【摘要】 目的 探讨健康教育路径在下腔静脉滤器（inferior vena cava filter，VCF）置入术患者中的应用效果。 方法 2008年1月－2010年5月，将62例VCF置入术患者随机分为观察组（32例）和对照组（30例），观察组采用健康教育路径进行健康教育，对照组患者采用常规健康教育。 结果 观察组患者的健康教育达标率明显高于对照组（Plt;0.05），焦虑发生率明显低于对照组。 结论 应用健康教育路径对VCF置入术患者实施，能提高患者对健康知识的掌握程度和效果，促进患者早日康复；同时可强化护患沟通，和谐护患关系。【Abstract】 Objective To investigate the effect of health education pathway in patients treated with placement of inferior vena cava filter (VCF). Methods Sixty-two patients treated with placement of inferior VCF from January 2008 to May 2010 were randomly divided into experimental group (n=32) and control group (n=30). Health education pathway and routine general way were adopted respectively to treat patients in the experimental group and the control group. Results Standard-achieving rate of the health education in the experimental group was significantly higher than that in the control group (Plt;0.05), and the incidence of anxiety was also lower in the experimental group. Conclusion Health education pathway for patients treated with placement of inferior VCF can increase the patients’ health care knowledge, lessen patients’ anxiety, and strengthen the nurse-patient communication and harmonious relations.
目的探讨经腘静脉置溶栓导管灌注溶栓治疗急性下肢深静脉血栓形成（DVT）的临床应用价值。方法对28例急性DVT患者（其中2例合并肺动脉栓塞）在超声引导下经患肢腘静脉穿刺置入溶栓导管至髂、股静脉血栓中进行溶栓治疗，并对溶栓效果进行分析。 结果全组患者溶栓后症状明显改善，下肢肿胀消退，肺部症状缓解。溶栓后患、健侧大腿周径差〔(1.72±1.23) cm〕明显小于溶栓前〔(5.47±1.29) cm〕,差异有统计学意义(t=12.14，Plt;0.01)， 患肢大腿消肿率为91.58%; 溶栓后患、健侧小腿周径差〔(1.55±0.77) cm〕也明显小于溶栓前〔(5.04±1.32) cm〕，差异有统计学意义（t=13.81，Plt;0.01)，患肢小腿消肿率为84.92%。溶栓后静脉通畅评分〔(4.34±3.55)分〕明显低于溶栓前〔(15.23±4.64) 分〕，差异有统计学意义(t=6.42，Plt;0.01 )，溶栓后静脉平均通畅率为87.43%。 2例合并肺动脉栓塞患者中，1例栓子完全溶解，1例大部分溶解。 所有患者均无严重并发症。 25例患者获随访，随访1～12个月（平均7.16个月），无一例出现血栓再发。结论经腘静脉置管溶栓治疗急性DVT是一种安全、有效的治疗方法。
Objective To explore the therapeutic effect of catheter-directed thrombolysis combined with vena cava filter on deep venous thrombosis (DVT) of lower extremity.Methods The clinical data of 65 patients with DVT of lower extremities from January 2008 to August 2009 were analyzed retrospectively, whose course of diseases were not more than 7 d and clinical type included central type and mixed type. Thirty-two cases were treated with catheter-directed thrombolysis combined with vena cava filter, while administrating treatment of anticoagulation and activating blood circulation to dissipate blood stasis, which were named as study group. Thirty-three cases were treated traditionally with thrombolysis, anticoagulation, and activating blood circulation to dissipate blood stasis, which were named as control group. The course of therapy was continued 10-14 d, then the efficacy in two groups patients was evaluated. Results It was (7.35±1.42) cm that circumference difference before treatment between affected extremties and unaffected extremties in study group, which of 3, 7, and 14 d after treatment was (4.21±1.12) cm， (2.87±0.98) cm, and (1.22±1.02) cm, respectively. Circumference difference between before and after treatment had significant difference in study group (Plt;0.01). It was (6.97±1.27) cm that circumference difference before treatment between affected extremties and unaffected extremties in control group, which of 3, 7, and 14 d after treatment was (5.72±1.31) cm, (4.58±0.88) cm, and (3.18±1.24) cm, respectively. Circumference difference between before treatment and 3, 7, and 14 d after treatment had significant difference in control group (Plt;0.05 or Plt;0.01). Circumference difference before treatment in two groups had no significant difference (Pgt;0.05). Circumference difference after treatment at different time points in two groups was significantly different, respectively (Plt;0.01). Circumference difference after treatment at different time points in study group was significantly less than that in control group, respectively (Plt;0.01). After 14 d, complete recanalization rate （71.88%, 23/32） and cure rate (71.88%, 23/32) of iliofemoral vein in study group were significant higher than that (36.36%, 12/33) in control group (Plt;0.01). No pulmonary embolism occurred. Conclusion In terms of ideal therapy targets of DVT of lower extremity, the catheterdirected thrombolysis combined with vena cava filter is obviously superior to traditional thrombolysis treatment.
