摘要
目的总结心脏永久性起搏器置入后上肢深静脉血栓的发生情况及治疗经验。方法302例心脏永久起搏器置入术后或行起搏器更换手术的患者,采用彩色血流和频谱多普勒超声方法,部分患者行患侧上肢静脉造影检查,探查患者上肢深静脉血栓形成情况,门诊随访至术后6～12个月。结果上肢深静脉血栓组和无血栓组在年龄、性别、病史,植入电极导线数量,抗血小板/抗凝治疗情况等临床资料无差异。随访中发生上肢深静脉血栓形成,静脉狭窄、闭塞45例,发生率14.9%,无患者发生血栓脱落栓塞事件,其中有症状的患者14例,占31.1%,均有不同程度患侧上肢肿胀、疼痛、肤色变深,有的患者活动明显受限,出现时间于术后3天～1年,检查提示为新鲜血栓,经尿激酶溶栓、低分子肝素、华法林抗凝治疗以及抗血小板治疗后,患者症状均明显改善,治疗3个月后超声显示血栓消失。无症状者31例,占68.9%,28例(90.3%)为陈旧性血栓,侧枝循环丰富;余3例为新鲜血栓。结论心脏永久起搏器术后上肢深静脉血栓形成是常见并发症之一,术后应密切观察,定期随访。对上肢深静脉血栓形成患者,给予华法林维持治疗3个月是必须和有效的。
Objective To investigate the incidence and treatment of deep venous thrombosis of upper extremities after implantation of cardiac pacemaker. Methods 302 patients were retrospectively studied. In order to detect upper extremity deep venous thrombosis（ UEDVT）, the patients underwent upper extremities vascular ultrasound. Some patients had up- per extremities digital subtraction venography. The patients were divided into UEDVT group and non-UEDVT group. Resuits The incidence of UEDVT was 14.9% （45/302）. 14 patients （31. 1% ）had upper extremities symptoms, such as swollen, pain, skin color changed or activity limited of the upper extremities in 3 days to 1 year after pacemaker implanta- tion. Since the examination showed new thrombosis in deep veins of upper extremities, the patients received thrombolysis treatment, anticoagulation, fluid expansion, by using low molecular heparin 100 IU/kg, subcutaneous injection twice a day, or urokinase 300 000 - 500 000 U/d intravenous drip through upper extremity veins in pacemaker implantation side for 3 - 5 days. Low molecule dextran 500 ml/d intravenous drip for 5 days. The symptoms and deep venous thrombosis of all 14 patients disappeared. Maintenance therapy with oral anticoagulant of warfarin lasted more than 3 months. 31 UEDVT pa- tients had no upper extremities symptoms, 28 of them were detected old thrombosis with collateral circulation, 3 patients had new thrombosis. A follow-up period was at least 6 - 12 months after pacemaker implantation. All of patients had no thromboembolism. Conclusions Deep venous thrombosis of upper extremities after implantation of cardiac pacemaker is one of common postoperative complications. Applying low molecular heparin or warfarin treatment and maintenance therapy with warfarin is safe and effective. [ Chinese Journal of Cardiac Pacing and Electrophysiology ,2008,22 （5） ：411 -413 ]
出处
《中国心脏起搏与心电生理杂志》
2008年第5期411-413,共3页
Chinese Journal of Cardiac Pacing and Electrophysiology
关键词
心血管病学
心脏起搏
并发症
深静脉血栓
血管超声
Cardiology
Cardiac pacing
Complications
Deep venous thrombosis
Vascular ultrasound
作者简介
杨俊娟（1966-），女（汉族），河北定州人，主任医师，硕士生导师，医学博士，研究方向为心脏起搏及心电生理、心律失常射频消融术等。
