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Тромбофлебит вен верхних конечностей лечение

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17 августа 2019

Пораженные сосуды могут размещаться вблизи от поверхности кожи, вызывая тромбофлебит поверхностных вен, или в глубине мышечных тканей, вызывая тромбоз глубоких вен (ТГВ). Заболевание может быть вызвано травмой, операцией или длительной неподвижностью.

Что вызывает тромбофлебит?

Тромбофлебит верхней конечности имеет много причин и факторов риска:

  • Локальная травма или повреждение вены (например, внутривенным катетером или инъекцией).
  • Слишком длительная неподвижность (например, после инсульта).
  • Катетеризация центральных вен или постановка кардиостимулятора.
  • Беременность.
  • Прием противозачаточных средств или гормональная заместительная терапия.
  • Послеоперационный период.
  • Наличие онкологических заболеваний или нарушений свертывания крови.
  • Нарушение венозного оттока из верхних конечностей, связанное, например, с удалением лимфатических узлов при мастэктомии по поводу рака молочной железы.
  • Наличие ожогов.

Как проявляется тромбофлебит верхних конечностей?

Поверхностный тромбофлебит верхних конечностей приводит к тому, что пораженная область становится красной, горячей, отекшей и болезненной. Это заболевание может сопровождаться незначительным повышением температуры тела. По ходу воспаленных вен можно прощупать плотные, болезненные тяжи. Острый период ТГВ может проявляться покраснением и отеком пораженной руки с болью и повышенной чувствительностью. Реже и позже встречаются такие клинические признаки как посинение и расширение коллатеральных вен на руках и грудной клетке.

Осложнения тромбофлебита верхних конечностей

Если воспаление и тромбоз поразили поверхностные вены рук, осложнения встречаются редко. При развитии ТГВ верхних конечностей риск появления серьезных осложнений выше. Они могут включать:

  • Тромбоэмболию легочных артерий (ТЭЛА). Если часть тромба в глубоких венах отрывается, она может попасть в легкие, вызывая опасное для жизни состояние. Конечно, при ТГВ ног это осложнение встречается чаще. Но риск развития тромбоэмболии легочной артерии при ТГВ рук все же существует, хотя его часто недооценивают. Недавние данные показывают, что 5 – 10% всех тромбоэмболий легочной артерии вызваны миграцией тромба именно из верхних конечностей.
  • Посттромбофлебитический синдром. Это состояние может развиться спустя месяцы и даже годы после ТГВ руки. Посттромбофлебитический синдром может вызвать длительную и сильную боль, постоянный отек и ощущение тяжести в пораженной руке, изменение ее цвета. Это заболевание может привести к снижению трудоспособности пациента.

Как диагностируется тромбофлебит

Для установления диагноза врач осматривает и обследует руку. Поверхностный тромбофлебит можно обнаружить только по симптомам заболевания, для уточнения диагноза возможно проведение ультразвукового исследования. Тромбофлебит глубоких вен диагностировать намного сложнее, опираясь только на клиническое обследование. Чаще всего для этого используются дополнительные инструментальные методы – ультразвуковое исследование, компьютерная или магнитно-резонансная томография, венография.

Для подтверждения наличия тромбофлебита может быть полезным анализ крови на D-димер. Это химическое вещество, которое высвобождается при распаде тромбов. Нормальный уровень D-димера указывает на маловероятность тромбофлебита. Однако у этого анализа есть и ограничения – повышенный уровень D-димера можно обнаружить при других заболеваниях, включая операцию, беременность или злокачественные новообразования.

Как лечить тромбофлебит?

Лечение тромбофлебита зависит от размещения, степени, симптомов и причин возникновения заболевания. Как правило, поверхностный тромбофлебит верхней конечности можно вылечить прикладыванием теплых компрессов, повышенным положением пораженной руки и пероральным приемом противовоспалительных препаратов (Ибупрофена, Диклофенака). Полезными могут быть также местные противовоспалительные средства, такие как гель Диклофенака.

Если причиной тромбофлебита поверхностных вен является внутривенный катетер, его нужно удалить. Если воспаление имеет инфекционный характер, тогда используются антибактериальные средства. В тяжелых случаях инфицированного тромбофлебита может понадобиться хирургическое вмешательство. При поверхностном тромбофлебите нужно с помощью ультразвукового исследования исключить тромбоз глубоких вен. При его обнаружении или риске развития может понадобиться прием антикоагулянтных препаратов – средств, разжижающих кровь: Эноксапарина, Фондапаринукса, Гепарина, Варфарина. Иногда пациентам с выраженным тромбозом глубоких вен может понадобиться лечение с помощью Тромболизиса.