Objective To discuss and evaluate the value of insertion of inferior vena cava filter in treating lower extremity deep venous thrombosis (DVT). Methods Inferior vena cava filters were placed in 46 patients with lower extremity DVT prior treatment, 20 in which were treated by therapy with anticoagulation and thrombolysis, and therapy with pressure gradient, and the other 26 patients by operation and thrombolysis therapy, and therapy with pressure gradient. Whether patients occurred pulmonary embolism was observed and the form and site of filters were monitored by periodic fluoroscopy. Results Inferior vena cava filters were placed successfully in all patients, 38 cases were implanted permanence inferior vena cava filter, 8 cases were implanted temporary inferior vena cava filter. Symptoms and signs of DVT disappeared or remitted in 44/46 patients after treatment. None of pulmonary embolism was occurred. Follow up 2-24 months (average 13 months) for 36 cases with permanence inferior vena cava filter, there was no complication of the filter and pulmonary embolism occurred. Conclusions The method of inserting inferior vena cava filter is simple and safe, which can prevent pulmonary embolism effectually to offer sufficient safeguard for the treatment of DVT.
ObjectiveTo assess the therapeutic effect of catheter thrombolysis combined with inferior vena cava (IVC) filter placement in treatment of deep venous thrombosis (DVT) complicated with floating IVC thrombus. MethodsThe clinical data of 16 patients with DVT complicated with floating IVC thrombus from July 2013 to November 2014 in this hospital were collected. These patients were treated with the catheter thrombolysis combined with IVC filter placement, the IVC filter was placed via jugular vein, the catheter thrombolysis was performed by the side of the small saphenous vein, the amount of urokinase was (60-80) ×104 U/d. Results①The floating IVC thrombi of 13 patients were disappeared following catheter thrombolysis combined with IVC filter placement therapy, a small amount of visible thrombi were adhered on the recycled IVC filter, the lower limb swelling was relieved, the IVC could effectively open.②The IVC filters of 2 patients could not be recycled due to the adhesion of floating IVC thrombus and lumen of IVC resulting in luminal stenosis.③The floating IVC thrombus of 1 patient was disappeared, the IVC filter could not be recy-cled due to a large of thrombi adhered on the IVC filter. The lower limb swelling was slowly relieved. The complications such as severe pulmonary embolism didn't happen in all the patients during treatment and following-up. ConclusionThe limited data preliminarily shows that it is an effective and safe method by catheter thrombolysis combined with IVC filter placement in treatment of DVT complicated with floating IVC thrombus.
ObjectiveTo explore the effect of catheter directed thrombolysis (CDT) in treatment of acute deep venous thrombosis (ADVT) in lower extremity. MethodsLimb circumference at 15 cm above and below the knee at affected side, as well as patency improvement score of 46 patients with ADVT in lower extremity, who received treatment in The Rocket Army General Hospital of PLA between January 2014 and October 2015, were colleted retrospectively, to analyze the effect of CDT in treatment of ADVT in lower extremity. ResultsAll patients were placed catheter successfully, 5 patients were placed catheter by 'contralateral mountain' technique retrograde, 40 patients were placed catheter through the limb popliteal vein at affected side anterograde, guiding by ultrasound, 1 patient was placed catheter through femoral vein at affected side. All of 46 patients got successful thrombolysis, and thrombolysis time was (4.7±1.8) d (3-12 d). There were 8 patients suffered from complications in different situation, and got treatment of drug withdrawal or tube drawing all ease, no one died. Compared with before CDT treatment in same group, the limb circumference at 15 cm above (P=0.028, P=0.017, P=0.031) and below (P=0.035, P=0.038, P=0.047) the knee at affected side, and patency improvement score (P=0.023, P=0.028, P=0.031) in all patients group, 22-45 years group, and 46-74 years group were all lower after CDT treatment. The limb circumference at 15 cm above (P=0.073, P=0.387, P=0.358) and below (P=0.416, P=0.625, P=0.253) the knee at affected side after CDT treatment were not differed with corresponding indexes of healthy side in the same group of all patients group, 22-45 years group, and 46-74 years group. Ultrasound after treatment showed that, blood vessel recanalization occurred in 15 patients (32.6%), partial blood vessel recanalization occurred in 28 patients (60.9%), but thrombus of 3 patients (6.5%) didn't removed, the total effective rate was 93.5% (43/46). Forty three patients were followed up for 1-24 months, the median is 18-month. During follow-up period, skin color obviously deepened after the activity occurred in 5 patients, obvious limb acid bilges occurred in 19 patients, vein thrombosis (DVT) recurred in 9 patients of 28 patients with partial blood vessel recanalization, in addition, thrombosis syndrome (PTS) occurred in 11 patients. ConclusionCDT is the most direct and effective way to treat ADVT.
