10449 92
ၡāāࢋ
1-2 30%
34 10
ᙯᔣෟĈஎొᐖਔং ( Deep vein thrombosis )
ংޢা࣏ཏ ( Post- thrombotic syndrome )
݈֏
எొᐖਔং ( deep vein thrombosis ) дለ࡚
ۤົ̚ࠎ˘૱֍়ঽĂ൴ϠதࡗࠎՏѐՏ˼ˠ
̚ 1 ˠ1 Ąংޢা࣏ཏ ( post- thrombotic syn- drome) ࠎஎొᐖਔংޢ̝׀൴াĂॲፂለ࡚
ࡁտ̚Ăдௐ˘ѨஎొᐖਔংޢĂࡗѣ 2 0 % ঽˠົГѨ൴ϠংĂͷ̚ࡗѣ 20-50% ົд 2ѐ̰ົ൴Ϡংޢা࣏ཏ2,3ĄᓜԖܑᇈΞଂ
ᅅাېΒ߁ቲҒԼតăᐖਔѡૺăଈొཚණ̙
ዋĂҌᚑࢦাېтၙّূ൭ăࠤҌଈొሚႹ4Ą
ֱাې၆ଈ۰Ϡ߿ົౄјࢬᇆᜩĄтңΝ
֨̈́ཉংޢা࣏ཏ̪ؠኢĄ
ঽּಡӘ
˘Ҝ 3 4 ໐շّฎमдͽـ݈ઉଐԛ։
рĄдҝੰ݈ 2 ฉฟؕѣν̈ჿཚණĂাېд ܜॡม৭ϲٕ֕ྮޢົΐࢦĂҭߏдЃिޢাې
ົഴᅅĄҝੰॡ֗ࠎ 180 ̶̳ćវࢦࠎ 60 ̳
͝Ąдநጯᑭߤ͞ࢬĂҕᑅࠎ 120 Ɲ 80 ୮ѼՑ ߗĂ͕ྯࠎ 80 ྯ/̶Ăν̈ჿѣͪཚĂҭϩቲ តࡓٕԊొ൴ሤ۞ன෪Ąዶநጯᑭߤ࠰ࠎϒ
૱Ąొ X Ѝځពள૱Ąд၁រވҕ୵ᑭߤ͞
ࢬĂ protein C ࠎ 111.9 ( ϒ૱ቑಛĈ 70-140 )ć pro- tein Sࠎ 85.8 ( ϒ૱ቑಛĈ 55-160 )ć anti-thrombin I I Iࠎ 11 4 . 6 ( ϒ૱ቑಛĈ 8 0 - 1 3 0 ) ćҕ̈ڕࠎ 185x103/ɢ L ( ϒ૱ቑಛĈ 140-450x103/ɢ L )Ă
ዶ၁រވᑭߤᇴፂӮдϒ૱ቑಛ̰Ąᗁरֶፂᓜ ԖাېĂޘᘃႷঽˠѣஎొᐖਔংĄٺߏฟ
ֹؕϡԩҕڼᒚ ( Β߁ enoxaparine 60 mg q12h ̈́ warfarin 1.5 mg qd ) Вڼᒚ 5 ͇Ăٺੰ
݈ warfarin Լј 3 mg qd Ąੰॡ̈ჿ̏ཚ ණຏᛇͷѩॡҕ୵ INR ࠎ 2.58 ĄаזฎԊᚶ ᜈፉЇฎम̍үĂдੰ˟ߐഇޢĂν̈ჿཚණ Г൴ĂॲፂঽˠٙĂϏॡڇᘽĄௐ˟Ѩҝ
