彩色多普勒超声在颅脑损伤后围术期患者隐性孤立性小腿肌间静脉丛血栓中的应用

摘要

目的探讨彩色多普勒超声在颅脑损伤后围术期患者隐性孤立性小腿肌间静脉血栓中的应用价值.方法对解放军第一一三医院高压氧科收治的782例颅脑损伤后围术期患者行常规下肢深静脉彩色多普勒超声检查,分析孤立性小腿肌间静脉丛血栓的临床及声像图特点.结果小腿肌间静脉丛血栓119例,其中孤立性小腿肌间静脉丛血栓102例,合并近端深静脉血栓者17例.孤立性小腿肌间静脉丛血栓患者中,双肢病变13例(12.7%,13/102)；单肢病变89例(87.3%,89/102),其中左侧52例(58.4%,52/89),右侧37例(41.6%,37/89).超声声像图示：受累静脉内径不规则增宽,管壁增厚,内膜粗糙,其内可见不均质异常实性回声,呈长条形,横切呈类圆形,阻塞部位管腔不能或部分能压闭；彩色多普勒超声示：无彩色血流显示或血流充盈缺损向心绕行.比目鱼肌血栓长度(2.1±0.8)cm,受累静脉内径(7.9±3.2)mm；腓肠肌血栓长度(1.7±0.6)cm,受累静脉内径(6.4±2.1)mm.比目鱼肌血栓长度及受累静脉内径大于腓肠肌,差异均有统计学意义(t值分别为4.87、4.96,P均<0.05).结论彩色多普勒超声是诊断颅脑损伤后围术期患者孤立性小腿肌间静脉丛血栓的首选方法,可显示血栓的部位、大小、累及范围,并可对血栓进行动态监测,为临床治疗及疗效评价提供可靠依据.%Objective To explore the clinical value of color Doppler ultrasonography in diagnosis of calf muscular venous thrombosis during peri-operation period after craniocerebral injury .Methods Regular lower limb deep venous color Doppler ultrasonography was performed in 782 patients who came from the department of hyperbaric oxygen during peri-operation period after craniocerebral injury .Results There were 119 cases of calf muscular venous thrombosis in total ,in which 102 cases were isolated calf venous thrombosis and 17 cases were complicated with proximal deep vein thrombosis .The incidence of calf venous thrombosis in single leg(89 patients,87.3%,89/102)was higher than that in both legs(13 patients,12.7%, 13/102),and the incidence of calf venous thrombosis in left leg (52 cases,58.4%,52/89)was higher than that in right leg(37 cases,41.6%,37/89).Ultrasonography showed irregularly widened vein with thickened wall and coarse intima.Heterogeneous echogenicity which was elongated in the long axis and round in the short axis can be found in the vein.The lumen of the obstruction site can not be partly or completely pressed . Color Doppler ultrasnongarphy showed no color flow or blood filling defect .The length of thrombus in soleus was(2.1 ±0.8) cm and the affected vein diameter was (7.9 ±3.2) mm.The length of thrombus in gastrocnemius was(1.7 ±0.6) cm and the involvement vein diameter was (6.4 ±2.1) mm.There were significant difference between soleus and gastrocnemius (t=4.87,4.96,both P<0.05).Conclusions Color Doppler ultrasnongarphy is the preferred method to diagnose isolated calf muscular venous thrombosis during peri-operation period after craniocerebral injury .It can display the position and size of thrombus and the extent of complication,dynamically monitor thrombus and provide a reliable basis of clinical treatment and curative effect evaluation.