superficial thrombophlebitis
Introduction
Introduction to thrombotic superficial phlebitis Thrombotic phlebitis (superficialthrombophlebitis) is a common clinical condition and can cause significant discomfort and limited function. Although this is a benign, self-limiting disease, it can recur and persist. It has been reported in the literature that about 11% of thrombotic superficial phlebitis spread and cause deep vein thrombosis. And can migrate alternately throughout the human body. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: sepsis
Cause
Causes of thrombotic superficial phlebitis
(1) Causes of the disease
Slow blood flow (30%):
Reduced physical activity or limited activity, slow blood flow, increased concentration of blood coagulation factors, long-term bed rest, decreased muscle strength, weakened support for blood vessel walls, and pressure on blood vessels, resulting in poor blood flow.
Vascular wall damage (25%):
Mechanical damage such as long-term repeated venipuncture, catheterization, infusion of a variety of highly irritating hypertonic solutions. Improper fixing method. The puncture site is not fixed firmly, causing the needle to slide. The catheter diameter used is too thick to stimulate the vessel wall. The puncture site is too close to the joint, and mechanical vasculitis occurs due to the joint friction causing the needle tube to constantly rub against the vessel wall.
Hypercoagulable state of blood (20%):
Surgical trauma, burns, myocardial infarction, blood transfusion, tumors, etc. lead to hypercoagulability can be induced.
Reduced vessel wall elasticity (12%):
Such as advanced age, smoking, diabetes, obesity, limb edema, heart failure, etc. can also be induced.
The most common cause of superficial venous thrombosis is related to venous intimal injury caused by superficial venous catheterization, irritant drugs, infection, etc. It can also occur in the superficial vein of varicose veins due to blood stasis; antithrombin III, protein exists in some cases Abnormalities in C and protein S; oral contraceptives and pregnancy may also be associated with the onset of thrombotic superficial phlebitis, but there is no definitive evidence. In addition, certain malignancies such as acute lymphocytic leukemia and cholangiocarcinoma have been shown to release Some procoagulant substances, which can be complicated by thrombotic superficial phlebitis, are not described at present.
(two) pathogenesis
1. Thrombotic superficial phlebitis after injury: Thrombotic superficial phlebitis after injury usually occurs after the limb is directly traumatized, and the corresponding area along the vein appears a tender cord, due to subcutaneous hemorrhage after venous injury, often Subcutaneous ecchymosis can be seen. Thrombotic superficial phlebitis often occurs in the site of venous puncture, most of which is caused by injection of irritant or cytotoxic drugs. This is the most common type of thrombotic superficial phlebitis. It is rare to have thrombophlicular phlebitis in the puncture catheter itself. The clinical manifestation is redness and pain in the puncture site, which usually lasts for several days or weeks, and sometimes takes several months to completely relieve.
2. Thrombotic superficial phlebitis after varicose veins: thrombotic superficial phlebitis often occurs in the superficial varicose veins of the lower extremities. Thrombosis can spread up or down along the saphenous vein, or varicose veins that occur in the non-saphenous vein trunk. For the fork, except for some secondary to injury, quite a part of it often does not have any incentive. Thrombophlebitis often shows a tender induration in the varicose veins, often with erythema around it. In rare cases, if the thrombosis reaction spreads To the iliac vein wall and skin, significant subcutaneous hemorrhage may occur, based on the inflammatory reaction around the cell and the synthesis and release of cytokines. Thrombotic superficial phlebitis occurs mostly in the varicose veins near the venous stasis ulcer.
3. Infectious thrombotic superficial phlebitis: In 1932, after De Takats proposed surgery, after injection, injury or radiotherapy, and occult infection in varicose veins, is an important factor in the development of thrombophlebitis, L in the blood Type or other atypical bacterial types may play an important role in the disease, another type of infectious thrombophlebitis is septic phlebitis, septic phlebitis usually occurs after long-term application of intravenous infusion Intravenous suppuration is often associated with sepsis, which is a serious, even fatal, complication.
4. Migratory thrombophlebitis: In 1845, Jadious first described migratory thrombophlebitis, characterized by recurrent superficial venous thrombosis in different sites, but most commonly in the lower extremities, despite a large number of pathogenic diseases. Factors have been found, but there is still no definitive factor that may be closely related to two diseases:
(1) Surface manifestation of visceral cancer: In 1856, Trousseau first reported cancer-related; Sproul noted that patients with pancreatic tail cancer are prone to migratory thrombophlebitis.
(2) migratory thrombophlebitis is often associated with vasculitis, such as multiple nodular arteritis, thromboangiitis obliterans.
Buerger reported that of the 19 patients with thromboangiitis obliterans, 8 had migratory thrombophlebitis; and Shionoya followed up 255 patients with thromboangiitis obliterans, 43% developed migratory thrombophlebitis. The migratory superficial phlebitis of the upper extremity, in addition to thromboangiitis obliterans, is also seen in nodular erythema and Behcet's disease.
