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2013 г. №3 Том 21

В ПОМОЩЬ ПРАКТИЧЕСКОМУ ВРАЧУ

DOI: http://dx.doi.org/10.18484/2305-0047.2013.3.120   |  

В.Я. ХРЫЩАHОВИЧ

ПОСТТРОМБОТИЧЕСКАЯ БОЛЕЗHЬ: ДИАГHОСТИКА, ЛЕЧЕHИЕ, ПРОФИЛАКТИКА

УО «Белорусский государственный медицинский университет»,
г. Минск, Республика Беларусь

Посттромботическая болезнь (ПТБ) оказывает серьезное негативное влияние на здоровье пациентов и наносит существенный экономический ущерб бюджету здравоохранения. Являясь следствием тромбоза глубоких вен (ТГВ), частичная или полная окклюзия вен, а также клапанная дисфункция, приводят к повышению венозного давления в микроциркуляторном сосудистом русле. Наряду с тем, что воспалительный процесс при ТГВ может способствовать рассасыванию тромбов, он также вызывает разрушение венозных клапанов. Диагностика ПТБ основана преимущественно на клинических проявлениях, к коим относятся ощущение тяжести и боль в ногах, отек, зуд, судороги, трофическая язва и липодерматосклероз. Среди нескольких клинических шкал или классификаций ПТБ наиболее предпочтительной является шкала Villalta. Факторами риска развития ПТБ являются проксимальный ТГВ и рецидив тромбоза, ожирение, варикозная болезнь, неадекватная антикоагулянтная терапия ТГВ. При установленном диагнозе, лечение ПТБ проводят по тем же принципам, что и хронической венозной недостаточности с использованием компрессионной терапии и возвышенного положения нижних конечностей. Недостаточно изучена роль веноактивных препаратов в профилактике и лечении ПТБ. Хирургическое лечение может применяться у весьма ограниченного контингента пациентов. Дальнейшие исследования должны определить роль тромболизиса и тромбэктомии, которые уже к настоящему времени показали свой терапевтический потенциал. Большее внимание следует уделять назначению и использованию компрессионного трикотажа у пациентов, перенесших ТГВ.

Ключевые слова: посттромботическая болезнь, тромбоз глубоких вен, консервативное лечение, оперативное лечение, профилактика
с. 120 – 128 оригинального издания
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Адрес для корреспонденции:
220116, Республика Беларусь, г. Минск, пр-т Дзержинского, д. 83, УО «Белорусский государственный медицинский университет», 2-я кафедра хирургических болезней,
e-mail: vladimirkh77@mail.ru,
Хрыщанович Владимир Янович
Cведения об авторах:
Хрыщанович В.Я., к.м.н., доцент 2-й кафедры хирургических болезней УО «Белорусский государственный медицинский университет».
Контакты | ©Витебский государственный медицинский университет, 2007