Superficial thrombophlebitis of the extremities
Introduction
Introduction to thrombosis of superficial phlebitis Thrombotic superficial phlebitis is a thrombotic inflammation in the visible vein of the human body. The clinical manifestation is along the superficial vein. It is red, swollen, hot, painful, with a cord or hard nodule. The tenderness is obvious. Common clinical diseases. Thrombosis can cause inflammation, and inflammation can also cause blood clots, which are mutually causal. basic knowledge The proportion of illness: 0.005% Susceptible people: no specific population Mode of infection: non-infectious Complications: pulmonary embolism thrombosis venous thrombosis
Cause
Causes of thrombosis of superficial phlebitis
Causes
Thrombotic superficial phlebitis of the extremities can be caused by different reasons, and can be divided into three categories clinically:
Superficial phlebitis caused by chemical drug stimulation:
Intravenous injection of various irritating solutions, such as hypertonic glucose solution, various antibiotics, alkylating agents, organic iodine solution, etc., can cause chemical stimulation on the inferior venous intima of the injection, resulting in a wider range of The injury, rapid thrombosis, and a significant inflammatory response.
Catheter for continuous infusion:
It often causes direct damage to the vein wall, thrombosis, and rapid inflammatory response, which is common in critically ill patients such as extensive burns, severe trauma and major surgery.
Lower extremity varicose veins:
Whether it is a saphenous vein or a small saphenous vein, due to venous blood stasis, the skin of the foot boots often suffers from nutritional changes and is subject to chronic infection, which can cause hypoxic and inflammatory damage to the varicose veins, leading to thrombosis. Superficial phlebitis.
Prevention
Prevention of thrombosis of superficial phlebitis
Proper warmth: Everyone knows that in a warm environment, the blood vessels will expand and the skin will become rosy; on the contrary, the skin will appear pale, so in the cold season and in the air-conditioned room, it is appropriate to keep warm, which is true for patients with vasculitis. It is very important that the cold will cause the blood vessels to contract, the blood flow to be reduced, and the symptoms caused by ischemia to become more serious.
Preventing trauma and timely treatment of wounds not only aggravate vascular injury and paralysis, but also reduce the anti-infective power of the limbs that are already in an ischemic state, causing the wounds to be difficult to heal, even if the mold infections that are usually not taken seriously, such as athlete's foot, etc. The affected limb poses a threat. Therefore, avoid foot collisions, crush injuries, and prompt treatment if trauma or foot mold infection occurs.
Exercise on the affected limb: Functional exercise not only prevents muscle atrophy, but also increases the blood flow of the limb, promotes the opening of the vascular branch and maintains the ability of the limb to move. However, the exercise of the affected limb cannot be performed too fast, and the amount of activity should be appropriate because the affected limb itself is in short supply. Blood status, excessive activity will inevitably aggravate the symptoms. The activities mentioned here are appropriate, so as not to cause limb pain.
Reduce blood viscosity: blood flow rate is slow, blood viscosity increases, can cause thrombosis, completely occluded the already narrow artery, can drink more water, usually eat black fungus, and can take small dose under the guidance of a doctor aspirin.
Complication
Complications of thrombosis and superficial phlebitis Complications, pulmonary embolism, thrombosis, venous thrombosis
In the later stage, there are dystrophic changes, accompanied by hoarding dermatitis, hyperpigmentation or superficial ulcer. The circumference of the femoral and temporal iliac crest is more than 1cm thicker than the healthy limb. The swelling and pain are aggravated when walking, and it is relieved after lying down. If the thrombus falls off, it will move. To the lungs, it may cause severe pulmonary embolism complications. There are two ways for PE (pulmonary embolism) caused by thrombosis of superficial phlebitis in the lower extremities:
(1) The basic pathological changes of thrombotic superficial phlebitis are inflammatory reaction and thrombosis. The thrombus can spread up or down along the saphenous vein, which may involve deep veins of the lower extremities and form thrombus, which may lead to pulmonary embolism. Clinically, the lower extremity cavity Patients with venous thrombosis may sometimes have a history of thrombotic superficial phlebitis of the lower extremities.
(2) The superficial vein thrombosis of the lesion directly falls off, and PE is caused by blood circulation.
Symptom
Common symptoms of thrombosis of superficial veins of the extremities Common symptoms The limbs are cold and hot, ... Subcutaneous nodules lower pigmentation of the lower leg... Skin pigmentation deepening lower extremity edema Local venous tenderness Varicose veins pulsation or waveform change low heat
1. There are repeated venipuncture, intravenous injection of drugs, hypertonic solution or history of varicose veins of the lower extremities.
2. The venous area of the lesion is red and swollen, with obvious pain and tenderness. The local skin temperature rises. After the acute inflammation dissipates, the hardness of the cord is increased, the skin remains pigmented, and there is no systemic symptoms.
3. Repeated authors said that the migratory thrombophlebitis, migratory thrombophlebitis is more common in the calf and superficial phlebitis, occurs in the thigh and upper limbs, the performance of the attack and Generally, there is no significant difference in thrombotic superficial phlebitis. Because the lesions involve small and medium-sized superficial veins, although there are thrombosis and clogging in the lumen, it does not cause venous blood disorder. The whole limb swelling is rare. Clinical The performance is often in a region near the limbs or the superficial veins of the trunk. Suddenly, most of them are scattered in red nodules. They are painful and tender and stick to the skin with inflammation around them. The lesions are linear and generally short. Occasionally, the vein segment of the lesion can be as long as 30cm. The diseased vein touches a hard cord and can appear in batches. Therefore, some lesions just appear and other parts have subsided. The disease is characterized by: nodules are very Quickly subsided, most of them only lasted for 7-18 days, the cord gradually became inconspicuous, eventually disappeared, leaving local brown pigmentation, no nodules, no necrosis, and no swelling of the affected limb. The body may have low fever, increased white blood cells, and accelerated erythrocyte sedimentation rate. After each nodule subsides for several weeks or years, the superficial veins in other parts of the body can react in the same way. Repeated recurrences, long-term illness, residual pigmentation And the cord can be covered with the whole body.
Examine
Examination of thrombosis of superficial phlebitis
(1) The physical activity of the affected limb is limited. The lesion is locally swollen with ridges or granular nodular veins. The redness is hot, tender and touches the texture. The columnar, columnar, nodular veins In the swollen area, after the temperament period, the swelling gradually subsided, and the part was dark red pigmentation, and the strips, granules, and nodular venous bulges were more obvious, and the texture was harder. For example, the varicose veins showed a dark brown mass-like bulge area. If the catheter is caused, the pus can be taken out when the tube is pulled.
(2) The white blood cell count can reach 20x109/L, and the pathological examination is feasible for patients with suspected diagnosis.
(3) venography can be seen in the deep venous stenosis or blockage of the affected limb.
Diagnosis
Diagnosis and diagnosis of thrombosis superficial phlebitis
Thrombophlebitis is mainly divided into two types: thrombotic superficial phlebitis and thrombotic deep phlebitis. The former is divided into limb thrombotic superficial phlebitis, superficial thrombophlebitis of the chest and abdominal wall vein and shallow thrombotic shallowness. Phlebitis, etc., the latter is divided into calf muscle venous plexus thrombophlebitis and iliac vein and iliac vein thrombophlebitis, clinically diagnosed according to different characteristics.
