深静脉血栓

深静脉血栓
深静脉血栓
	右腿的深静脉血栓。注意红肿处。
类型	经济机舱症候群
分类和外部资源
医学专科	心脏内科
ICD-11	BD71
ICD-10	I80.2
ICD-9-CM	453.40
DiseasesDB	3498
MedlinePlus	000156
eMedicine	med/2785
MeSH	D020246
	[编辑此条目的维基数据]

深静脉血栓是在深静脉形成的血栓，常形成于下肢或骨盆部位深处的静脉。有时也形成于上肢的静脉（这被称为Paget-Schrötter综合症（英语：Paget–Schroetter disease））。

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诱因

近期接受外科手术、住院^[1]^[2]、长期缺乏活动（例如在长程航班中^[2]^[3]）、吸烟、肥胖、年长、服用特定药物（例如雌性激素或促红细胞生成素）以及先天的血栓形成倾向等因素会提高形成深静脉血栓的风险。服用复合口服避孕药或处于产后护理期的妇女由于雌性激素水平上升而有更高的风险形成深静脉血栓。

旅行血栓症

旅行血栓症^[4]是指旅行者形成深静脉血栓。^[5]也有使用“经济舱综合征”或“经济客位综合征”来描述这个症状。^[6]乘坐飞机远途旅行的人通常易患旅行血栓症。深静脉血栓可以引起肺栓塞这一严重并发症。

旅行者形成血栓可能是缺乏活动、脱水和隐藏因素的共同作用。在飞行途中的环境因素也可能与此有关。^[7]^[8]尽管和飞行有关系，但这个问题是和缺乏活动联系在一起的，所以乘坐巴士、火车和汽车的旅行者也有同样的风险。^[9]

患有易形成血栓疾病（如抗磷脂综合征或癌症）的人患病风险会高出很多。风险最高的人群包括老人、有严重疾病（例如癌症）的病人、最近接受矫形外科手术（腿或膝盖）的人以及孕妇。^[10]一些研究者认为耐力类运动员也是高危人群。^[11]^[12]

世界卫生组织的WRIGHT（World Health Organisation Research Into Global Hazards of Travel）项目研究了旅行和静脉血栓（包括深静脉血栓和/或肺栓塞）的关系。^[13]据该项目报告，形成静脉血栓的风险大约在乘坐长程航班（大于4小时）后翻倍。其他让旅行者长时间保持坐着不动的旅行方式也会增加风险。风险随着旅行时间和其他旅行者具有的静脉血栓风险因素增长。

症状

深静脉血栓出现时可能没有症状，但多数情况下四肢会疼痛、肿大、发红、发热，可能使浅静脉胀大。深静脉血栓可能引起的最严重的并发症是血栓分裂流入肺部引发的肺栓塞。未经治疗的下肢深静脉血栓引发肺栓塞而导致死亡的概率是3%。由上肢深静脉血栓导致的死亡非常罕见。^[14]

流行病学

深静脉血栓影响约5%的人群。^[15]

诊断

常用血液D-二聚体检测和对静脉的多普勒超声检查诊断深静脉血栓。有时，深静脉血栓的诱因需要进一步检查。

预防

旅行者

有证据显示在旅行时穿压力袜或紧身衣可以减少在长程航班上形成深静脉血栓的情况。2001年的一个随机对照研究比较了2组长程航班乘客，其中一组穿紧身袜类而另一组不穿，并对所有那些乘客进行扫描和血液测试以检查深静脉血栓情况。结果显示10%没有穿紧身袜类的乘客出现了无症状的深静脉血栓。而穿了紧身袜类的一组没有出现深静脉血栓。研究者由此认为，穿弹性紧身袜类可以减少长程航班旅客出现深静脉血栓情况。^[16]

其它预防措施包括摄取足够水分（饮水，尽量不饮用含酒精和咖啡因饮料）、走动和活动小腿肌肉。^[5]有风险因素的旅行者应该寻求医疗建议并考虑预防性治疗。

坐在靠窗座位的飞机乘客，因为较不易起身走动，出现深静脉血栓的风险更大。^[17]

参考资料

[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]. （原始内容存档于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]. （原始内容存档于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]. （原始内容存档于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. （原始内容存档于2024-03-28）（英语）.
[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.

参考文献

Dalen JE. Venous thromboembolism. CRC Press. 2003 [2020-01-02]. ISBN 978-0-8247-5645-1. （原始内容存档于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. （原始内容存档于2013-12-31）.
Rosendaal FR. van Beek EJ, Büller HR, Oudkerk M , 编. Deep vein thrombosis and pulmonary embolism. John Wiley & Sons. 2009 [2020-01-02]. ISBN 978-0-470-74499-4. （原始内容存档于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. （原始内容存档于2020-11-25）.

外部链接

（英文）Economy-Class Syndrome and Deep Vein Thrombosis （页面存档备份，存于互联网档案馆）
（英文）North American Thrombosis Forum （页面存档备份，存于互联网档案馆）
（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 （页面存档备份，存于互联网档案馆）
（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]. （原始内容存档于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]. （原始内容存档于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]. （原始内容存档于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. （原始内容存档于2024-03-28）（英语）.

[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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