深靜脈血栓

深靜脈血栓
深靜脈血栓
	右腿的深靜脈血栓。注意紅腫處。
類型	經濟機艙症候群
分類和外部資源
醫學專科	心臟科
ICD-11	BD71
ICD-10	I80.2
ICD-9-CM	453.40
DiseasesDB	3498
MedlinePlus	000156
eMedicine	med/2785
MeSH	D020246
	[編輯此條目的維基數據]

深靜脈血栓是在深靜脈形成的血栓，常形成於下肢或骨盆部位深處的靜脈。有時也形成於上肢的靜脈（這被稱為Paget-Schrötter綜合症（英語：Paget–Schroetter disease））。

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誘因

近期接受外科手術、住院^[1]^[2]、長期缺乏活動（例如在長程航班中^[2]^[3]）、吸煙、肥胖、年長、服用特定藥物（例如雌性激素或促紅細胞生成素）以及先天的血栓形成傾向等因素會提高形成深靜脈血栓的風險。服用複合口服避孕藥或處於產後護理期的婦女由於雌性激素水平上升而有更高的風險形成深靜脈血栓。

旅行血栓症

旅行血栓症^[4]是指旅行者形成深靜脈血栓。^[5]也有使用「經濟艙綜合徵」或「經濟客位綜合徵」來描述這個症狀。^[6]乘坐飛機遠途旅行的人通常易患旅行血栓症。深靜脈血栓可以引起肺栓塞這一嚴重併發症。

旅行者形成血栓可能是缺乏活動、脫水和隱藏因素的共同作用。在飛行途中的環境因素也可能與此有關。^[7]^[8]儘管和飛行有關係，但這個問題是和缺乏活動聯繫在一起的，所以乘坐巴士、火車和汽車的旅行者也有同樣的風險。^[9]

患有易形成血栓疾病（如抗磷脂綜合徵或癌症）的人患病風險會高出很多。風險最高的人群包括老人、有嚴重疾病（例如癌症）的病人、最近接受矯形外科手術（腿或膝蓋）的人以及孕婦。^[10]一些研究者認為耐力類運動員也是高危人群。^[11]^[12]

世界衛生組織的WRIGHT（World Health Organisation Research Into Global Hazards of Travel）項目研究了旅行和靜脈血栓（包括深靜脈血栓和/或肺栓塞）的關係。^[13]據該項目報告，形成靜脈血栓的風險大約在乘坐長程航班（大於4小時）後翻倍。其他讓旅行者長時間保持坐着不動的旅行方式也會增加風險。風險隨着旅行時間和其他旅行者具有的靜脈血栓風險因素增長。

症狀

深靜脈血栓出現時可能沒有症狀，但多數情況下四肢會疼痛、腫大、發紅、發熱，可能使淺靜脈脹大。深靜脈血栓可能引起的最嚴重的併發症是血栓分裂流入肺部引發的肺栓塞。未經治療的下肢深靜脈血栓引發肺栓塞而導致死亡的概率是3%。由上肢深靜脈血栓導致的死亡非常罕見。^[14]

流行病學

深靜脈血栓影響約5%的人群。^[15]

診斷

常用血液D-二聚體檢測和對靜脈的多普勒超聲檢查診斷深靜脈血栓。有時，深靜脈血栓的誘因需要進一步檢查。

預防

旅行者

有證據顯示在旅行時穿壓力襪或緊身衣可以減少在長程航班上形成深靜脈血栓的情況。2001年的一個隨機對照研究比較了2組長程航班乘客，其中一組穿緊身襪類而另一組不穿，並對所有那些乘客進行掃描和血液測試以檢查深靜脈血栓情況。結果顯示10%沒有穿緊身襪類的乘客出現了無症狀的深靜脈血栓。而穿了緊身襪類的一組沒有出現深靜脈血栓。研究者由此認為，穿彈性緊身襪類可以減少長程航班旅客出現深靜脈血栓情況。^[16]

其它預防措施包括攝取足夠水分（飲水，儘量不飲用含酒精和咖啡因飲料）、走動和活動小腿肌肉。^[5]有風險因素的旅行者應該尋求醫療建議並考慮預防性治療。

坐在靠窗座位的飛機乘客，因為較不易起身走動，出現深靜脈血栓的風險更大。^[17]

