How to treat lower extremity thrombosis?

Question 1: What are the treatment methods for venous thrombosis of lower limbs? (1) treatment

A small amount of deep venous thrombosis of lower limbs can lead to fatal pulmonary embolism, so the treatment should include venous thrombosis of lower limbs itself and how to prevent pulmonary embolism. There are two main treatment methods for acute phase: surgical treatment and non-surgical treatment, each with its own characteristics, and which method is better is still controversial. The treatment methods of chronic stage include drug therapy, surgical therapy and compression therapy.

1. Acute treatment

(1) General treatment: Once deep venous thrombosis of lower limbs occurs, the patient should stay in bed to reduce the chance of pulmonary embolism caused by thrombus shedding due to walking and avoid squeezing swollen lower limbs. Raising the affected limb above the heart level is beneficial to blood return and promotes the swelling to subside. Bed rest time is generally about 2 weeks. After 2 weeks, wearing elastic socks with step pressure difference or wrapping the affected limb with elastic bandage can accelerate tissue swelling and relieve symptoms.

(2) Anticoagulation therapy: Anticoagulation therapy is the earliest and most widely used method to treat venous thrombosis of lower limbs. Anticoagulation itself cannot dissolve the formed thrombus, but it can inhibit the diffusion of thrombus and cooperate with the body's own fibrinolytic system to dissolve thrombus, thus achieving the purpose of treatment. At the same time, it can effectively reduce the occurrence of pulmonary embolism and play a decisive role in the prevention and treatment of pulmonary embolism. Other surgical or non-surgical treatment methods should generally use anticoagulant therapy as adjuvant therapy. The duration of anticoagulation therapy can run through the whole course of disease, which usually takes 1 ~ 2 months, some patients can last for half a year ~ 1 year, and some even need lifelong anticoagulation. However, anticoagulant therapy is prohibited in the following situations: patients with digestive tract ulcer, patients with severe liver and renal insufficiency, patients with recent cerebral hemorrhage, patients with abortion, patients with congenital coagulation factor deficiency, etc.

① Heparin: the most commonly used anticoagulant, whose anticoagulant effect is mainly to inhibit thrombosis by increasing the activity of antithrombin ⅲ (AT ⅲ). Heparin takes effect quickly, has a short half-life and is stable in the body. The aqueous solvent of heparin is mainly 12500U/ branch, which is equivalent to 100mg. There are two ways of administration: intravenous injection and subcutaneous deep fat injection. Intramuscular injection is easy to cause hematoma at the injection site and should not be used. Subcutaneous injection of deep fat layer is simple, but the concentration of heparin in the body is not easy to control accurately, and the injection site is generally selected under the abdominal wall. Intravenous injection method uses micropump for continuous intravenous administration. This heparin administration method has the advantages of quick onset, easy dosage control, stable heparin concentration in vivo and easy adjustment, and is an ideal administration method. The specific method is to inject heparin 50mg (6250U) intravenously at one time, so that the concentration of heparin in the body quickly reaches the peak, and then drip heparin diluent intravenously at 30ml/h (heparin 200mg (25000U) dissolved in 500ml 5% glucose saline). However, the dosage of heparin should be reduced to 20 ml/h in the following cases: those who have had surgery within 2 weeks; Stroke within 2 weeks; Platelet count >;

Question 2: How to treat venous thrombosis of lower limbs? It's better to treat symptoms. You should have a light diet and eat more black fungus, and your blood circulation is particularly good ~ ~? Venous thrombosis of lower extremity refers to the formation of venous thrombosis of lower extremity.

There was no difference in age and sex, and the lesions mainly occurred in veins of limbs. Thrombosis, especially deep venous thrombosis of lower limbs, often has poor therapeutic effect, and often leaves deep venous obstruction or venous valve insufficiency of lower limbs. Occasionally, severe cases may cause pulmonary embolism due to thrombus shedding.

Blood stasis, hypercoagulability and vascular wall injury are the three main factors causing venous thrombosis, one of which may play a leading role, and other factors complement each other, leading to thrombosis.

clinical picture

1. superficial venous thrombosis (i.e. thrombotic superficial phlebitis)

Most of them occur in superficial veins of limbs (those blue-purple blood vessels with clearly visible skin), such as great saphenous vein and small saphenous vein. This disease is easy to recur.