При неэффективности консервативной терапии могут применяться хирургическое лечение – аспирация, фрагментация тромба, баллонная ангиопластика, стентирование, тромбэктомия или венозное шунтирование.Восстановление после поверхностного тромбофлебита может занять несколько недель, а после глубокого – от нескольких недель до нескольких месяцев.

Тромбофлебитом или тромбозом верхних конечностей называют заболевание, которое сопровождается воспалением сосудов. Это приводит к образованию тромбов, способных закупорить просвет вен. Данное состояние является чрезвычайно опасным, поскольку оно приводит к нарушению кровообращения и другим осложнениям.

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Тромбофлебит верхних конечностей встречается довольно редко. Данное заболевание чаще всего поражает ноги (область голеностопа).

Причины тромбофлебита

Тромбофлебит верхних конечностей может развиться вследствие таких причин:

  • повреждение сосудов при проведении некоторых медицинских процедур (установка катетеров, инъекции, продолжительная инфузионная терапия). Также данная причина тромбоза четко прослеживается у наркоманов;
  • развитие аллергической реакции на фоне приема некоторых препаратов;
  • повреждение вен из-за травмы или оперативного вмешательства;
  • реакция на укусы некоторых насекомых;

  • пребывание конечностей в неподвижном состоянии длительный период, что характерно после переломов;
  • развитие гнойных процессов, что происходит при сепсисе, остеомиелите, флегмоне;
  • повышение свертываемости крови, что происходит на фоне развития некоторых заболеваний;
  • наследственная предрасположенность к тромбофлебиту;
  • наличие возрастных изменений в функционировании кровеносной системы;
  • перенесенный инсульт;
  • прием оральных контрацептивных средств, особенно если он происходит без соблюдений рекомендаций врача;
  • наличие избыточного веса.

Симптомы тромбоза поверхностных вен

Тромбоз поверхностных вен верхних конечностей сопровождается болью и отечностью в месте развития воспалительного процесса. Очень часто данное состояние усугубляется лимфаденитом. Это воспаление, которое протекает в лимфатических узлах и сопровождается гнойным процессом.

Тромбофлебит поверхностных вен приводит к гиперемии, которая характеризуется переполнением сосудов кровью. При данном состоянии образуются воспалительные инфильтраты, а температура тела повышается до 38°С.

При наличии этой проблемы размер и форма верхних конечностей не изменяется. В некоторых случаях развивается небольшая отечность, которая не сковывает движений. Но если своевременно не предпринять необходимые меры для устранения данного симптома, он усугубляется. В результате развивается сильная припухлость, сопровождающаяся болезненностью. Также в месте отека может образовываться инфильтрат, который имеет гнойное содержимое.

Если при тромбофлебите поверхностных вен появляются тромбы, присоединяются и другие признаки недуга:

  • конечности немеют и теряют чувствительность;
  • кожный покров приобретает синюшный оттенок;
  • на поверхности конечности образуется венозная сетка;
  • появляется чувства жара и озноба в пораженной области;
  • в месте образования тромба образуется некроз;
  • увеличиваются лимфоузлы.

Если тромбофлебит протекает остро, человек испытывает сильную боль. Через несколько дней степень неприятных ощущений уменьшается. Лишь при прощупывании пораженной области наблюдается незначительный дискомфорт.

Тромбофлебит глубоких вен

К симптомам тромбофлебита верхних конечностей, который поражает глубокие вены, относят:

  • сильная боль и отечность, которая сопровождается онемением, покраснением и синюшностью кожных покровов. Тромбоз глубоких вен возникает внезапно, и его симптомы обычно застают человека врасплох;
  • тромбофлебит развивается довольно быстро. Кожа теряет свою чувствительность, что свидетельствует о начале процесса омертвения;
  • нарушение процесса кровообращения приводит к появлению подкожных сосудистых сеточек;
  • все симптомы тромбофлебита, поражающего глубокие вены, активно проявляются на протяжении трех дней. Интенсивность боли в этот период часто меняется и может усиливаться во время физических нагрузок;
  • болезненность очень часто распространяется по всей верхней конечности, а не только локализуется в зоне развития тромбов. Поэтому человек все время испытывает усталость и выраженную тяжесть в руках;
  • спустя несколько суток течения тромбофлебита конечность приобретает синюшный оттенок, что указывает на начало некротического процесса. Поэтому так важно обращение к врачу на ранних этапах развития заболевания.

