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Тромбоэмболия артерий нижних конечностей

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17 августа 2019

Тромбоэмболия нижних конечностей – это несамостоятельное заболевание, как правило, возникает как осложнение при тромбофлебите, варикозном расширении вен, сердечно-сосудистых заболеваниях. Происходит острая закупорка (эмболия) вены оторвавшимся тромбом от первичного места образования.

Причины

Факторы, которые способствуют появлению тромбоэмболии нижних конечностей:

  • наследственная предрасположенность;
  • повышенная свертываемость крови;
  • избыточная масса тела;
  • курение;
  • чрезмерное употребление алкоголя;
  • стойкое повышение артериального давления;
  • различны сердечно-сосудистые заболевания;
  • сахарный диабет;
  • беременность;
  • нарушение гормонального фона;
  • тромбофлебит;
  • оперативное вмешательство на нижних конечностях.

Клиническая картина тромбоэмболии нижних конечностей

Так как при тромбоэмболии ткани отмирают довольно быстро и каждая минута на счету, следует обратить внимание на следующие симптомы:

  1. Сильные отеки стоп, голеней и коленей.
  2. Варикозное расширение вен.
  3. Болевые ощущения при пальпации пораженных участков.
  4. Онемение нижних конечностей.
  5. Боли в ногах после длительных прогулок пешком.
  6. Чувство холода в ногах, даже в тепле.
  7. Судороги.

Стадии и симптоматика заболевания

Тромбоэмболия нижних конечностей протекает в трех стадиях. Болезнь быстро прогрессирует, поэтому нужно срочное получение медицинской помощи, иначе возникает риск потери конечностей.

1 стадия. В течение двух часов возникают нарушения функциональности.

  • отечность нижних конечностей;
  • двигательная функция сохранена;
  • боль в ногах;
  • бледные и холодные кожные покровы ног.

2 стадия. Продолжительность 12-24 часов.

  • ишемия тканей (обескровливание);
  • сильные боли;
  • потеря чувствительности;
  • цианоз кожных покровов (посинение);
  • отсутствие подвижности в суставах.

3 стадия. Необратимые изменения в тканях. Развивается острое воспаление.

  • полная потеря чувствительности;
  • появление коричневых пятен;
  • развитие гангрены.

Диагностика

Диагностировать тромбоэмболию можно несколькими способами:

  1. Флебография – рентгенологическое исследование с введением внутривенно контрастного вещества. Тромб будет преградой для дальнейшего нормального пути контрастного вещества.
  2. Ультразвуковая доплерография – позволяет измерить скорость, объем крови по венам и оценить ее свойства движения. А также разницу этих показателей на двух ногах.
  3. МРТ (магнитно-резонансная томография) – более детальное исследование при помощи электромагнитного поля, без использования контрастного вещества.
  4. КТ (компьютерная томография) – рентгеновские лучи послойно исследуют ткани. Более точная процедура, нежели МРТ.
  5. Импедансная плетизмография – исследование позволяющее определить, тромбоэмболии глубоки вен. Икроножную мышцу сдавливают для смыкания вен, при помощи специального манжета.
  6. Анализ крови – выявляет повышенную свертываемость крови.

Лечение медикаментами и народными средствами

Тромбоэмболию нижних конечностей лечат комплексно. Проводится медикаментозная терапия или хирургическое вмешательство.

Медикаментозная терапия включает в себя назначение следующих групп препаратов:

  • антикоагулянты (разжижают кровь);
  • обезболивающие препараты;
  • противовоспалительные средства;
  • антиспастические;

Оперативное вмешательство проводят, если не помогла медикаментозная терапия или в экстренных случаях.

Народные методы лечения тромбоэмболии. Данное лечение идет как дополнительное после операции или терапии.

  1. Отвар из шишек хмеля. Возьмите 2 ст. л. шишек и залейте их 2-мя стаканами горячей воды. Прогрейте смесь на водяной бане в течение 10-15 минут. Принимайте отвар натощак по пол стакана 3 раза в день, в течение месяца.
  2. Ванночки для ног с целебными травами несколько раз в неделю в течение 30 мин.
  3. Растирание ног яблочным уксусом. Можно делать каждый день перед сном.
  4. Обтирания 40% спиртом с каланхоэ. Для этого возьмите 200 мл спирта и 30 грамм листьев каланхоэ, смешайте и дайте настояться 2 часа, затем проводите обтирания пораженных участков.
  5. Компресс из бодяги. Вам понадобится 30 грамм бодяги и 250 мл кипятка. Смешать и дать настояться смеси не менее 2 часов. После этого нанести получившуюся смесь на пораженные участки и держать в течение часа.

