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年輕人下肢動脈血栓,,年輕人養生須知

中醫(yi)世家 2023-07-29 09:00:46

一(yi)、年輕人下肢動脈血(xue)栓該怎么辦

對(dui)水腫患者體(ti)檢時還應注意(yi)水腫的表現和以(yi)下特征:

1)水(shui)腫(zhong)(zhong)(zhong)的(de)分(fen)布 注(zhu)意是(shi)全身水(shui)腫(zhong)(zhong)(zhong)還是(shi)局部(bu)(bu)水(shui)腫(zhong)(zhong)(zhong)。根據(ju)水(shui)腫(zhong)(zhong)(zhong)分(fen)布的(de)不同可(ke)初步(bu)提示引起(qi)水(shui)腫(zhong)(zhong)(zhong)的(de)可(ke)能原因。全身性(xing)水(shui)腫(zhong)(zhong)(zhong)常為(wei)對(dui)稱性(xing),一般以下(xia)垂(chui)部(bu)(bu)位(wei)最(zui)為(wei)顯著,且(qie)多表現(xian)在組(zu)織松(song)弛的(de)部(bu)(bu)位(wei),如眼瞼、面頰、踝部(bu)(bu)及陰囊等處。局部(bu)(bu)性(xing)水(shui)腫(zhong)(zhong)(zhong)則可(ke)發生在身體任何的(de)部(bu)(bu)位(wei)。

2)水(shui)(shui)腫(zhong)(zhong)的(de)(de)部(bu)位(wei)特征(zheng) 晨起時僅(jin)表現(xian)眼瞼或顏面(mian)部(bu)水(shui)(shui)腫(zhong)(zhong)者(zhe)(zhe)常為腎臟病(bing)患(huan)者(zhe)(zhe);水(shui)(shui)腫(zhong)(zhong)僅(jin)限于(yu)(yu)胸廓以上(shang)伴(ban)有(you)(you)靜脈擴(kuo)張充盈(ying)者(zhe)(zhe),可(ke)(ke)見(jian)于(yu)(yu)上(shang)腔(qiang)(qiang)靜脈壓迫征(zheng)。此(ci)(ci)時應(ying)注意(yi)其(qi)頸腋部(bu)有(you)(you)無(wu)腫(zhong)(zhong)大的(de)(de)淋(lin)巴結;上(shang)體(ti)有(you)(you)持久和漸進性水(shui)(shui)腫(zhong)(zhong)時應(ying)想到上(shang)腔(qiang)(qiang)靜脈的(de)(de)壓迫,如縱隔腫(zhong)(zhong)瘤、升主動脈瘤及(ji)血栓(shuan)等頸水(shui)(shui)腫(zhong)(zhong)常見(jian)于(yu)(yu)丹毒(du)、盧德維咽(yan)峽炎(yan)等;胸、腹壁、腰(yao)部(bu)等處的(de)(de)水(shui)(shui)腫(zhong)(zhong),如伴(ban)有(you)(you)壓痛和發熱常提(ti)示(shi)有(you)(you)膿胸、腎周(zhou)圍炎(yan)等;如水(shui)(shui)腫(zhong)(zhong)僅(jin)限于(yu)(yu)兩(liang)側下肢應(ying)考(kao)慮(lv)全(quan)身(shen)性水(shui)(shui)腫(zhong)(zhong)患(huan)者(zhe)(zhe)由于(yu)(yu)站立體(ti)位(wei)所致(zhi),如僅(jin)一(yi)側下肢水(shui)(shui)腫(zhong)(zhong)者(zhe)(zhe)往(wang)(wang)往(wang)(wang)為靜脈血栓(shuan)、絲蟲病(bing)、淋(lin)巴管(guan)(guan)阻(zu)塞等,常伴(ban)有(you)(you)陰囊水(shui)(shui)腫(zhong)(zhong)。由于(yu)(yu)淋(lin)巴管(guan)(guan)阻(zu)塞而(er)引起者(zhe)(zhe)水(shui)(shui)腫(zhong)(zhong)部(bu)位(wei)無(wu)指(zhi)壓性,皮(pi)膚較(jiao)厚較(jiao)堅韌稱(cheng)之為象皮(pi)腿。此(ci)(ci)外,局部(bu)性水(shui)(shui)腫(zhong)(zhong)可(ke)(ke)發生在(zai)身(shen)體(ti)的(de)(de)任(ren)何局部(bu),常見(jian)為炎(yan)、創傷(shang)及(ji)變態(tai)反(fan)應(ying)性疾病(bing)。炎(yan)癥及(ji)創傷(shang)常伴(ban)有(you)(you)紅、腫(zhong)(zhong)、熱、痛,此(ci)(ci)為急性期炎(yan)癥的(de)(de)特征(zheng);變態(tai)反(fan)應(ying)性水(shui)(shui)腫(zhong)(zhong)往(wang)(wang)往(wang)(wang)發病(bing)急劇,可(ke)(ke)合(he)并發癢,常有(you)(you)接觸史和過敏史。

