静脉 血栓形成
Overview
血栓形成 (throm-BO-sis) refers to the formation of a blood clot in a blood vessel. 而凝块可以在动脉或静脉中形成, 这篇文章只关注发生在静脉中的血块, 叫做静脉血栓形成.
血栓, 或“血栓,阻塞或损害静脉中的血液流动, 导致症状和继发性并发症.
血栓形成可能没有明显的原因, 但它通常与血凝块的遗传倾向有关, 外科手术, 不动, 口服避孕药的使用或潜在的医疗状况. 医疗状况，例如 怀孕, 癌症炎性肠病，当然 疾病疾病 和 肥胖 会增加血栓形成的风险.
血栓常发生在腿部. When it affects the deep veins — rather than the superficial veins you can see under your skin — it is called a deep vein thrombosis (also called deep venous thrombosis), 或深静脉血栓形成.
Embolism (EM-bo-lizm) refers to the sudden blockage of a blood vessel from a clot or other material. 不像血栓是在阻塞部位形成的, an embolism originates in one location in the body 和 travels to a second site where it causes the blockage. One of the more common types of embolism occurs in the lung, called a pulmonary embolism (PE). Pulmonary embolisms usually come from a deep vein thrombosis that formed in the leg or pelvic region, 它们可能会危及生命.
我们治疗静脉血栓的方法
主要治疗深静脉血栓, 或者在深静脉中形成的血块, 抗凝治疗. Anticoagulant medications can prevent clots from forming 和 stop an existing clot from getting bigger, 身体会自行清除血块. A small percentage of patients also need a filter inserted into the large vein that leads from the legs to the heart, 来阻止将来的血块到达肺部. UCSF's world-class hematologists 和 interventional radiologists work together to provide expert insertion 和 removal of these filters.
对于那些特别容易发生血栓的准妈妈们, our hematology team works closely with UCSF obstetricians who specialize in high-risk 怀孕. This partnership provides the best possible treatment before, 怀孕期间和怀孕后.
奖 & 识别
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迹象 & 症状
A venous thrombosis can form anywhere in the body, 和 症状 depend on the site of the clot.
腿是最常见的部位之一. 迹象 和 症状 include pain or stiffness, swelling 和 redness in the affected leg. 这种不适可能从大腿上部到脚踝的任何地方开始. All of these signs 和 症状 do not need to be present if you have a blood clot in your leg. 通常，患者只会感到肿胀和一些不适. If the clot or part of the clot travels to the lungs — a pulmonary embolism — you can experience chest pain, 呼吸急促或头晕.
一些病人通过静脉导管接受药物或液体. Catheters can stimulate thrombus formation in the vein near 和 around the catheter, 称为导管相关DVT. 因为导管通常位于手臂或胸部, 这样的血栓会导致手臂或颈部肿胀, 无论疼痛与否.
病人 with inflammatory bowel disease 和 patients with certain blood disorders, including 骨髓增殖性肿瘤 和 paroxysmal nocturnal hemoglobinuria, sometimes develop thrombosis in veins in the abdomen. 这被称为肠系膜静脉血栓形成. 肠系膜静脉血栓形成有时会引起腹部不适, 但可能没有相关症状.
诊断。
An 超声波 检查是诊断腿部或手臂血栓最常用的检查方法. A CAT(或CT)扫描, a sophisticated type of x-ray, is commonly used to diagnose a pulmonary embolism. A CAT scan is also the most common method used to diagnose a thrombosis in the abdomen, 骨盆和头部.
胸部血栓形成, abdomen or pelvis is sometimes discovered during a CAT scan performed for a different reason. The patient 和 doctor need to develop individualized treatment plans for these incidentally discovered clots.
除了找到血块本身, the diagnostic evaluation sometimes involves blood tests that can help explain why the clot happened in the first place. 其中一些测试寻找特定的基因变化, 其他人会在你的血液中寻找抗体, 和 others test for the amount or activity of proteins that help you form 和 clear blood clots.
治疗
Anticoagulation is the cornerstone for treating deep venous thrombosis 和 pulmonary embolism. 抗凝药物会降低身体形成血栓的能力. 有些人称抗凝剂为“血液稀释剂”,但它们实际上不会“稀释”你的血液, 它们损害了血液的凝血能力.
血管在日常生活中会出现小缺陷, 凝血系统修补这些缺陷以防止出血. 血栓ting system is also responsible for stopping bleeding when you cut yourself. The goal of anticoagulation therapy is to find a middle ground where you continue to clot when your body needs to clot, yet at the same time prevents your thrombosis or embolism from getting worse. 这是, anticoagulation therapy seeks to prevent new clots 和 the growth of current clots, while your body’s natural system for removing clots — called the 'lysis' or 'lytic’ system — clears the thrombus or embolism.
Anticoagulation therapy traditionally involves heparin or heparin-like medicines given by vein or by a shot under the skin, 然后口服华法林(香豆素). 病人 taking warfarin need regular monitoring with a blood test called an INR. New oral anticoagulants are becoming available that do not require regular blood test monitoring, 和 some of them do not require receiving anticoagulants by vein or under the skin. 现在, 然而, 大多数dvt和pe是通过静脉或皮下给药治疗的, 接着是口服抗凝剂, 最常见的是华法林.
在某些情况下, 患者需要一个物理设备, 一个“过滤器,插入从腿部到心脏的大静脉, 叫做下腔静脉. 过滤器的作用是阻止任何未来的栓塞到达肺部. 而只有一小部分患者需要这样的装置, UCSF has world-class interventional radiologists who work closely with our hematologists to provide expert insertion 和 removal of these filters when needed.
For obstetrical patients who have had or are predisposed to having a blood clot, UCSF hematologists work closely with the UCSF high-risk obstetricians to provide optimal treatment plans before, 怀孕期间和怀孕后.
加州大学旧金山分校健康医学专家已经审查了这些信息. It is for educational purposes only 和 is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.