ੰॡĂ̪ග̟ԩҕڼᒚĂдੰ݈щଵ८̄
ᗁጯᐖਔᛷᇆдᗕ˭۳ᐖਔҌ˭ටᐖਔ֭൴ன ѣҕংĄ( ဦ˘ ) ੰޢĂঽˠϏؠॡڇᘽĂΪ ѣдাېΐᆐॡĂ̖ڇϡ warfarin Ąдܝ෧
ᖸ 10 ࣎͡Ă INR ࣃ̂ొ̶Ҳٺ 2.0 Ąд൴ঽ 1 0࣎͡ޢĂཚණ۞ଐԛ̏Ϥ̈ჿؼҩҌ̂ჿĂ ͷᇆᜩ۞̍үĂঽˠЯѩГޘˢੰĄѩॡν˭
۳াېΒ߁֕ྮॡূ൭ăຏᛇள૱̈́ՔࢦຏĄந
ጯᑭߤѣͪཚăϩቲតࡓ̈́̈ჿᑅ࢝ॡົѣূ
൭Ă҃ᐖਔҕგᛷᇆдஎᆸ̈́ᆸᐖਔ֭ܡ
Ą( ဦ˟ ) ॲፂ Villita ෞ̶ᛳٺᅅҌ̚ޘং
ޢা࣏ཏĄѩޢঽˠдܝ෧ᖸॡĂাې˘ۡ
ᜈĂ͍дፋ͇̍үඕՁޢĂাېົΐᆐĂঽ ˠЯѩШ̍үಏҜϦኛᖚઃᓟĄ
ኢ
ংޢা࣏ཏଈ۰૱ѣ۞෦Β߁ଈొূ
ဦ˘Ĉдௐ˟ѨҝੰॡĂੰ݈८̄ᗁጯᐖਔᛷᇆ֭
൴னᗕ˭۳ᐖਔҌ˭ටᐖਔѣҕংĄ
ဦ˟Ĉᐖਔҕგᛷᇆ൴னдஎᆸ̈́ᆸᐖਔ֭ܡ
1Ĉ݈∧ᐖਔ ( anterior tibial vein ), 2 Ĉදᐖਔ ( peroneal vein ), 3Ĉ⯰ᐖਔ ( popliteal vein ), 4Ĉஎ۵ᐖਔ ( deep femoral vein ), 5 Ĉᐪ۵ᐖਔ (iliofemoral vein)
൭ăՔࢦຏᛇăཚණă٩ඏăສᚧຏă̈́ו൭ ຏĄݭাېࠎдܜॡม৭ϲ̈́֕ྮॡাېົΐ ࢦĂдЃि̈́πޢাېົഴᅅĄдநጯᑭߤ૱
֍ѣͪཚăҕგᕖૺăҒ৵Ք፥ăৃܑ̈́ϩ ᐖਔѡૺĄдᚑࢦଈ۰Ξਕົѣ lipodermatoscer- losis̈́ሚႹĄ
ংޢা࣏ཏ̝ঽϠந፟ᖼ̪ѣۋኢĂϫ݈
ᄮࠎܜഇᐖਔܡĂ͔ᐖਔᘝቯᗼĂᐖਔր
̚ೈᒖεአĂ̈́ᐖਔҕ୵ਗ਼߹ౌߏΞਕࣧ
Я5,6Ąᐖਔҕংԛј࿅ВΒ߁ˬ࣎ՎូĂҕং
ࢵАົܢٺҕგጨĂତ͔ҕგጨԊొ൴ۆ
ͅᑕĂឰҕংԛј̂ҕĂޢᖣវ̰ҕং໘ ྋ፟טĂֹҕგГޘޭೇ఼ၰ7Ąڼᒚஎొᐖਔ
ং̝ޢĂтڍҕং໘ྋ̙ԆБΞਕົጱᐖਔ ܡĂᐖਔᘝቯజᗼĂ̈́ᐖਔᑅ̿ĄдА݈
ࡁտ˵ҕংԛјҌҕং໘ྋĂֹҕგГޘޭ
ೇ఼ၰ۞ॡมĂజᄮࠎߏϏֽົ൴णјᐖਔҕ୵ ਗ਼߹̝ࢦࢋЯ̄8 Ą Van Bemmelen ଯኢጱᐖਔ
