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Thrombophlebitis


Inflammation of the walls of the veins with the formation of a thrombus in them. Phlebitis is isolated, in which the walls of the veins are inflamed, but there is no thrombus formation. In the development of the disease lies a complex of reasons: infection, slowing blood flow through the veins, lowering the body's reactivity, changing the composition of the blood, increasing its clotting and disrupting the integrity of the vascular walls.
There are acute, subacute and chronic thrombophlebitis. By localization, thrombophlebitis of deep and superficial veins is isolated, and by the nature of the process - purulent and non-purulent.
Symptoms and course:
In acute thrombophlebitis of deep veins in the first days there are severe pains in the limb, the temperature rises to 39.5-40 ± C, there is a significant swelling of the entire limb, the skin on it becomes tense, shiny, pale, and sometimes cyanotic.
Tense limb is usually colder than healthy. In cases of the transition of acute thrombophlebitis to purulent development of multiple abscesses is observed along the thrombosed vein, which can lead to cellulitis of the limb. Very often acute thrombophlebitis is cured without going into the chronic stage. The duration of acute thrombophlebitis from 10 days to 3 months. and more.
Acute thrombophlebitis of the superficial veins begins with mild pain along the superficial venous trunks, the temperature rises to 37.5 ± C, rarely to 38 ± C, and later the temperature becomes subfebrile and normal. There is a slight swelling of the affected limb. The skin along the veins is hyperemic in the form of strips, then seals of various sizes appear, depending on the diameter of the affected vein, which can be determined by careful palpation. Most often affects the large saphenous and, rarely, small saphenous vein of the lower extremities. The duration of the disease is from 10 to 30 days.
Chronic thrombophlebitis of deep and superficial veins takes a long time - from several months to 1 year or more.
When migrating thrombophlebitis mainly affects the superficial veins of the upper and lower extremities. Suddenly, painful nodules appear along the veins, the skin above them swells and reddens. Such nodules occur along the superficial veins in different parts of one or the other limb. The general condition of the patient varies little. Temperature often subfebrile. Migratory thrombophlebitis often recurs and lasts for years. This disease is more common in men. It is characterized by the simultaneous lesion of arteries and belongs to the thrombangitis obliterans group.
Treatment:
May be conservative and surgical. In acute thrombophlebitis (especially deep veins), strict bed rest is recommended to prevent the spread of microflora and the occurrence of emboli. The elevated position of the limb on the tire improves venous outflow and reduces swelling and pain. It is recommended to drink (up to 2-3 liters per day), if there are no contraindications from the cardiovascular system.
With acute and subacute superficial thrombophlebitis, patients are allowed to turn, sit down, and release a limb from the tire for 10-20 minutes. and keep it horizontal. To improve the collateral circulation in subacute and chronic thrombophlebitis, warming compresses are recommended. In acute thrombophlebitis, especially in the first days of the disease, thermal procedures, fatty dressings due to increased pain should not be used. To reduce pain and improve collateral circulation, Vishnevsky lumbar novocaine blockade is used: 80 ml of a 0.25-0.5% novocaine solution is injected into the periophysial cellulose of the affected side, repeating injections after 5-6 days (23 times). The use of cold in these cases is permissible if the patient has a pulse on the arteries of the foot of the affected limb. With a weakening or no pulsation, the cold intensifies a spasm of the arteries.
Physiotherapeutic methods (ultraviolet irradiation, Solux, infrared rays, etc.) are used at the chronic stage of superficial thrombophlebitis, during the organization of a thrombus. Spa treatment (Pyatigorsk, Sochi-Matsesta) can be resolved strictly individually only for long-term chronic superficial thrombophlebitis without exacerbations and trophic disorders.
For the treatment of thrombophlebitis in all stages of the use of anticoagulants in combination with the above methods. Anticoagulants reduce blood clotting. Hirudinotherapy (leeches) should be used only for acute thrombophlebitis, if the patient has contraindications to anticoagulants. Hirudin, falling from the glands of leeches in the blood, lowers its viscosity and coagulability. Along with this disappears spasm of the arterial vessels. The leeches can be put simultaneously on 5-10 pieces on the limb along the affected vessel, after 5-6 days to repeat the procedure. The skin on the limb should be shaved and washed with warm water without soap. For fast leeching, the skin is smeared with a solution of glucose or sweet water. Force leech should not be removed, because it, pumping 10-20 ml of blood, disappears by itself. It is not recommended to use leeches for anemia, low blood clotting, in the first months of pregnancy and during treatment with mercury preparations.
Dikumarin, neodikumarin, fenilin, sipkumar and others reduce the content of prothrombipa in the blood and thus prevent the formation of new blood clots in the vessels, use these drugs should be under the control of prothrombin in the blood, the rate of which ranges from 87 to 100%, and with thrombophlebitis reaches 117- 127%. The reduction of prothrombin to 25-30% should be considered marginal, as further can lead to bleeding from the nose, gums, uterus, hematuria, etc.
The rapid decrease in prothrombin in the blood under the influence of anticoagulants is associated with the age and individual sensitivity of the patient to these drugs. The most sensitive patients are over 60 years old. With the appearance of microhematuria, the dacha is temporarily stopped. With the emergence of other bleeding, the drug is canceled and prescribed means that increase blood clotting (vitamin K, 10% calcium chloride solution orally, transfusion of hemostatic doses of blood and serum).
Anticoagulants are contraindicated in the presence of fresh wounds, ulcers, open forms of pulmonary tuberculosis, diseases of the kidneys, liver, hemorrhagic diathesis, etc. Antibiotics are used for high fever or suspected purulent thrombophlebitis. As a means of direct influence on blood clots, fibrinolytic drugs are used, which in the early stages of the process lead to the lysis of blood clots. Fibrinolytic drugs include fibrinolysin, streptokinase, urokinase, trypsin, chymotrypsin.
Surgical methods: vein ligation, dissection, venectomy, and excision of the thrombosed superficial vein sites.
Prevention:
It is determined by the timely treatment of diseases that are complicated by the development of thrombophlebitis. Patients with varicose veins, trophic ulcers, etc. should undergo surgical treatment. Increasing the level of prothrombin in the blood necessitates the appointment of anticoagulants, which is especially necessary for patients with restricted active movement.