3)水(shui)(shui)腫(zhong)(zhong)(zhong)(zhong)的(de)(de)指(zhi)壓(ya)(ya)特性(xing) 根據指(zhi)壓(ya)(ya)可區分為指(zhi)壓(ya)(ya)性(xing)水(shui)(shui)腫(zhong)(zhong)(zhong)(zhong)(凹陷(xian)性(xing)水(shui)(shui)腫(zhong)(zhong)(zhong)(zhong))和非(fei)指(zhi)壓(ya)(ya)性(xing)(非(fei)凹陷(xian)性(xing))水(shui)(shui)腫(zhong)(zhong)(zhong)(zhong)兩(liang)大類。用(yong)手(shou)指(zhi)按壓(ya)(ya)水(shui)(shui)腫(zhong)(zhong)(zhong)(zhong)部位出現的(de)(de)凹陷(xian),抬手(shou)后(hou)幾秒(miao)鐘內不(bu)消失(shi)者稱凹陷(xian)性(xing)水(shui)(shui)腫(zhong)(zhong)(zhong)(zhong)。凹陷(xian)性(xing)水(shui)(shui)腫(zhong)(zhong)(zhong)(zhong)在臨床上最為常見(jian),而非(fei)凹陷(xian)性(xing)水(shui)(shui)腫(zhong)(zhong)(zhong)(zhong)少見(jian),僅見(jian)于(yu)甲狀腺功能(neng)低下所(suo)致(zhi)(zhi)的(de)(de)黏液性(xing)水(shui)(shui)腫(zhong)(zhong)(zhong)(zhong)及淋巴管阻塞所(suo)致(zhi)(zhi)的(de)(de)水(shui)(shui)腫(zhong)(zhong)(zhong)(zhong),這些水(shui)(shui)腫(zhong)(zhong)(zhong)(zhong)液中(zhong)含有(you)大量蛋白(bai),因而不(bu)表現指(zhi)壓(ya)(ya)性(xing)。