Диагностика

Симптомы и лечение тромбофлебита пребывают в тесной взаимосвязи. Но начинать любые мероприятия для устранения все негативных процессов в организме можно только после комплексной диагностики. Она включает:

  • общий анализ крови, который обнаруживает наличие воспалительного процесса в организме;
  • коагулограмма. Проводится исследование крови, позволяющее определить функционирование ее свертывающей системы;
  • допплерография. Метод, основанный на проведении ультразвуковой диагностики, позволяющий выявить любые нарушения процесса кровообращения;
  • ангиосканирование сосудов. Современный метод диагностики, позволяющий определить состояние вен и наличие кровяных сгустков;
  • реовазография. Позволяет определить все необходимые параметры кровотока в конечностях;
  • рентгенологическое исследование вен. Производится после введения в сосудистое русло специального препарата;
  • МРТ. Применяется крайне редко, когда в результате других диагностических процедур получено недостаточно информации.

Консервативная терапия при тромбофлебите

Лечение тромбофлебита верхних конечностей может происходить консервативно, если заболевание не привело к слишком большим негативным изменениям в сосудах. Медикаментозная терапия показана исключительно при тромбозе поверхностных вен. Если заболевание поразило глубокие сосуды, избавиться от него можно только хирургическим путем.

При тромбофлебите применяются медикаменты, которые помогают устранить воспалительный процесс и предотвратить закупорку. Любые препараты назначаются строго по индивидуальным показаниям, основываясь на тяжести течения заболевания. Для устранения тромбоза врачи чаще всего используют:

  • местные противовоспалительные мази – Троксевазин, Лиотон;
  • для устранения болевого синдрома – Ибупрофен, Диклофенак, Аспирин;
  • для улучшения процесса кровообращения – Гепарин, Фраксипарин.

Другие рекомендации во время лечения

Лечить тромбофлебит только медикаментозно невозможно. Для устранения данной проблемы нужно следовать таким рекомендациям:

  • при остром течении заболевания человек должен соблюдать строгий постельный режим. Желательно, чтобы конечность была подвешенной, что улучшит отток крови;
  • важно пить много воды, что поможет снизить вязкость крови. За сутки нужно употреблять не меньше 2 л жидкости;
  • на протяжении дня нужно питаться часто, но небольшими порциями;
  • из рациона необходимо полностью исключить алкоголь. Также желательно отказаться от жирной пищи, колбас, консервов, смородины, шпината, капусты, бобовых и бананов. В рацион нужно включить молочные продукты, овсянку, помидоры, чеснок, лук. Также разрешается кушать нежирное мясо и рыбу;
  • утром желательно перематывать конечности эластическими бинтами;
  • если поражены поверхностные вены, рекомендуется применить физиотерапевтическое лечение (электрофорез, УВЧ).
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Хирургическое лечение тромбофлебита

При наличии восходящего тромбофлебита или в случае поражения глубоких вен прибегают к хирургическому вмешательству. Также операция показана, когда консервативные методы лечения не приносят положительного результата и болезнь начинает стремительно прогрессировать.

Хирургическое вмешательство проводится после тщательной диагностики. Необходимо точно выявить локализацию воспалительного процесса и место размещения тромбов. Операция позволяет полностью или частично устранить проблему, что снижает риск развития опасных последствий.

Обычно хирургический метод лечения совмещается с консервативным. Применение медикаментозных средств позволяет очистить сосуды от оставшихся сгустков и предотвратить дальнейшее развитие воспалительного процесса.

Прогноз при тромбофлебите

Тромбоз считается очень опасным заболеванием. Если несвоевременно обратиться к врачу и не назначить все необходимые лечебные мероприятия возникают следующие осложнения:

  • появляется тромб, который полностью перекрывает просвет сосуда;
  • развиваются гнойные процессы и некроз;
  • происходит закупорка легочной артерии, что приводит к смерти;
  • при развитии гангрены прибегают к ампутации проблемной конечности.

Но если медицинская помощь оказана своевременно и больной выполняет все рекомендации врача, исход болезни более благоприятен. В данном случае наступает полное выздоровление и человек может вернуться к нормальной жизни.

Тромбофлебит – это воспаление стенки вены, характеризующееся поражением эндотелия и формированием тромба в просвете сосуда. Патологический процесс может развиваться как на верхних, так и на нижних конечностях. Он может быть:

  • Поверхностным (локализуется в подкожных венах)
  • Глубоким (страдают магистральные сосуды, расположенные ближе к кости)

Тромбофлебит необходимо отличать от другого заболевания – флеботромбоза – поражения вен без воспаления, характеризующегося только образованием тромба.