參考資料

[1]
Spencer FA, Lessard D, Emery C, Reed G, Goldberg RJ. Venous thromboembolism in the outpatient setting. Arch. Intern. Med. 2007, 167 (14): 1471–5. PMC 2762787 . PMID 17646600. doi:10.1001/archinte.167.14.1471.
[2]
Bulger CM, Jacobs C, Patel NH Epidemiology of acute deep vein thrombosis.Tech Vasc Interv Radiol. 2004 Jun;7(2):50-4. PMID 15252760
[3]
Tsai A, Cushman M, Rosamond W, Heckbert S, Polak J, Folsom A. Cardiovascular risk factors and venous thromboembolism incidence: the longitudinal investigation of thromboembolism etiology. Arch Intern Med. 2002, 162 (10): 1182–9. PMID 12020191. doi:10.1001/archinte.162.10.1182.
[4]
Bagshaw M. Traveller's thrombosis: a review of deep vein thrombosis associated with travel. The Air Transport Medicine Committee, Aerospace Medical Association.. Aviation, space, and environmental medicine. 2001, 72 (9): 848–851. PMID 11565823.
[5]
Philbrick JT, Shumate R, Siadaty MS, Becker DM. Air travel and venous thromboembolism: a systematic review. Journal of general internal medicine : official journal of the Society for Research and Education in Primary Care Internal Medicine. 2007, 22 (1): 107–14. PMC 1824715 . PMID 17351849. doi:10.1007/s11606-006-0016-0.
[6]
Cruickshank, JM; Gorlin, R; Jennett, B. Air travel and thrombotic episodes: the economy class syndrome.. Lancet. August 1988, 2 (8609): 497–8. PMID 2900413.
[7]
Bendz B, Rostrup M, Sevre K, Andersen TO, Sandset PM. Association between acute hypobaric hypoxia and activation of coagulation in human beings. Lancet. 2000, 356 (9242): 1657–8. PMID 11089830. doi:10.1016/S0140-6736(00)03165-2.
[8]
存档副本. [2022-01-10]. （原始內容存檔於2006-10-19）.
[9]
Ferrari E, Chevallier T, Chapelier A, Baudouy M. Travel as a risk factor for venous thromboembolic disease: a case-control study. Chest. 1999, 115 (2): 440–4. PMID 10027445. doi:10.1378/chest.115.2.440.
[10]
Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR, Colwell CW; American College of Chest Physicians. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008, 133 (6 Suppl): 381S–453S. PMID 18574271. doi:10.1378/chest.08-0656.
[11]
Meyering C, Howard T. Hypercoagulability in athletes. Curr Sports Med Rep. 2004, 3 (2): 77–83. PMID 14980135.
[12]
Harvey T, Reynolds P. Athletics, Fitness. Airhealth.org. [February 3, 2010]. （原始內容存檔於2021-02-11）.
[13]
World health organization. WHO Research Into Global Hazards of Travel (WRIGHT) Project : final report of phase I. 2007.
[14]
. Turpie AGG. Deep Venous Thrombosis. The Merck's Manuals Online Medical Library. March 2008 [2011-06-17]. （原始內容存檔於2020-03-13）.
[15]
Duffett, Lisa. Deep Venous Thrombosis. Annals of Internal Medicine. 2022-09, 175 (9) [2024-03-28]. ISSN 0003-4819. doi:10.7326/AITC202209200. （原始內容存檔於2024-03-28）（英語）.
[16]
Scurr JH, Machin SJ, Bailey-King S, Mackie IJ, McDonald S, Smith PD. Frequency and prevention of symptomless deep-vein thrombosis in long-haul flights: a randomised trial. Lancet. May 2001, 357 (9267): 1485–9. PMID 11377600. doi:10.1016/S0140-6736(00)04645-6.
[17]
Schreijer, Anja J. M.; Suzanne C. Cannegieter, Carine J. M. Doggen, Frits R. Rosendaal. The effect of flight-related behaviour on the risk of venous thrombosis after air travel. British Journal of Haematology. Nov 25, 2008, 144 (3): 425–429. PMID 19036084. doi:10.1111/j.1365-2141.2008.07489.x.

參考文獻

Dalen JE. Venous thromboembolism. CRC Press. 2003 [2020-01-02]. ISBN 978-0-8247-5645-1. （原始內容存檔於2013-06-20）.
Guyatt GH, Akl EA, Crowther M, et al. Executive summary: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. February 2012, 141 (2 Suppl): 7S–47S. PMC 3278060 . PMID 22315257. doi:10.1378/chest.1412S3.
Hecht ME. A practical guide to hip surgery: From pre-op to recovery. Sunrise River Press. 2010 [2020-01-02]. ISBN 978-1-934716-12-0. （原始內容存檔於2013-12-31）.
Rosendaal FR. van Beek EJ, Büller HR, Oudkerk M , 編. Deep vein thrombosis and pulmonary embolism. John Wiley & Sons. 2009 [2020-01-02]. ISBN 978-0-470-74499-4. （原始內容存檔於2013-06-20）.
Welch E. Venous thromboembolism: A nurse's guide to prevention and management. John Wiley & Sons. 2010 [2020-01-02]. ISBN 978-0-470-51189-3. （原始內容存檔於2020-11-25）.