4)水(shui)(shui)(shui)腫(zhong)(zhong)部位(wei)的(de)(de)表現(xian) 水(shui)(shui)(shui)腫(zhong)(zhong)部位(wei)由(you)于組(zu)織間液增多,因而表現(xian)腫(zhong)(zhong)脹、皮膚繃緊、彈性降低、組(zu)織重(zhong)量增加(jia)。非炎(yan)癥性水(shui)(shui)(shui)腫(zhong)(zhong)還(huan)表現(xian)水(shui)(shui)(shui)腫(zhong)(zhong)部位(wei)顏色蒼白、溫(wen)度偏低,在(zai)凹(ao)陷性水(shui)(shui)(shui)腫(zhong)(zhong)的(de)(de)部位(wei)皮膚破損處可(ke)有(you)組(zu)織液溢出。水(shui)(shui)(shui)腫(zhong)(zhong)程度加(jia)重(zhong)在(zai)一定(ding)意(yi)義(yi)上表示病情加(jia)重(zhong),但(dan)這不(bu)是一個確切的(de)(de)指(zhi)標。水(shui)(shui)(shui)腫(zhong)(zhong)本(ben)身的(de)(de)輕重(zhong)程度并不(bu)決(jue)定(ding)預后(hou)的(de)(de)好壞,有(you)些疾病水(shui)(shui)(shui)腫(zhong)(zhong)表現(xian)可(ke)以很嚴(yan)重(zhong),出現(xian)非常明(ming)顯的(de)(de)水(shui)(shui)(shui)腫(zhong)(zhong)如腎病綜合征的(de)(de)病人,但(dan)預后(hou)不(bu)一定(ding)就壞,采用合理治療(liao)后(hou)可(ke)以基本(ben)痊(quan)愈;有(you)些嚴(yan)重(zhong)水(shui)(shui)(shui)腫(zhong)(zhong)的(de)(de)病人,應用利尿劑后(hou)水(shui)(shui)(shui)腫(zhong)(zhong)可(ke)以迅(xun)速(su)消退,但(dan)其原發(fa)疾病并沒有(you)改善。

5)水(shui)腫(zhong)(zhong)(zhong)(zhong)病人(ren)體重(zhong)的變化(hua) 在(zai)條件(jian)適當控制的情(qing)況下多(duo)次檢(jian)測(ce)體重(zhong),觀察體重(zhong)的增減,是判定(ding)病人(ren)水(shui)腫(zhong)(zhong)(zhong)(zhong)消長(chang)的相(xiang)當敏感(gan)和最(zui)有(you)價值的指標,它比(bi)臨床上通常應(ying)用(yong)指壓觀察體表凹陷的程度(du)要(yao)敏感(gan)得多(duo)。特(te)發性(xing)水(shui)腫(zhong)(zhong)(zhong)(zhong)患者每天午后(hou)開始出現水(shui)腫(zhong)(zhong)(zhong)(zhong),次日(ri)晨起又消退,每天水(shui)腫(zhong)(zhong)(zhong)(zhong)時體重(zhong)可(ke)(ke)增長(chang)1.4 kg,故一日(ri)多(duo)次測(ce)量體重(zhong)可(ke)(ke)作為診斷(duan)的依據(ju)。此外還可(ke)(ke)在(zai)應(ying)用(yong)利尿劑的前后(hou),稱量體重(zhong),以了(le)解病人(ren)對利尿劑的反應(ying)及病人(ren)水(shui)腫(zhong)(zhong)(zhong)(zhong)液積(ji)聚和消退的程度(du)。

二、年(nian)輕人(ren)下(xia)肢動脈血(xue)栓(shuan)表(biao)現

下肢動脈硬(ying)化閉塞癥有哪些(xie)早期表現(xian)呢?

一(yi)、手腳冰冷,而且(qie)常常伴有麻(ma)木的感(gan)覺(jue)可(ke)能是(shi)下肢動脈硬化閉塞癥的前期表(biao)現(xian)。

二(er)、在(zai)活(huo)動(dong)或行(xing)(xing)走一段距(ju)離后出現肌肉疼痛、痙攣和疲乏無(wu)力,這時患者常(chang)需要停止(zhi)活(huo)動(dong)或行(xing)(xing)走休息數分鐘后才能繼續活(huo)動(dong)和行(xing)(xing)走,這種現象醫學上稱之為“間歇性跛行(xing)(xing)”

。三、靜息(xi)(xi)痛(tong),在休息(xi)(xi)時間也(ye)可感到(dao)肢體疼痛(tong)、麻木(mu)和感覺異常,尤以(yi)夜間最(zui)為明顯。

