栓塞後症候群：一病例報告

A Case Study of Preventing Post-Thrombotic Syndrome after Deep Vein Thrombosis

陳俊延(Chun-Yen Chen) ； 蔡正河(Cheng-Ho Tsai) ； 葉宏一(Hung-I Yeh)

《內科學誌》 19卷2期 (2008/04) Pp. 153-157

https://doi.org/10.6314/JIMT.2008.19(2).08

摘要

栓塞後症候群為深部靜脈栓塞後之併發症，其特徵是持續患部疼痛腫脹。在歐美的研究中，有症狀的深部靜脈栓塞的病人在發病l-2年後，約有30%病人會有栓塞後症候群。在台灣目前未有此症候群發生率的相關資料。從這個病例，我們嘗試報告在深部靜脈栓塞後發生栓塞後症候群的病情發展。在義大利研究中，在第一次深部靜脈栓塞後，發生栓塞後症候群的危險因子為使用抗凝血劑治療不完全、年老、高身體質量指數及單側深部靜脈栓塞再發。一部份栓塞後症候群病人可能因為腳部症狀導致失能，無法維持正常工作。我們將報告一位34歲男性因深部靜脈栓塞再發及未規則服用抗凝血劑，於10個月追蹤後發生栓塞後症候群。目前仍無一標準檢查或診斷率則可以定義栓塞後症候群。栓塞後症候群之診斷主要是依據典型臨床症狀。防止此症候群發生最好方法為防止深部靜脈靜脈栓塞之發生，一旦發生深部靜脈栓塞後，投予抗凝血劑必須有適當劑量及治療時間來防止栓塞後症候群發生。彈性襪使用於栓塞後症候群目前仍有爭議，但是對於病人患肢有持續症狀或腫脹時，則建議使用彈性襪。

關鍵字

深部靜脈栓塞 ； 栓塞後症候群

並列摘要

Post Thrombotic Syndrome (PTS) is a chronic complication of Deep Vein Thrombosis (DVT). This syndrome is characterized by chronic and persistent pain with swelling in the affected limb. From Europe and North America's medical studies, data show that PTS develops within one to two years in 30% of DVT patients.. However, there is no PTS data available in Taiwan. In this case report, we will make the attempt to report PTS development after DVT. One recent study from Italy demonstrates that older patients with under-treatment of Vitamin K antagonist, ipsilateral recurrence and high BMI have a higher chance of developing post-thrombotic manifestations after suffering the first episode of DVT. Some patients with PTS are disabled and unable to maintain a steady job due to their related leg symptoms. For our case study, we have completed a 10-month follow-up study of a 34-year-old patient with DVT. We find that the reason this patient suffered PTS is because of inadequate intensity of anticoagulation for DVT and recurrent DVT. Even to this day, there is no ”gold standard” test method nor has there been a universal diagnosis definition of PTS. In this report, we are suggesting that the diagnosis of PTS should be based primarily on the presence of typical clinical features. The best way to minimize both risk recurrence and bleeding of PTS is by prescribing adequate intensity and duration of anticoagulation for initial DVT treatment. Daily use of elastic compression stockings in managing PTS is controversial. Elastic compression stockings is recommend in patients with persistent symptoms or swelling after DVT.

並列關鍵字

Deep vein thrombosis ； Post-thrombotic syndrome