In the acute stage, the affected limb is locally painful and swollen, and a tender cord can be felt along the damaged vein, with high skin temperature and redness. After 1 ~ 3 weeks, venous inflammation gradually subsided, and there were bands and skin pigmentation locally, which lasted for a long time.

2. Deep venous thrombosis of lower limbs

Thrombosis can occur in any part of the vein of the lower extremity, and the symptoms will be mild and severe according to the different parts of the thrombus.

When thrombosis only occurs in the deep vein of the leg (peripheral type), the symptoms are not obvious, showing mild calf swelling pain, mild gastrocnemius tenderness and local heavy feeling, so it is easy to be ignored; When the thrombus continues to extend from the calf to the thigh, the swelling pain of the calf becomes more and more obvious, the superficial vein below the groin expands and swells, and the triangular area of the femur (the triangular area of the inner thigh near the groin is about 3M2) has obvious tenderness, and the tender cord can be felt, thus forming iliofemoral vein thrombosis (central type). At this time, it may be accompanied by fever, fatigue, tachycardia, leukocytosis and other systemic symptoms. If the thrombus goes out to sea, it will cause pulmonary embolism with serious consequences. When pulmonary embolism occurs, there will be cough, chest pain, dyspnea and even cyanosis, shock and sudden death. If the whole deep venous system of lower limbs is extensively thrombosed (mixed type), which not only causes venous obstruction due to thrombosis, but also causes strong arterial spasm, the pain of lower limbs is severe, the whole limb is widely and obviously swollen, and the skin is tense, shiny and purple-brown. Blisters may appear in some parts, and the pulsation of posterior tibial artery and dorsal tibial artery disappears, leading to shock and limb venous gangrene (ulcer and necrosis). This special type is also called "femoral contusion".

diagnose

With the above typical clinical manifestations, it is generally not difficult to diagnose.

In order to further determine the location, degree and scope of the lesion, the following examination methods can be adopted:

1, ultrasonic inspection is a common inspection method. Ultrasound can directly observe the diameter and lumen of vein and understand the size and location of embolism. Real-time color Doppler imaging has good specificity and sensitivity (up to 95%) for deep vein thrombosis above the knee.

2. Venography is the most accurate examination method, which can effectively judge whether there is thrombus, its size, location, shape and collateral circulation. At the same time, retrograde angiography can be used to understand the function of venous valves. However, this method is necessary because it has certain damage and may also cause allergic reaction or renal function damage.

treat cordially

First, the treatment of superficial thrombophlebitis

1. General treatment: stay in bed, raise the affected limb above the heart level, apply local hot compress, and wear elastic socks or bandages if necessary. Avoid standing or sitting for a long time.

2, drug treatment: painkillers include: Baotaisong, indomethacin (indomethacin), piroxicam (Yantongxikang), aspirin, etc. Generally, antibiotics or anticoagulants are not needed for treatment.

Second, the treatment of deep venous thrombosis

General treatment: rest in bed, raise the affected limb above the heart level, about 20 ~ 30 cm away from the bed surface, and slightly bend the knee joint. Keep the stool unobstructed and avoid pulmonary embolism caused by forced defecation and thrombus shedding. Wear long stretch socks for 6 weeks to 3 months after getting up.

2. Anticoagulation therapy

Answer: Heparin: Intravenous heparin can make the thromboplastin time reach 1.5-2 times of normal, and the treatment lasts for 5-7 days. However, the dosage of intravenous heparin is difficult to control, and a little carelessness may cause bleeding, so the safer methods can be low molecular weight heparin and subcutaneous injection.

1, b: warfarin: Warfarin was taken orally after 5 days of heparin treatment until the INR index of coagulation (thrombokinase time) reached 2-3 times of the normal level. Thereafter, the maintenance dose was given for 3 ~ 4 months.

3. The commonly used drugs for thrombolytic therapy are urokinase, streptokinase and fibrinolytic enzyme. Because it is easy to cause bleeding, its long-term curative effect is no better than ...

Question 3: How should lower extremity thrombosis be generally treated? Symptomatic prescription suppository

Question 4: Is the treatment of leg thrombosis arterial or venous?

Acute arterial embolism requires emergency embolectomy.

Intracavitary thrombolysis is very effective after 6-8 hours of thrombosis. Thrombolysis and anticoagulation should be performed in the acute stage, and absolute bed rest is required. If the thrombus position is high, besides age and other factors, we can consider placing venous filter, routine thrombolytic and anticoagulant therapy for about 2 weeks, and then taking warfarin 1.5 years to monitor pt and INR.