Non-surgical treatment includes anti-infection, thrombolysis, anticoagulation and depolymerization.
2. Surgical treatment is suitable for acute patients, especially for bruises and white swelling of thighs. It is best to take embolus within 3 days of onset. Femoral vein incision and Fogarty catheter embolization are usually used. In order to prevent pulmonary embolism, an inferior vena cava filter can also be placed before embolectomy.
Absolute bed rest within 10 ~ 14 days after acute attack, including bed defecation. Hot compress and massage are prohibited for the affected limb to avoid thrombus falling off. Raise the affected limb to 20 ~ 30cm higher than the heart level, slightly bend the knee joint, and pad a wide soft pillow. 10 ~ 14 days later, you can get out of bed. Perform dozens of foot dorsiflexion exercises every day for 3 ~ 5 minutes each time to promote venous return.
Pulmonary embolism is the most serious complication of deep venous thrombosis of lower limbs. If the patient has chest pain, palpitation, dyspnea and hemoptysis, he should lie flat immediately to avoid taking a deep breath, coughing and turning over violently. Report to the doctor, and give continuous ECG monitoring, high concentration oxygen inhalation, closely observe the changes of vital signs and blood oxygen saturation, and actively cooperate with the rescue.
In the process of drug care and treatment, observe whether the patient has gingival bleeding, nosebleeds, skin purpura, hematuria, bloody stool, etc. Press the puncture point 15 minutes after infusion. Drug therapy includes the following three types.
(1), anticoagulant therapy is suitable for small-scale thrombosis. Generally, low-molecular-weight heparin sodium is used, and warfarin is finally used until the patient returns to normal life for 3 ~ 6 months.
(2) Urokinase is commonly used in thrombolytic therapy, and its main function is to hydrolyze fibrin in thrombus to achieve the purpose of thrombolysis.
(3) The drugs for depolymerization include low molecular dextran, dipyridamole and Salvia miltiorrhiza. It can expand blood volume, dilute blood, reduce viscosity and prevent platelet aggregation, and is often used as adjuvant therapy.
In the acute stage of pain care, patients should be told to stay in bed absolutely, raise the affected limb to 20 ~ 30cm higher than the heart level, promote venous blood return, and use diuretics and hormones according to the doctor's advice to relieve pain. When in pain, it is forbidden to massage the affected limb with hot compress, and if necessary, give psychological care and analgesic drugs.
Dietary nursing Eat a crude fiber and low-fat diet to keep the stool unobstructed and avoid the increase of intra-abdominal pressure and affect the venous return of lower limbs.
health education
Before operation: 1, absolutely stay in bed in acute phase 10- 14 days, and massage and hot compress of the affected limb are prohibited.
2. No smoking
3. Position guidance: Raise the affected limb to 20-30 cm above the heart level to promote venous return.
4, dietary guidance: low-fat, vitamin-rich food, keep the stool unobstructed.
Postoperative: 1. After operation, the dorsum of foot was extended and flexed several times a day.
2. Brush your teeth with a soft brush during anticoagulant therapy to avoid collision and fall.
3. Observation and guidance on the condition: If the patient feels chest pain, dyspnea and hemoptysis, if the urine and urine color are abnormal or the skin has ecchymosis, please call the medical staff immediately.
Discharge guidance
1, the behavior guidance warned patients to absolutely ban smoking, and guided patients to use elastic socks correctly to relieve symptoms. According to the condition of the affected limb, gradually return to normal work and life, avoid long-distance walking and standing, stay in bed in time when the affected limb is not properly swollen, and raise the affected limb to 20 ~ 30cm above the heart level.
2, dietary guidance to a low-fat, cellulose-rich diet, keep the stool unobstructed, drink plenty of water, can promote circulation, improve waste excretion, reduce blood viscosity, and prevent thrombosis.
3, medication guidance in strict accordance with the doctor's advice oral anticoagulant drugs, observe the urine and urine color during medication. Skin and mucosa, repeated weekly, 1 time for routine blood examination and coagulation time.
4, review guidance to outpatient review 3 ~ 6 months after discharge, inform patients that the disease may have the possibility of venous valve insufficiency, such as lower limb swelling, supine position or elevated position.