Причины и симптомы патологии

Этиология поражения вен на руках:

  1. Генетическая предрасположенность к травматизации эндотелия стенки сосудов.
  2. Перенесенные операции, ожирение, сахарный диабет, эндокринные заболевания, нарушающие обмен веществ, и сердечная недостаточность могут быть причинами дисфункции свертываемости крови, что приводит к образованию тромбов.
  3. Инфекция или острый воспалительный процесс в окружающих тканях переходит на стенку сосуда и агрессивно воздействует на нее. Примеры: перелом костей, флегмоны, отморожение, остеомиелит.
  4. Варикоз – дисфункция нормальной работы клапанов вен, в результате которой происходит обратный ток крови (рефлюкс).
  5. Инфекция в бассейне вены. Часто развивается после введения препаратов, не предназначенных для инъекций, либо очень агрессивных раздражающих лекарственных средств. Причиной может быть введение катетера в сосуд.
  6. Механическое препятствие, нарушающее отток крови.
  7. Посттромбофлебитический синдром – хроническая патология, появляющаяся после перенесения тромбоза глубоких вен с деструкцией клапанного аппарата.
  8. Аутоиммунные заболевания. В данной ситуации иммунная система организма атакует свои же клетки – эндотелий вен.
  9. Злокачественные новообразования (диссеминированный рак, острые лейкозы). Опухоль вырабатывает и выбрасывает в кровоток тромбопластиноподобные продукты, что создают ДВС-синдром.

Симптомы разнообразны и зависят от глубины залегания поврежденных сосудистых ветвей.

Тромбоз поверхностных вен

Обычно он выражается в виде следующего симптомокомплекса:

  • Боли. Могут возникать по ходу вены или распространяться по всей поверхности руки. При движении конечности болезненность усиливается.
  • Частый и самый первый симптом — отек.
  • Гиперемия (покраснение) кожи.
  • Болезненное уплотнение вены – один из признаков воспаления эндотелия стенки.
  • При септическом поражении можно прощупать мягкий ком в просвете сосуда – инфильтрат, состоящий из гноя и крови. При отсутствии лечения он будет распространяться дальше по вене, образуя «тяжи».
  • Повышение температуры, лихорадка.

При тромбофлебите верхних конечностей симптомы и лечение отличаются в зависимости от глубины поражения ветвей сосудов.

Редко бывает гнойное расплавление тромба, переходящее в подкожную флегмону.

Тромбоз глубоких вен

В этом случае симптомы выражены ярче, а развитие патологического процесса идет стремительнее.

  • Боли умеренные или интенсивные, постоянные, усиливаются при движении руки.
  • При поражении глубоких вен возможен риск образования флегмон (более острая клиническая картина).
  • Отек конечности более выраженный.
  • Болезненность мышц, они становятся плотными.
  • Подкожные вены расширены, хорошо видны на поверхности руки.
  • Высокая температура, лихорадка.
  • Возможно развитие сепсиса и септического шока: потеря сознания, возможны тошнота и рвота, резкое падение артериального давления, учащенное дыхание и сердцебиение, повышение температуры тела выше 38°С или ее падение ниже 36°С.
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Диагностика тромбофлебита верхних конечностей

При тромбозе глубоких вен верхних конечностей симптомы не позволяют руке функционировать, доставляют дискомфорт пациенту, лишают его сна. Все это приводит пациента в больницу для получения помощи.

Узкий специалист — ангиолог – при осмотре обращает внимание на отечность, болевой синдром и покраснение руки. Этой информации может быть недостаточно для распознавания тромбофлебита. Дополнительно врач использует и другие методы диагностики: лабораторные и инструментальные.

Анализы

  1. Общий и биохимический анализ крови.
  • Ускорение СОЭ указывает на воспаление в организме.
  • Лейкоцитоз говорит об активации иммунной системы.
  • С-реактивный белок – маркер острой фазы воспаления.
  • Фибриноген – белок, превращающийся в нерастворимую форму, которая является базисом для тромба.
  1. Коагулограмма покажет сдвиг свертывающей системы в сторону гиперкоагуляции («слипания» клеток крови).
  2. Тест на D-димер – продукт разложения тромба. Повышенная его концентрация свидетельствует о тромбозе.
  3. Дополнительные исследования для изучения факторов свертывания.

Инструментальная диагностика

  1. УЗИ:
  • Доплерография. Самый распространенный метод ультразвукового исследования вен. Практически не имеет противопоказаний.
  • Дуплексное сканирование вен. Отражает проходимость сосудистого просвета.
  • Триплексное исследование. Позволяет оценить интенсивность и направление кровотока.
  • Соноэластография. Новейший метод УЗИ, показывающий плотность тканей. Применяется для диагностики онкологических заболеваний.
  1. КТ-ангиография. Подробно иллюстрирует состояние стенки вены и кровотока. Наиболее информативный способ исследования тромбофлебита.

