC低回声不可压缩性超声敏感性特异性加压超声97%96%彩色多普勒84%94%DiNisioM,VanSluisGL,BossuytPM,etal.Accuracyofdiagnostictestsforclinicallysuspectedupperextremitydeepveinthrombosis:asystematicreview[J].JThrombHaemost,2010,8(4):684-692UEDVT诊断•急性期：确诊血栓后的前三个月可以降低血栓后综合征、血栓复发的发生率。•预防期：急性期治疗后的阶段目的是控制血栓形成的危险因素治疗（参考下肢深静脉血栓形成）治疗（参考下肢深静脉血栓形成）•拔除深静脉置管•抗凝•溶栓•上腔静脉滤器•手术取栓术Grant,J.D.,etal.,Diagnosisandmanagementofupperextremitydeep-veinthrombosisinadults.ThrombHaemost,2012抗凝ACCP建议：同下肢深静脉血栓KearonC,KahnSR,AgnelliG,etal.Antithrombotictherapyforvenousthromboembolicdisease:AmericanCollegeofChestPhysiciansEvidence-BasedClinicalPracticeGuidelines(8thEdition)[...