Лечение народными методами следует проводить под наблюдение врача, иначе вы можете только усугубить свое положение.

Профилактика

  1. Совершайте длительные пешие прогулки.
  2. Исключите из рациона такие продукты: копчености, колбасы, белый хлеб, бананы, манго, жирные молочные продукты, наваристые мясные бульоны.
  3. Откажитесь от вредных привычек.
  4. Исключите или уменьшите потребление соли до 3-5 грамм в день.
  5. Пейте больше воды, примерно 1,5-2 л в сутки.
  6. Носите компрессионное белье.
  7. Своевременно обращайтесь за медицинской помощью.
  8. Контрастный душ.

Прогноз

При обращении за медицинской помощью на ранних стадиях заболевания, прогноз очень даже благоприятный. После назначенного лечения врачом, необходимо строго соблюдать поставленные рекомендации, тогда вы сможете избежать рецидивов.

Отзывы

Ирина

Мне поставили диагноз тромбоэмболия глубоких вен нижних конечностей.
Сначала пыталась лечить сама, но ничего не помогало, обратилась в больницу. Назначили операцию по удалению тромба из сосуда. Операция прошла успешно. Сейчас занимаюсь профилактическими мероприятиями. Отказалась от соли и алкоголя полностью, ношу компрессионное белье, пью больше воды. Также делаю обтирание спиртовой настойкой с каланхоэ, очень помогает. Всем советую, не затягивайте с лечением, идите в больницу.

Валентина

Мне давно поставили диагноз тромбофлебит с риском возникновения тромбоэмболии нижних конечностей. Чтобы предотвратить тромбоэмболию, я начала пить отвар из шишек хмеля, это отвар снимает воспаление и боль в ногах. Очень мне помог, мне стало легче, начала больше гулять пешком. Также я постоянно ношу компрессионное белье и делаю растирание яблочным уксусом.

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Тромбоэмболия нижних конечностей опасное заболевание, которое может лишить вас возможности нормально передвигаться, а то и вовсе оставить без конечностей. Очень важно обращаться в медицинские учреждения для ранней диагностики и своевременного лечения заболевания.

Кровеносная система человека очень похожа на дерево, где крупные артерии — это легочная артерия и аорта, а в роли ветвей выступают мелкие кровеносные сосуды. В силу особенностей каждого организма и многочисленных факторов густота крови, текущей по венам, у всех разная. Опасность состоит в том, что в сосудах могут образовываться тромбы — сгустки крови — как результат развития тромбоэмболии. Что такое тромбоэмболия нижних конечностей, каковы причины ее возникновения, а также каковы симптомы и особенности лечения этого заболевания, рассмотрим далее.

Что такое тромбоэмболия

Тромбоэмболия — это заболевание, которое не является самостоятельным. Оно возникает как следствие различных патологических процессов в организме, которые и послужили причиной образования тромбов.

Тромбоэмболия — это закупорка кровеносного сосуда тромбом, оторвавшимся от места, где он образовался и попавшем в циркулирующую кровь. Он представляет собой сгусток крови, который образовался вследствие активации системы свертывания крови, и может быть ответом на повреждение стенки сосуда. Сгусток перекрывает поток крови в сосуде подобно пробке, и как результат — развитие ишемии.

Чаще всего патология развивается в нижних полых венах, а это угроза развития тромбоэмболии легочных артерий, аорты, а также закупорки сосудов в левых отделах сердечной мышцы.

Тромбоэмболия опасна прежде всего тем, что может спровоцировать развитие гангрены конечностей.

Причины развития тромбоэмболии

Нарушение кровотока в артериях нижних конечностей провоцируют прежде всего заболевания сердечно-сосудистой системы, которые повышают риск образования тромбов, они составляют 95 % всех причин. Сюда можно отнести такие патологии:

  • Кардиомиопатия.
  • Пороки сердца.
  • Мерцательная аритмия.
  • Нарушение кровообращения в сердечной мышце.
  • Ревматизм с поражением клапанов сердца.
  • Атеросклероз.
  • Аневризмы сосудов сердца.
  • Эндокардит инфекционно-септический.

  • Травмы ног.
  • Различные заболевания крови.
  • Системные заболевания.
  • Повышенный уровень сахара в крови.
  • Высокая свертываемость крови.
  • Онкологические заболевания.
  • Тяжелая форма варикоза.
  • Чрезмерное и неправильное использование лекарственных препаратов.