Дифференциальная диагностика

Существует ряд заболеваний со схожей симптоматикой, поэтому врач должен уточнить диагноз, чтобы проводить верный курс лечения.

  1. Мигрирующий тромбофлебит верхней конечности. Склонность к рецидиву, течение длительное. Поражает самые крупные вены.
  2. Послеоперационные поражения. Отличаются местом расположения – чаще в глубоких сосудах. Во избежание этих осложнений после хирургического вмешательства людям, склонным к тромбообразованию в верхних конечностях, утягивают плечи или предплечья эластичным бинтом.
  3. Злокачественные образования. Выявляются с помощью соноэластографии. Отличается планом лечения.
  4. Варикозная дилатация вен. Будут проявляться трофические язвы кожи и экземы.
  5. Целлюлит – дистрофия тканей, базирующаяся на нарушении микроциркуляции в подкожно-жировой клетчатке.
  6. Лимфедема – невозможность оттока лимфы. Образуется ярко выраженный отек.
  7. Растяжение или разрыв мышц. Особенность – синюшность кожи. В анализах не будет маркеров воспаления и гиперкоагуляции крови.

Лечение заболевания

Если поражение локально, то терапия допускается амбулаторная.

Врач назначает специальную диету с уменьшенным употреблением соли, ограничивает физическую активность, советует держать пораженную руку выше уровня тела.

Прогрессирующие формы патологии лечат только в стационаре под постоянным контролем медицинского персонала – так тромбофлебит поверхностных вен устраняется быстрее и эффективнее.

Медикаментозное

  1. Лекарственная повязка с гепариновой мазью на зону поражения. Цель – лизирование тромба. Сверху утягивают всю конечность эластичным бинтом.
  2. Антиагреганты. Тормозят агрегацию («слипание») тромбоцитов.
  3. Ангиопротекторы (венотоники) – лекарственные вещества, укрепляющие стенку сосудов.
  4. Антибактериальные препараты для предупреждения развития сепсиса.
  5. Антигистаминные. Для снятия отечности и подавления воспалительной реакции.
  6. Внутривенно гепарин.
  7. Инфузии реологических лекарственных средств. Корректируют вязкость и другие механические характеристики крови.
  8. Нестероидные противововспалительные препараты для подавления нагноения при тромбофлебите.
  9. Мочегонные. Для ликвидации отеков.

Хирургическое

При запущенных случаях длительное медикаментозное лечение может не помочь. Приходится прибегать к услугам сосудистого хирурга. Применяются следующие оперативные вмешательства:

  • Тромбэктомия – удаление сгустка, закупоривающего просвет сосуда.
  • Вскрытие абсцесса.
  • В определенных ситуациях (некроз, флегмона, влажная гангрена) мышечный массив конечности вскрывают, дренируют («промывают»), иссекают омертвевшие ткани или даже прибегают к ампутации.

Народные средства и гомеопатия

Лечиться в домашних условиях травами можно, но это очень рискованно: если процесс тромбообразования уже начался, без лекарственных средств его затормозить сложно.

Данные рецепты лучше использовать в качестве мер профилактики:

  • Настойка на водке из плодов и цветков Конского каштана. Ангиопротектор, лизирует тромб.
  • Огуречный сок – 500 мл натощак. Действует аналогично обезболивающему.
  • Отвар из коры дуба: 1 ст. ложка сырья на 250 мл кипятка. Варить 30 мин. Принимать по 1 ст. ложке 3 раза в день.
  • Масляный настой календулы прикладывают к пораженному участку. Оказывает противовоспалительный и противоотечный эффект.
  • Мякиш белого хлеба смешивают с яблочным уксусом и пищевой содой. Смесь наносят на вспухшую область. Сверху обматывают полотенцем. Оставляют компресс на ночь.

Профилактика

Лечить любое заболевание проще на начальных стадиях, своевременно обращаясь к врачу при появлении симптомов. Лучше всего – не болеть вовсе.

Меры для снижения риска возникновения и рецидива тромбофлебита:

  1. Двигательная активность. Необходимо регулярно сокращать все группы мышц для стимуляции сосудов во избежание венозного застоя.
  2. Не допускать обезвоживания.
  3. У больных в послеоперационный период должны быть утягивающие повязки или медикаментозные препараты для профилактики формирования сгустков крови.
  4. Правильное питание. Высокий уровень холестерина в крови и сахарный диабет создают опасный гормональный фон, способствующий развитию атеросклероза и тромбофлебита.
  5. Допускается применение народных средств.
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