ౕᗆ̙БࢋΒ߁˟࣎ՎូĂࢵАЯࠎܕბᐖਔ ܡĂᅈბᐖਔົᕖૺĂତᐖਔᘝቯЯࠎᐖਔ
ۡशត̂ڱԆБౕЪĂޢд̱࣎͡ޢЯࠎᐖ ਔᘝቯԆБజᗼĂጱϖ˳ᐖਔౕᗆ̙Б9Ą ॲፂ Ginsberg ࡁտଂާّஎొᐖਔং൴ϠޢĂ ᅮࢋ 3-6 ̖࣎͡ΞͽឰЯᐖਔܡ̈́൴ۆͅᑕ͔
۞ূ൭ཚණᒔቤྋĄٙͽࢋ෧ᕝংޢা
࣏ཏҌ͌ࢋඈזஎొᐖਔংޢ 3-6 ࣎͡10Ą ϫ݈̪˘ᇾᑭߤٕ෧ᕝΞͽؠཌྷং
ޢা࣏ཏĄЯࠎމ៍ᑭߤᐖਔౕᗆ̙Б۞̍
পளّ̙Ăٙͽϫ݈ংޢা࣏ཏ۞෧ᕝ̪
ࢋያᓜԖাېĄд Milne ࡁտ̚Ăͽౌ˪ઙ
ࢰگֽෞҤᐖਔᘝቯౕᗆ̙БĂ൴னஎొᐖਔং
ঽˠӈܮѣᐖਔਗ਼߹̝މ៍ᙋፂĂ˵Ξͽ՟ѣ
ংޢা࣏ཏ۞ᓜԖܑᇈ11Ąٙͽ̂ొ̶ѣং
ޢা࣏ཏ۞ঽˠົҡᐌѣᐖਔᘝቯౕᗆ̙Бćҭ ߏ˘ֱঽˠѣᚑࢦᐖਔᘝቯౕᗆ̙БݒΪѣᅅ
ংޢা࣏ཏ۞াېĄଂ֖ࡦొઇᐖਔᛷᇆࠎ෧ ᕝ˭۳ᐖਔܡ۞͞ڱ̝˘ĂΞͽឰԧࣇϤྋ࣠
˯˞ྋᐖਔ͚̈́ೈᒖĂҭߏڱซҖΑਕ˯
۞ෞҤćౌ˪ઙࢰگΞͽ೩ֻᐖਔҕ߹Αਕ
۞ෞҤ̈́ؠҜĄ
Villata ۞ংޢা࣏ཏෞ̶ܑĂЧีᚑࢦ
ޘ̶ˬඈ৺Ă̶Ҿග̟ 1-3 ̶ĂΒ߁ 5 ࣎াې ( ূ ൭ă൭ّ൯ăՔࢦຏăສᚧຏă̈́ຏᛇள૱ )
̈́ 6 ࣎ᇈ෪ ( ͪཚăࡓҒർඕăҒ৵Ք፥ăᐖਔ ѡૺăϩቲតࡓă̈́̈ჿূ൭ )Ąࡶෞ̶ᓁ̶ࠎ 5-14̶ĂᛳٺᅅҌ̚ޘংޢা࣏ཏć̶ᇴ̂
ٺ 15 ̶ͽ˯ࠎᚑࢦংޢা࣏ཏĄ࣎ᖎٽෞ
̶ֹܑ̏ϡд 4 ࣎ለ߷ࡁտ2,3,12,13ĄΩγ Ginsberg
̈́Тဈ˵൴णΩ˘इෞ̶ᇾĂ˵ᑕϡд˘
ֱࡁտ1 4 , 1 5Ąࣇᄮࠎഅѣާّஎొᐖਔংঽ
ΫĂঽˠѣᜈ˘࣎͡ূ൭̈́ཚණĂͷѣݭপ ᇈ-াېົд˘͇̍үඕՁٕܜॡม৭ϲٕӱ
តᆖचćд˯ЃिٕཙొٶॡাېົቤྋĂ Ξͽ෧ᕝࠎংޢা࣏ཏĄΩγĂѣᐖਔౕᗆ̙
Б۞މ៍ᙋፂ˵Ξͽү˘ᅃӄᇾĂপҾߏдѣ ΞਕࠎЯ৵͔˭۳ͪཚ۞ॡ࣏Ą
дཌྷ̂Ӏ۞ཏࡁտពϯĂдௐ˘Ѩஎొᐖ ਔংޢĂჯ K ԩڼᒚ̙ԆБăಏّ
ংГ൴ă֗វኳณᇴă̈́ѐҁࠎ൴Ϡং
ޢা࣏ཏ̝ПᐍЯ̄Ą͍ߏдঽˠڇϡჯ
