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目的总结老年急性下肢深静脉血栓形成(DVT)的临床特点及诊治经验。方法回顾性分析笔者所在医院于2012年1月至2014年12月收治的98例老年急性下肢DVT患者的临床资料。结果老年DVT患者发病至就诊时间为1~10 d,平均4 d;其主要症状为进行性加重的下肢肿胀。所有患者接受个体化的规范的以抗凝为主的综合治疗。出院后96例患者获访,随访率为98.0%,随访时间为12~24个月(平均18个月)。治疗后3个月96例患者患肢的临床严重程度评分(venous clinical severity score,VCSS)和患肢周径变化(患肢大腿中部周径变化和患肢小腿中部周径变化)与治疗前相比均有显著改善(P<0.001)。96例患者中,治愈9例,显效81例,有效6例。住院及随访期间本组患者均无致死性肺动脉栓塞(PE)发生,且无严重出血并发症发生;随访期间无DVT复发。结论老年急性DVT患者就诊晚,采用个体化的规范的以抗凝治疗为主的综合治疗是安全和有效的。
Objective To summarize the clinical features and diagnosis and treatment of acute lower extremity deep vein thrombosis (DVT) in the elderly. Methods The clinical data of 98 elderly patients with acute lower extremity DVT admitted to our hospital from January 2012 to December 2014 were retrospectively analyzed. Results The onset of treatment for elderly patients with DVT ranged from 1 to 10 days, with an average of 4 days. The main symptoms were progressive lower extremity swelling. All patients underwent individualized normative anticoagulant therapy. After discharge from the hospital, 96 patients were followed up for 98.0%. The follow-up time ranged from 12 to 24 months (average 18 months). Three months after treatment, 96 patients’ venous clinical severity score (VCSS) and change of limb circumference (the change of middle limb thigh diameter and the middle leg leg circumference) (P <0.001). Of the 96 patients, 9 were cured, 81 were markedly effective and 6 were effective. During hospitalization and follow-up, none of the patients in this group had fatal pulmonary embolism (PE), and no severe bleeding complications occurred. No recurrence of DVT was observed during follow-up. Conclusion The elderly patients with acute DVT were treated late and the individualized and standardized anticoagulant therapy was safe and effective.