5. Thoracic thrombosis superficial phlebitis: chest wall thrombotic superficial phlebitis, also known as Mondor disease, refers to the anterior chest wall, breast, rib margin and superficial vein of the upper abdomen have thrombosis, and secondary inflammation changes, Mondor disease is rare, its Venous inflammation is usually confined to the anterior wall portion of the upper part of the breast (lateral thoracic vein), the lower part of the breast passes over the reflexed part of the breast, along the area of the rib and upper abdomen (thoracic, upper abdominal wall vein), and extends from the inside to the inside of the nipple The area under the xiphoid and the upper abdominal wall (the upper abdominal wall) is characterized by local tenderness, tenderness, and cord-like structure. It is more obvious when the skin is tightened or the upper limb is raised. The cause is not yet clear, except for the sudden exertion of the upper limb. Suffering from injury, which constitutes the pathogenesis of this disease, may also be related to malignant tumors. Recently, the literature reports that Mondor disease occurs mostly after breast surgery, long-term oral contraceptives, hereditary protein C deficiency, anti-cardiolipin antibody positive, etc. When the situation.
Prevention
Thrombotic superficial phlebitis prevention
1. Keep warm: Exposure to cold air and direct contact with cold items can cause arterial contractions or spasms. It should be kept at room temperature and humidity to avoid direct contact with cold water. In the cold season, you should pay attention to keep warm, and the warm time should be half a month or a month before the normal person. In the cold season, you should keep warm when you go out, avoid the body from being exposed, and the underwear and shoes should be loose and soft.
2. Quit smoking and alcohol and adjust your mentality: nicotine, alcohol and mood swings can make the sympathetic nerves excited, cause vasospasm, should help patients quit smoking, while eating less or not drinking caffeinated drinks Patients with trauma have less or no irritating food. Patients with arteriosclerotic disease or diabetes should adhere to a low-fat and low-sugar diet.
3. Protect the affected limb from injury: The affected limb with insufficient blood supply to the artery may be prolonged and hemorrhagic if it is slightly stimulated.
4. Avoid pressure on the affected limbs: tight clothing, cross-legged legs or legs in the knees, sitting on the armpits, etc., can compress the blood vessels, affecting arterial blood supply, phlebitis patients should try to avoid.
Complication
Complications of thrombotic superficial phlebitis Complications sepsis
Septic phlebitis can be complicated by sepsis and sepsis, often causing death.
Symptom
Thrombotic superficial inflammatory symptoms Common symptoms are red cords, swimming... Skin pigmentation deep vein thrombosis, local venous chord nodules, congestive intraosseous lesions
In the acute phase, local venous pain, redness is strip-like or reticular, and there are tender cords along the vein. After 1 to 2 weeks, the redness and swelling disappear, replaced by pigmentation, and the ropes are hard as rope. Some patients may accompany There is general malaise, recurrent phlebitis, skin pigmentation, and hardening after thrombosis.
Examine
Examination of thrombotic superficial phlebitis
1. Superficial phlebitis caused by venous catheterization, feasible blood culture, 2 times the same strain positive, can be used as evidence of infection.
2. Blood test: There may be abnormalities of antithrombin III, protein C or protein S.
3. Gastrointestinal function test: For patients with unexplained migratory thrombophlebitis, gastrointestinal function tests should be performed to rule out the possibility of malignant tumors.
4. Two-way Doppler flow imaging: blood clots in the superficial veins and the extent of hemagglutination can be found.
5. Venous angiography: generally do not need to do venography, sometimes to exclude deep vein thrombosis, can be carried out.
6. CT examination: more effective scanning of the vena cava thrombus.
Diagnosis
Diagnosis and diagnosis of thrombotic superficial phlebitis
diagnosis
Diagnosis is usually not difficult, the patient complained of the site along the vein, pain accompanied by a cord-like structure or nodules, often accompanied by inflammation around the vein caused by redness in the vein, migratory thrombophlebitis and general thrombosis Sexual superficial phlebitis is no different, it is manifested in a certain area, a sudden appearance of linear or reticular red swelling cord, pain and tenderness, soft texture at the beginning, then gradually hardened, redness and congestion gradually become pigmentation In the long-term pathogenesis, the seizures are intermittent and migratory, and they fall to the ground and alternate in the human body. The remaining pigmentation and cords can spread the whole body, septic thrombophlebitis The diagnosis is difficult, the diagnosis rate is 62.4%. If there is a history of infusion, there is unexplained sepsis, and the same strain is positive for blood culture 2 times. After eliminating other causes of sepsis, the vein should be probed, Doppler. Ultrasound, venography, and CT examinations can exclude deep vein and vena cava thrombosis.
Differential diagnosis
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 thoracic and abdominal wall veins and migratory thrombophlebitis.
The latter is divided into calf muscle venous plexus thrombophlebitis and iliac vein and iliac vein thrombophlebitis.
Clinically, it should be carefully diagnosed according to different characteristics.