KԩڼᒚॡĂѣ࿅˘Ηॡม̰ INR Ҳٺ 2.0Ăࠎংޢা࣏ཏ൴Ϡ̝Пᐍཏ ( ౼ზͧࠎ 2.71 Ă 95% ܫᏥડมࠎ 1.44-5.10 )15Ąд Prandoni ࡁտ̚ĂಏГ൴ّஎొᐖਔং̈́ѐ᛬ඈЯ৵ ᄃংޢা࣏ཏ൴Ϡѣ࠹ᙯ16Ą
ᇅّᜑֹϡٺ֨̈́நংޢা࣏ཏ۞֎
Ғ̪ѣۋᛉĄֹϡᇅّᜑΞͽഴ͌ᐖਔᑅ̈́ᐖਔ ਗ਼߹ĂԼචᖐ̈ೈᒖ̈́ᅃӄ̈ჿ҉҇ᑒү ϡĂͽഴ͌ͪཚাېĄ Brandjies ඈˠĂд
͟มఢֹϡ̈́ተܜޘ۞ᇅّᜑ ( ٺཙኺᑅ˧ࡗ ࠎ 40 mmHg )Ăٺܕბ˭۳ᐖਔংޢᖸ˟
ѐĂ൴ன Villata ̶ᇴځពࢫҲ3Ąҭߏᇅّᜑ၆ ٺ˘ֱঽˠΞਕڱዋᑕĂࣧЯΒ߁ࡍᑛޢღ ᒿຏăϩቲສᚧຏᛇă್̈́ሤຏĂֹঽˠึڇ
ّ̙тഇĄܕ˵ѣࡁտᖸ 202 ࣎ঽˠ൴ன ࡍᑛᇅّᜑڱ֨ংޢা࣏ཏĂү۰Ξ ਕࣧЯࠎٙќะ࣎९ᇴͧྵ͌Ăͽٺᇅّᜑ۞
ड़ڍ̙ځព17Ąٙͽ Ginsberg ̈́ТဈޙᛉĂ၆ ٺஎొᐖਔংҌ͌˘࣎͡ޢѣཚණன෪ٕাې ᚑࢦ۞ঽˠѝഇѣቤྋҭдᖸഇม˫ೇ൴Ăᑕ ѝഇֹϡᇅّᜑĄՏֹ͟ϡᇅّᜑΞਕົഴ͌ং
ޢা࣏ཏ̝൴ϠĂ̈́֨ͤߊѣাېГೋ̼Ăপ
Ҿߏдঽˠдᐖਔংޢ̏ѣᜈাېٕཚණன ෪18 Ą
ϫ݈நংޢা࣏ཏ۞ࣧࠎ᎕ໂ֨எ
ొᐖਔং۞Г൴ĄϤٺА݈ࡁտពϯĂಏஎ
ొᐖਔংГ൴ࠎ൴Ϡংޢা࣏ཏПᐍЯ̝̄
˘Ăٙͽ֨Г൴ࠎࢵࢋϫᇾĄѩϫᇾΞᖣϤд எొᐖਔং൴ϠޢĂዋ༊ֹϡ۞ԩҕณ ᄃڼᒚॡมĂͽഴ͌Г൴̝Ξਕّ̈́ҕ׀൴া
ֽ྿јĄώঽּд൴ϠஎొᐖਔংޢĂϤٺϏ
ॡڇᘽ҃дൺഇ̰൴ϠᐖਔংĂ҃ޢ˫Ϗ
ॡڇᘽٺ൴Ϡংޢা࣏ཏĄҌٺтڍঽˠѣ
۞ПᐍЯ̄тѐҁă̈́֗វኳณᇴĂ˵
ื၆ঽˠΐૻିĄ
ણ҂͛ᚥ
1.Anderson FA, Wheeler B, Goldberg RJ, et al. A population-based perspective of the hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism. Ann Intern Med 1991; 151: 933-8.
