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1、上肢深靜脈血栓upperextremitydeepvenousthrombosis UEDVT定義腋靜脈、鎖骨下靜脈、橈靜脈、尺靜脈、肱靜脈、頸內(nèi)靜脈、頭臂干靜脈最常見：腋靜脈、鎖骨下靜脈原發(fā)性：約占20%繼發(fā)性：指存在危險(xiǎn)因素的深靜脈血栓形成，約占80%CucMai,M.D.H.M.,UpperextremityDeepVenousThrombosisAReview.TheAmericanJournalofMedicine,2011.流行病學(xué)時(shí)間作者住院病人/nUEDVT/n發(fā)生率%1998Kroge
2、r1600003340.21998-2006SyedMustafa44163650.15KrogerK,ScheloC,GockeC,etal.ColourDopplersonographicdiagnosisofupperlimbvenousthromboses[J].ClinSci(Lond),1998,94(6):657-661.SyedMustafa,M.,etal.,upperextremitydeepveinthrombosis.CHEST,2003DVT中所占比例時(shí)間作者DVT/nUEDV
3、T/n發(fā)生率%1999Spencer4836914%2004HyltonV545159211%SpencerFAECLD.UpperExtremityDeepVeinThrombosisACommunity-Based[J].AmJMed,2007,8(120):678-684.HyltonV.JoffeNKVF.Upper-ExtremityDeepVeinThrombosisAProspectiveRegistryof592Patients[J].Circulation,2004,12(110):1
4、605-1611.危險(xiǎn)因素原發(fā)性上肢深靜脈血栓：遺傳性血栓形成傾向：蛋白C、蛋白s或抗凝血酶、凝血因子Ⅲ缺乏，凝血因子VLeiden突變和凝血酶原G20210A突變解剖結(jié)構(gòu)異常：Paget-Schroetter綜合征Grant,J.D.,etal.,Diagnosisandmanagementofupperextremitydeep-veinthrombosisinadults.ThrombHaemost,2012.繼發(fā)性上肢深靜脈血栓CVC置入：45%與CVC有關(guān)腫瘤：38%與惡性腫瘤有關(guān)其他：起搏器
5、、30天內(nèi)手術(shù)史或制動(dòng)史、個(gè)人或者家族深靜脈血栓栓塞史、正在接受化療、伴隨疾?。ǜ哐獕?、糖尿病、神經(jīng)系統(tǒng)疾病、30內(nèi)肺部感染）MunozFJ,MismettiP,PoggioR,etal.Clinicaloutcomeofpatientswithupper-extremitydeepveinthrombosis:resultsfromtheRIETERegistry[J].Chest,2008,133(1):143-148RIETE研究多國(guó)家、多中心DVTUEDVTCVC腫瘤例數(shù)n11564512228
6、196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年美國(guó)多中心研究DVTUEDVTCVC腫瘤例數(shù)5451592324230比例%/11%55%UEDVT中比例39%UEDVT中比例Hy
7、ltonV.JoffeNKVF.Upper-ExtremityDeepVeinThrombosisAProspectiveRegistryof592Patients[J].Circulation,2004,12(110):1605-1611臨床癥狀和體征上肢腫脹：80%患側(cè)肢體疼痛：30—50%較少出現(xiàn)的：患側(cè)肢體紅斑、淺表靜脈曲張、肢體功能障礙、胸痛、呼吸困難、頸部腫脹無(wú)癥狀：約5%診斷D-二聚體超聲對(duì)比靜脈造影：金標(biāo)準(zhǔn)MRI、MRVCTV……vanM.DINISIO,G.L.S.,Accuracyo
8、fdiagnostictestsforclinicallysuspectedupperextremitydeepveinthrombosis.JournalofThrombosisandHaemostasisD-二聚體Merminodetal,2006,Switzerland：500ug/L多普勒超聲確診52例懷疑UEDVT中：1.D-dimer陽(yáng)性：15/5229%2.并發(fā)腫瘤中：8/2334.8%3.CVC：6/1833%4.無(wú)腫瘤、C
