以静脉肢体坏疽为特点的静脉血栓栓塞症并肝素诱导性血小板减少症的中西医结合治疗一例报道

doi:10.12114/j.issn.1007-9572.2022.0531

中国全科医学 ›› 2023, Vol. 26 ›› Issue (06): 769-774.DOI: 10.12114/j.issn.1007-9572.2022.0531

• 典型病例研究 • 上一篇

以静脉肢体坏疽为特点的静脉血栓栓塞症并肝素诱导性血小板减少症的中西医结合治疗一例报道

公瑞¹, 张玥²^,^*(), 程志新², 唐卫荷¹

1．250014　山东省济南市，山东中医药大学第一临床医学院
2．250014　山东省济南市，山东中医药大学附属医院周围血管病科

收稿日期:2022-06-08 修回日期:2022-08-06 出版日期:2023-02-20 发布日期:2022-08-25
通讯作者: 张玥
公瑞，张玥，程志新，等.以静脉肢体坏疽为特点的静脉血栓栓塞症并肝素诱导性血小板减少症的中西医结合治疗一例报道[J].中国全科医学，2023，26（6）：769-774.[www.chinagp.net]
作者贡献：公瑞负责论文的起草及撰写；张玥负责最终版本修订，对论文负责；程志新负责临床数据收集及整理；唐卫荷负责文献搜集及图表绘制。
基金资助:
国家自然科学基金资助项目(81774311)

A Case Report of Venous Thromboembolism with Heparin-induced Thrombocytopenia Characterized by Venous Limb Gangrene Treated with Integrated Traditional Chinese and Western Medicine

GONG Rui¹, ZHANG Yue²^,^*(), CHENG Zhixin², TANG Weihe¹

1. The First Clinical Medical College of Shandong University of Traditional Chinese Medicine, Jinan 250014, China
2. Department of Peripheral Vascular Diseases, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250014, China

Received:2022-06-08 Revised:2022-08-06 Published:2023-02-20 Online:2022-08-25
Contact: ZHANG Yue
About author:
GONG R, ZHANG Y, CHENG Z X, et al. A case report of venous thromboembolism with heparin-induced thrombocytopenia characterized by venous limb gangrene treated with Integrated Traditional Chinese and Western Medicine[J]. Chinese General Practice, 2023, 26 (6) : 769-774.

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摘要/Abstract

摘要： 肝素诱导性血小板减少症（HIT）和静脉肢体坏疽（VLG）是静脉血栓栓塞症（VTE）的罕见并发症，致死率、致残率较高。现报告1例以VLG为特点的VTE并发HIT的病例，在中西医结合治疗下取得了较为满意的治疗效果，以期为临床医师治疗此类疾病提供参考。

关键词: 静脉血栓栓塞症, 肝素诱导性血小板减少症, 静脉肢体坏疽, 中西医结合疗法, 病例报告

Abstract:

Heparin-induced thrombocytopenia (HIT) and venous limb gangrene (VLG) are rare complications of venous thromboembolism (VTE), with high rates of mortality and morbidity once they occur. A case of VTE with HIT characterized by VLG is reported. Relatively satisfactory therapeutic effect has been achieved under the treatment of Integrated Traditional Chinese and Western Medicine, and we hope to provide a reference for clinicians to treat such diseases.

Key words: Venous thromboembolism, Heparin-induced thrombocytopenia, Venous limb gangrene, Integrated Chinese Traditional and Western Medicine therapy, Case report

公瑞,张玥,程志新,等. 以静脉肢体坏疽为特点的静脉血栓栓塞症并肝素诱导性血小板减少症的中西医结合治疗一例报道[J]. 中国全科医学, 2023, 26(06): 769-774. DOI: 10.12114/j.issn.1007-9572.2022.0531.
GONG Rui,ZHANG Yue,CHENG Zhixin, et al. A Case Report of Venous Thromboembolism with Heparin-induced Thrombocytopenia Characterized by Venous Limb Gangrene Treated with Integrated Traditional Chinese and Western Medicine[J]. Chinese General Practice, 2023, 26(06): 769-774. DOI: 10.12114/j.issn.1007-9572.2022.0531.

图/表 8

图1 患者2021-02-14初入院时双下肢图像注：a为双下肢图像，b为右足底图像

Figuer 1 Images of lower limbs at initial admission on February 14，2021

图2 患者2021-03-04双下肢图像

Figure 2 Images of lower limbs of patient on March 4，2021

表1 治疗前与治疗后24 d患者双下肢不同位置肢围（cm）

Table 1 Limb circumference （cm） at different positions of lower limbs before treatment and 24 d after treatment

时间	髌骨上缘上15 cm		髌骨下缘下15 cm		内踝尖上10 cm
时间	左下肢	右下肢	左下肢	右下肢	左下肢	右下肢
治疗前	52.5	64.0	40.5	43.0	31.0	32.0
治疗后24 d	52.0	55.0	33.0	32.5	22.0	22.5

图3 患者2021-05-05第2次入院双足图像注：a为右足背图像，b为右足底图像，c为左足背图像，d为左足底图像

Figure 3 Bipedal image of patient at the second admission on May 5，2021

图4 患者2021-05-13双足清创图像注：a为右足背图像，b为左足背图像，c为右足底图像，d为左足底图像

Figure 4 Patient Bipedal debridement images on May 13，2021

图5 患者2021-08-15第3次入院双足图像注：a为左足背图像，b为右足背图像，c为左足底图像，d为右足底图像

Figure 5 Bipedal image of patient at the 3rd admission on August 15，2021

图6 患者2021-08-28拆除负压双足图像注：a为双足背图像，b为双足底图像

Figure 6 Patient images of removing bipedal negative pressure on August 28，2021

图7 患者2022-03-20随访一年双足图像注：a为右足底图像，b为左足背图像，c为右足背图像，d为左足底图像

Figure 7 Patient one year follow-up images of Bipedal on March 20，2019

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以静脉肢体坏疽为特点的静脉血栓栓塞症并肝素诱导性血小板减少症的中西医结合治疗一例报道

A Case Report of Venous Thromboembolism with Heparin-induced Thrombocytopenia Characterized by Venous Limb Gangrene Treated with Integrated Traditional Chinese and Western Medicine

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