2.Prandoni P, Lensing AW, Cogo A, et al. The long -term clinical course of acute deep vein thrombosis. Ann Intern Med 1996;
125; 1-7.
3.Brandjes DPM, Buller HR, Heijboer H, et al. Randomised trial of effect of compression stockings in patients with symptomat- ic proximal-vein thrombosis. Lancet 1997; 349: 759-62.
4.Bernardi E, Prandoni P. The post-thrombotic syndrome. Curr Opin Pulm Med. 200l; 6: 335-42.
5.Immelman EJ, Jeffery PC. The postphlebitic syndrome.
Pathophysiology, prevention and management. Clin Chest Med 1984; 5: 537-50.
6.Strandness DE Jr, Langlois Y, Cramer M, Randlett A, Thiele BL.
Long-term sequelae of acute venous thrombosis. JAMA 1983;
250: 1289-92.
7.Browse NL, Burnand KG, Lea- Thomas M. In: Disease of vein.
London: Hodder and Stoughhnton Ltd.; 1988: 307-8.
8.Meissener MH, Manzo RA, Bergelin RO, et al. Deep vein in- sufficiency: the relationship between lysis and subsequent re- flux. J Vasc Surg 1993; 18: 596-608.
9.van Bemmelen SP. Venous valvular incompetence: an experi- ence study in the rat. Allblasserdam, The Netherlands: Offset- Drukkerij Kaners BV; 1984.
10.Khan SR, Ginsberg JS. The post-thrombotic syndrome: current, knowledge, controversies and directions for future research.
Blood review 2002; 16: 155-65.
11.Milne AA, Stonebridge PA, Bradbury AW, et al. Venous func- tion and clinical outcome following deep vein thrombosis. Br J Surg 1994; 81: 847-9.
12.Villata S, Prandoni P, Cogo A, et al. The utility of non- invasive tests for detection of previous proximal-vein thrombosis.
Thromb Haemost 1995; 73: 592-7.
13.van Dongen CJJ, Prandoni P, Frulla M, Marchiori A, Prins MH, Hutten BA. Relation between quality of anticoagulant treatment and the development of the postthrombotic syndrome. J Thromb Haemost 2005; 3: 939-42.
14.Ginsberg JS, Gent M, Turkstra F, et al. Post- thrombotic syn- drome after hip or knee arthroplasty. Arch Inter Med 2000; 160:
669-72.
15.Ginsberg JS, Brill- Edward P, Kowalchuk G, et al. Intermittent compression units for the post- thrombophlebitic syndrome: a pilot study. Ann Intern Med 1989; 149: 1651-2.
16.Brandjes DPM, Buller HR, Heijboer H, et al. Randomized trial of effect of compression stockings in patients with symptomat- ic proximal-vein thrombosis. Lancet 1997; 349: 759-62.
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Blood reviews 2002; 16: 155-65.
..
A Case Study of Preventing Post-Thrombotic Syndrome After Deep Vein Thrombosis
Chun-Yen Chen, Cheng-Ho Tsai, and Hung-I Yeh
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 af- ter DVT. One recent study from Italy demonstrates that older patients with under-treatment of Vitamin K antag- onist, ipsilateral recurrence and high BMI have a higher chance of developing post-thrombotic manifestations af- ter 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 recur- rence 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. ( J Intern Med Taiwan 2008;
19: 153- 157 )
Cardiovascular Division, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan;
Mackay Medicine, Nursing and Management College, Taipei, Taiwan