Objective To explorer the application value of the inferior vena cava filter (IVCF) implantation in the prevention of recurrent pulmonary embolism (PE). Methods Clinical data of 265 inpatients with PE admitted from November 2014 to November 2016 were retrospectively analyzed. The patients were divided into an IVCF treatment group (55 cases) and an anticoagulant therapy group (210 cases) according to treatment measure. All patients were followed up for 3 months to 2 years through regular review. The one-year PE and deep vein thrombosis (DVT) recurrence rates, one-year mortality and two-year mortality were compared between two groups. Results The PE and DVT recurrence rates were 9.1% and 21.8% in the IVCF treatment group, and were 18.6% and 11.0% in the anticoagulant therapy group, respectively. The PE recurrence rate was lower and the DVT recurrence rate was higher in the IVCF treatment group compared with the anticoagulant therapy group, the differences were statistically significant (P<0.05). The one-year mortality (29.1% vs. 12.9%) and two-year mortality (34.5% vs. 14.8%) were significantly higher in the IVCF treatment group than those in the anticoagulant therapy group (P<0.05). Conclusions IVCF without anticoagulation can reduce incidence of pulmonary embolism caused by the lower extremity DVT, but will increase DVT recurrence rate. It may be an alternative option for prevention of PE in patients with contraindications to anticoagulant therapy or recurrent PE patients after regular anticoagulant therapy.
ObjectiveTo discuss the implantation and conversion technology of convertible inferior vena cava filter and the experience of management.MethodsThe clinical data of 115 patients with convertible inferior vena cava filter implantation admitted to our vascular surgery center from January 2018 to December 2018 was retrospectively analyzed.ResultsAmong the 115 patients with convertible inferior vena cava filter implantation, 74 were males and 41 were females. The ages ranged from 22 to 87 years, with median age 54 years. The successful rate of filter implantation was 100% without any surgical related complications. After implantation surgery, patients were followed up from 4 to 455 days with a median of 90 days and the recurrence rate of adverse events was 7.8% (9/115). The recurrence time were 16 to 104 days after conversion, with a median of 42 days. Twenty-three patients (20.0%) received filter conversion, one of them failed and all the others succeeded. The technical successful rate was 95.7% (22/23). The conversion operative time was 22.8 to 51.4 min, with median time 27.4 min. The intervals between implantation and conversion were from 4 to 455 days, with median time 159 days. Accessory techniques were used in 20 of 22 successful filter conversions and the application rate of accessory technique was 90.9%. The patients were followed-up from 30 to 180 days after conversion with a median time of 90 days and no adverse event was reported.ConclusionConvertible inferior vena cava filter is a significant choice for patients application of inferior vena cava filter due to its high safety of conversion surgery, technical success rate and possibility of conversion after long-term indwelling.
Objective To identify and analyze all medical injury liability disputes lawsuits pertaining to inferior vena cava filters (IVCF) in “Lexis®China” database, the causes and outcomes of litigation of the cases were clarified with a view, and to provide suggestions for preventing potential medical patient dispute lawsuits and improving the clinical diagnosis and treatment level of doctors. Method The term “inferior vena cava filter” was searched in Lexis®China, and spanning from 2011-01-01 to 2022-12-31. Results A total of 221 cases of medical injury liability disputes were found, after screening and exclusion, a total of 179 relevant cases were included in this study for analysis. All first instance lawsuits were brought by patients against hospitals and had a high rate of compensation awarded (91.6%). Forty four cases were entered second instance litigation, and the proportion of maintaining the original judgment was high (68.2%). The main content involving the modification of the judgment was to increase the compensation amount (85.7%). In the 14 lawsuits related to the failure to place IVCF by the medical authority, the litigation points were all disputes arising from the hospital’s improper diagnosis and treatment of VTE patients, which led to the failure to place IVCF, with the highest proportion (92.3%) of improper diagnosis and treatment of pulmonary embolism (PE). For PE and deep vein thrombosis patients with clear indications for IVCF implantation but not placed, leading to litigation, the hospital bore different liability for compensation (18%–100%) depending on the fault factors of the hospital’s negligence in diagnosis and treatment. The hospital could also be held responsible for inadequate informed disclosure to affect patient judgment (23.1%). In 165 lawsuits related to the placement of IVCF, the vast majority of IVCF implants were for the diagnosis and treatment of VTE in patients (73.9%). However, such unplanned operations caused additional injuries and expenses to patients, and VTE occurred most frequently during hospitalization (76.2%). This type of embolism was most commonly secondary to fracture incision and fixation surgery (31.2%), and the average liability of hospitals for compensation varied due to different secondary factors. The occurrence of intraoperative and postoperative complications related to IVCF implantation could also lead to litigation (18.8%), and the proportion of dead patients in litigation was relatively high (32.3%). The most common complication leading to litigation was PE recurrence or exacerbation (22.5%), while intraoperative complications were vascular injury during interventional procedures (2/3). The overall trend of IVCF-related lawsuits reserves between 2011 and 2020 showed an overall upward trend, reaching a peak of 37 cases in 2020; the average amount of damages exceeded 100 000 yuan per case in 10 of the 12 years included in the statistics. Conclusions In China’s IVCF-related medical liability lawsuits, patients most often sue their doctors, who are often sued for failure to insert a filter due to untimely diagnosis and treatment of VTE, inadequate notification of informed consent for IVCF insertion, unplanned IVCF insertion due to the presence of VTE and IVCF-related complications, and the outcome is often unfavourable to the doctors. In addition, the number of IVCF related lawsuits and hospital compensation amounts have remained high in recent years.