深静脉血栓和肺栓塞

Analgesia, Anaesthesia and Pregnancy Pub Date : 2019-05-02 DOI:10.1017/9781108684729.105

J. Griffin

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引用次数: 3

摘要

早在公元前2000年左右，血栓就被认为是一种疾病，但最早使用血栓这个词的是克劳迪亚斯·加莱诺斯(公元130 - 200年)。1676年，Wiseman首次描述了肺栓塞，但直到19世纪40年代，Rudolf Virchow才阐明了静脉血栓和肺栓塞之间的关系。1856年，Virchow描述了血栓形成的三要素，至今仍然有效。他认为血瘀、血管壁损伤和血液成分改变是静脉血栓形成的主要原因。尽管在过去的150年里，血栓形成的研究发生了很多变化，但对血栓形成机制的研究仍然集中在血流状况、血管壁的变化和血液的性质上。现在人们普遍认识到，单独一个因素通常不足以产生血栓。例如，在没有其他危险因素的情况下，正常睡眠或卧床休息时的淤血通常不会引起血栓。虽然血栓形成已被描述在各种解剖部位，最常见和临床意义的是深静脉的腿。静脉血栓发生在血流缓慢的区域，在那里，各种致血栓性刺激局部激活血液凝固，形成少量纤维蛋白沉积物。这些沉积物通常起源于小腿或大腿的深静脉，可作为血栓生长的起点，随后会捕获血细胞并形成额外的纤维蛋白凝胶。如果形成的血栓向近端延伸并增大到足以阻塞静脉流出，则患者可能会感到患肢疼痛和肿胀。或者，如果血栓脱落并向上移动，结果可能是肺栓塞(Millensen & Bauer, 1996)。1894年von Strauch首次报道了外科手术后血栓形成的并发症。肺栓塞作为一种重要的术后死亡原因，在世纪之交开始引起人们的关注。1905年，一项针对美国不同外科医生的调查表明，接受下腹手术和/或妇科手术的患者术后血栓形成的风险很高(Cordier, 1905)。Lister(1927)在对当时知识现状的分析中发现，年龄的增长是创伤后肺栓塞发生的重要危险因素。大约在同一时间，Gustat Petren分析了术后死亡率和肺栓塞死亡的原因，它们的数量增加，主要是面对它们的无助，无论是预防还是治疗，使肺栓塞成为当今实用手术的最大症结。不幸的是，尽管我们对深静脉血栓形成的原因以及治疗和预防静脉血栓栓塞性疾病的治疗和预防措施的了解有所增加，但它在今天的外科手术中仍然非常重要，并且仍然是术后死亡的主要原因。本文阐述了目前已知的静脉血栓栓塞性疾病-•描述了这种疾病的发病率和患病率;•讨论相关的风险因素及其相对重要性;•阐述了深静脉血栓准确诊断存在的困难;•利用已发表的经济评估，考虑现有的治疗和预防深静脉血栓形成的方案及其相对成本效益;•审查1993/94年国家医疗服务体系对深静脉血栓的费用，并计算如果采用适当的预防措施，可能的费用和挽救的生命;并通过询问如何确保所有有发展为深静脉血栓形成风险的患者得到充分的预防来结束。

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Deep-vein thrombosis and pulmonary embolism

The material presented here is being made available by the American Academy of Family Physicians for educational purposes only. Please note that medical information is constantly changing; the information contained in this activity was accurate at the time of publication. This material is not intended to represent the only, nor necessarily best, methods or procedures appropriate for the medical situations discussed. Rather, it is intended to present an approach, view, statement, or opinion of the faculty, which may be helpful to others who face similar situations.

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Analgesia, Anaesthesia and Pregnancy

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