外部連結

（英文）Economy-Class Syndrome and Deep Vein Thrombosis （頁面存檔備份，存於網際網路檔案館）
（英文）North American Thrombosis Forum （頁面存檔備份，存於網際網路檔案館）
（英文）Antithrombotic and Thrombolytic Therapy, 8th Ed: ACCP Guidelines. Chest (American College of Chest Physicians). June 2008, 133 (6 suppl b–C).
（英文）International Society on Thrombosis and Haemostasis （頁面存檔備份，存於網際網路檔案館）
（英文）DVT patient information

[pmid17646600-1] [1]
Spencer FA, Lessard D, Emery C, Reed G, Goldberg RJ. Venous thromboembolism in the outpatient setting. Arch. Intern. Med. 2007, 167 (14): 1471–5. PMC 2762787 . PMID 17646600. doi:10.1001/archinte.167.14.1471.

[ReferenceA-2] [2]
Bulger CM, Jacobs C, Patel NH Epidemiology of acute deep vein thrombosis.Tech Vasc Interv Radiol. 2004 Jun;7(2):50-4. PMID 15252760

[3] [3]
Tsai A, Cushman M, Rosamond W, Heckbert S, Polak J, Folsom A. Cardiovascular risk factors and venous thromboembolism incidence: the longitudinal investigation of thromboembolism etiology. Arch Intern Med. 2002, 162 (10): 1182–9. PMID 12020191. doi:10.1001/archinte.162.10.1182.

[pmid11565823-4] [4]
Bagshaw M. Traveller's thrombosis: a review of deep vein thrombosis associated with travel. The Air Transport Medicine Committee, Aerospace Medical Association.. Aviation, space, and environmental medicine. 2001, 72 (9): 848–851. PMID 11565823.

[pmid17351849-5] [5]
Philbrick JT, Shumate R, Siadaty MS, Becker DM. Air travel and venous thromboembolism: a systematic review. Journal of general internal medicine : official journal of the Society for Research and Education in Primary Care Internal Medicine. 2007, 22 (1): 107–14. PMC 1824715 . PMID 17351849. doi:10.1007/s11606-006-0016-0.

[6] [6]
Cruickshank, JM; Gorlin, R; Jennett, B. Air travel and thrombotic episodes: the economy class syndrome.. Lancet. August 1988, 2 (8609): 497–8. PMID 2900413.

[pmid11089830-7] [7]
Bendz B, Rostrup M, Sevre K, Andersen TO, Sandset PM. Association between acute hypobaric hypoxia and activation of coagulation in human beings. Lancet. 2000, 356 (9242): 1657–8. PMID 11089830. doi:10.1016/S0140-6736(00)03165-2.

[8] [8]
存档副本. [2022-01-10]. （原始內容存檔於2006-10-19）.

[pmid10027445-9] [9]
Ferrari E, Chevallier T, Chapelier A, Baudouy M. Travel as a risk factor for venous thromboembolic disease: a case-control study. Chest. 1999, 115 (2): 440–4. PMID 10027445. doi:10.1378/chest.115.2.440.

[pmid18574271-10] [10]
Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR, Colwell CW; American College of Chest Physicians. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008, 133 (6 Suppl): 381S–453S. PMID 18574271. doi:10.1378/chest.08-0656.

[PMID14980135-11] [11]
Meyering C, Howard T. Hypercoagulability in athletes. Curr Sports Med Rep. 2004, 3 (2): 77–83. PMID 14980135.

[12] [12]
Harvey T, Reynolds P. Athletics, Fitness. Airhealth.org. [February 3, 2010]. （原始內容存檔於2021-02-11）.

[13] [13]
World health organization. WHO Research Into Global Hazards of Travel (WRIGHT) Project : final report of phase I. 2007.

[14] [14]
. Turpie AGG. Deep Venous Thrombosis. The Merck's Manuals Online Medical Library. March 2008 [2011-06-17]. （原始內容存檔於2020-03-13）.

[15] [15]
Duffett, Lisa. Deep Venous Thrombosis. Annals of Internal Medicine. 2022-09, 175 (9) [2024-03-28]. ISSN 0003-4819. doi:10.7326/AITC202209200. （原始內容存檔於2024-03-28）（英語）.

[16] [16]
Scurr JH, Machin SJ, Bailey-King S, Mackie IJ, McDonald S, Smith PD. Frequency and prevention of symptomless deep-vein thrombosis in long-haul flights: a randomised trial. Lancet. May 2001, 357 (9267): 1485–9. PMID 11377600. doi:10.1016/S0140-6736(00)04645-6.

[17] [17]
Schreijer, Anja J. M.; Suzanne C. Cannegieter, Carine J. M. Doggen, Frits R. Rosendaal. The effect of flight-related behaviour on the risk of venous thrombosis after air travel. British Journal of Haematology. Nov 25, 2008, 144 (3): 425–429. PMID 19036084. doi:10.1111/j.1365-2141.2008.07489.x.

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