四(si)、足趾、足部(bu)和小腿(tui)的(de)皮膚顏色出現異常,蒼白、發紫、變黑(hei),嚴重(zhong)時還會產生潰瘍和壞死(si)。

五(wu)、腿抽筋(jin)(jin),除了受(shou)涼或缺鈣(gai)外,還有(you)可(ke)能(neng)是(shi)由動(dong)(dong)(dong)脈(mo)硬化引(yin)起(qi),因為當動(dong)(dong)(dong)脈(mo)發(fa)生硬化時,腿部(bu)血(xue)液循環會受(shou)阻暢,血(xue)液供應(ying)減(jian)少(shao)。血(xue)流不暢代(dai)謝產物就(jiu)不能(neng)被及時帶(dai)走,當達(da)到一定濃度時,就(jiu)會刺激肌(ji)肉收(shou)縮(suo)而引(yin)起(qi)疼痛抽筋(jin)(jin)。另外,血(xue)流受(shou)阻血(xue)供減(jian)少(shao)后,局部(bu)組織出(chu)現缺血(xue)缺氧,生理生化技能(neng)發(fa)生紊亂而致疼痛抽筋(jin)(jin)。以(yi)上(shang)就(jiu)是(shi)下肢動(dong)(dong)(dong)脈(mo)硬化閉塞癥(zheng)患者(zhe)的早期表(biao)現,如果大家出(chu)現以(yi)上(shang)某(mou)些癥(zheng)狀一定要檢查(cha)是(shi)否患有(you)下肢動(dong)(dong)(dong)脈(mo)硬化閉塞癥(zheng),若(ruo)是(shi)一定要及時治療。

三、年輕(qing)人下肢動脈血(xue)栓典型癥狀

疼痛往往是下(xia)肢動脈栓塞最(zui)早出現(xian)的癥狀(zhuang),以扣漸向遠處伸(shen)延。約20%病人最(zui)先出現(xian)癥狀(zhuang)是麻木,而疼痛并不明顯。

此外,下肢(zhi)動脈栓塞的(de)癥狀(zhuang)還有皮(pi)色和皮(pi)溫改變肢(zhi)體的(de)血(xue)液循環障礙。皮(pi)層(ceng)乳頭下靜脈叢血(xue)液首先排空,皮(pi)膚呈臘樣蒼白(bai)。若血(xue)管(guan)內尚積聚(ju)少量血(xue)液,在蒼白(bai)皮(pi)膚間可(ke)(ke)出現散在小(xiao)島狀(zhuang)紫斑。淺表靜脈蔞(lou)癟(bie),毛細血(xue)管(guan)充盈緩慢,腓腸肌呈生面團樣。缺(que)血(xue)進(jin)一步發展,肌肉可(ke)(ke)僵直,患(huan)肢(zhi)皮(pi)溫下降,以肢(zhi)體的(de)遠(yuan)段部分最(zui)明顯(xian)。皮(pi)溫改變實際上真正栓塞平面要(yao)低(di)一個關節。

突(tu)然發生劇烈(lie)的(de)患肢疼(teng)痛,為最早出現的(de)癥狀。部分(fen)病(bing)(bing)人(ren)僅感酸(suan)痛或呈鈍痛,少數病(bing)(bing)人(ren)疼(teng)痛并不(bu)明顯(xian),而是(shi)感覺喪失與(yu)麻(ma)木。肢體遠端疼(teng)痛是(shi)最為劇烈(lie),活(huo)動時產痛加重,因而使活(huo)動受限。

栓塞部位遠端(duan)(duan)由于周圍神經的(de)缺(que)血而引起感(gan)(gan)(gan)覺(jue)(jue)及運(yun)動的(de)障礙。出(chu)(chu)現感(gan)(gan)(gan)覺(jue)(jue)的(de)喪失(shi)或(huo)感(gan)(gan)(gan)覺(jue)(jue)異(yi)常,自覺(jue)(jue)患肢(zhi)麻(ma)木,有(you)針(zhen)刺樣感(gan)(gan)(gan);栓塞近端(duan)(duan)有(you)感(gan)(gan)(gan)覺(jue)(jue)過敏區(qu)或(huo)感(gan)(gan)(gan)覺(jue)(jue)減退(tui)區(qu),感(gan)(gan)(gan)覺(jue)(jue)異(yi)常為(wei)襪套式;下肢(zhi)動動麻(ma)痹,活動無力,可(ke)出(chu)(chu)現足下垂(chui)。

四、年輕人下肢動脈血栓(shuan)的西醫療法

嚴禁吸煙、防止受冷、受潮和外(wai)傷。但不應使用熱(re)療,以免(mian)組織需氧量(liang)增加(jia)而(er)加(jia)重(zhong)癥(zheng)狀。疼痛嚴重(zhong)者(zhe),可(ke)用止痛劑及鎮靜劑,慎用*成癮的(de)藥物,如(ru)哌替啶等。患(huan)肢應進(jin)行(xing)鍛煉,以利促使側支(zhi)循環建立。如(ru)Buerger運動法:先平臥抬高患(huan)肢45°以上,維持(chi)1~2分鐘(zhong),再(zai)在床邊(bian)下垂2-3分鐘(zhong).然后放(fang)置水平位(wei)2分鐘(zhong).并作(zuo)足部旋轉、伸(shen)屈活(huo)動,反復(fu)活(huo)動20分鐘(zhong).每天數次。

腰交(jiao)感(gan)神(shen)經切(qie)除術:適用于腘(guo)動(dong)脈遠側動(dong)脈狹窄或閉塞,處于第一、二期(qi)的(de)病人。先施行腰交(jiao)感(gan)神(shen)經阻滯試驗,可解除血管(guan)痙攣和促進側支循環形成(cheng)。近期(qi)效果(guo)尚稱滿意(yi),但遠期(qi)療效并不理想。

動(dong)脈(mo)重建(jian)術,旁路轉流術,適用(yong)于(yu)主(zhu)干(gan)動(dong)脈(mo)閉塞,但在閉塞動(dong)脈(mo)的(de)近側和遠(yuan)側仍有通暢的(de)動(dong)脈(mo)通道(dao)者。血栓內(nei)膜剝脫術,適用(yong)于(yu)短(duan)段的(de)動(dong)脈(mo)阻(zu)塞 利用(yong)內(nei)膜剝離(li)器(qi),或(huo)直視下切(qie)(qie)開動(dong)脈(mo)壁(bi),將增厚(hou)的(de)內(nei)膜連同血栓一并切(qie)(qie)除,然后縫(feng)合動(dong)脈(mo)壁(bi)切(qie)(qie)口(kou)。

下(xia)肢動(dong)脈(mo)硬(ying)(ying)(ying)(ying)化(hua)(hua)閉(bi)塞(sai)癥(zheng)PDA的(de)(de)血管(guan)腔內(nei)介入(ru)治療(liao)(liao),下(xia)肢動(dong)脈(mo)硬(ying)(ying)(ying)(ying)化(hua)(hua)閉(bi)塞(sai)癥(zheng)內(nei)科降(jiang)壓、降(jiang)脂(zhi),抗(kang)血小板聚集等治療(liao)(liao)僅能(neng)延緩(huan)下(xia)肢動(dong)脈(mo)硬(ying)(ying)(ying)(ying)化(hua)(hua)閉(bi)塞(sai)的(de)(de)病程進展,不能(neng)從根本上(shang)消除下(xia)肢動(dong)脈(mo)硬(ying)(ying)(ying)(ying)化(hua)(hua)閉(bi)塞(sai)癥(zheng)血管(guan)的(de)(de)狹窄、閉(bi)塞(sai)。下(xia)肢動(dong)脈(mo)硬(ying)(ying)(ying)(ying)化(hua)(hua)閉(bi)塞(sai)癥(zheng)血管(guan)腔內(nei)介入(ru)治療(liao)(liao)具(ju)有(you)微創、操作簡單、療(liao)(liao)效確切(qie)、可重復(fu)操作的(de)(de)優點,是診治血管(guan)性疾病的(de)(de)發展方向(xiang)。

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