Как результат этих состояний развивается тромбоэмболия сосудов нижних конечностей. А именно вот что происходит:

  • Изменяется состав крови, повышается ее вязкость.
  • Замедляется кровоток по сосудам и венам.
  • Повреждаются стенки сосудов.

Группы риска

Стоит сказать несколько слов о тех, кто входит в группу риска. Именно у этой категории пациентов тромбоэмболия артерий нижних конечностей имеет большие шансы на развитие. В эту группу можно отнести:

  • Работников офисов.
  • Людей, страдающих гиподинамией.
  • Работающих в одном положении на протяжении всего дня.
  • Пациентов, работающих на производстве, где тяжелый физический труд.

А также в зону риска попадают:

  • Люди старше 55 лет.
  • Беременные.
  • Страдающие ожирением.
  • Перенесшие патологические роды.
  • Перенесшие оперативное вмешательство.
  • Принимающие гормональные контрацептивы.

Также хочется особо отметить, что тромбоэмболия вен нижних конечностей очень часто наблюдается у любителей табака. Курение повышает вероятность образования тромбов.

Стадии развития заболевания

  1. В покое у пациента жалоб нет. При нагрузке на нижние конечности появляется иногда чувство тяжести в ногах и незначительная боль. Восстановление наступает быстро после отдыха.
  2. Двигательная активность сохраняется. Появляется отечность, сильные боли, потеря чувствительности участков кожи. Ноги бледнеют, становятся холодными.
  3. Развивается ишемия тканей. До 3 часов обратимые изменения. При этом присутствуют сильные боли, отсутствуют пульс и чувствительность. Через 6 часов присоединится неподвижность суставов.
  4. Необратимые процессы. Развитие гангрены, появление коричневых пятен.

Все эти процессы очень быстро развиваются, поэтому необходимо знать, каковы симптомы тромбоэмболии нижних конечностей. Рассмотрим их далее.

Симптомы заболевания

Не следует оставлять без внимания следующие состояния:

  • Чувство зябкости ног даже в тепле.
  • Резкая боль в ногах, которая появляется неожиданно.
  • Слабость в ногах, которая не позволяет свободно двигаться.
  • Онемение в ногах, покалывания.
  • Мышечные боли, судороги в ногах.
  • Чувствительность в области голени, стопы или бедер нарушена.
  • Кожа бледная и холодная.
  • Отсутствует пульсация сосудов.

Такие симптомы должны насторожить. Если же уже есть варикозная недостаточность, то это может способствовать развитию тромбоэмболии.

Главное — не упустить время и своевременно обратиться за помощью, так как ткани быстро отмирают.

Диагностируем заболевание

Какой метод диагностики необходимо использовать, зависит от локализации патологии.

При подозрении на тромбоэмболию используют следующие методы обследования:

  • Определение D-димера. Показание в пределах нормы практически исключает эмболию.
  • УЗИ вен конечностей с допплерографией. При этом визуализируются тромбы периферических вен.
  • Ангиография.
  • КТ и МРТ. Позволяют определить образование тромба в любом месте. Широко используют при риске ТЭЛА и тромбоэмболии в тяжелой форме.
  • УЗИ и ЭКГ сердца.
  • Рентгенография грудной клетки. Используют при подозрении на ТЭЛА.
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Для полного обследования пациенту, чтобы исключить другие патологии, назначают общий анализ крови, мочи и прочие анализы.

Срочная помощь при подозрении на тромбоэмболию

Тромбоэмболия нижних конечностей — очень опасное и серьезное заболевание. При подозрении на закупорку сосудов больного необходимо срочно доставить в больницу. При этом действия должны быть следующими:

  1. Обеспечить больному горизонтальное положение.
  2. Исключить движение и передвижение.
  3. Соблюдение постельного режима.

Если состояние тяжелое, при необходимости в лечебном учреждении под наблюдением врача проводят следующие мероприятия:

  • Устанавливают катетер в вену.
  • Проводят ИВЛ.
  • Вводят кислород через носовой катетер.

Используют следующие препараты:

  • «Гепарин».
  • «Дофамин».
  • «Реополиклюкин».
  • «Эуфиллин».
  • Антибиотики.
  • Обезболивающие препараты.

Как лечат тромбоэмболию

Для эффективного лечения необходимо как можно раньше посетить специалиста, если возникло подозрение на такое заболевание, как тромбоэмболия нижних конечностей. Лечение должно быть комплексным.

Прежде всего врач назначит препараты-антикоагулянты, которые способствуют разжижению крови. Также необходимо проводить терапию того заболевания, которое послужило толчком к развитию такой патологии.

Практически всегда применяются обезболивающие препараты, противовоспалительные средства.

Проводится тромболитическая терапия. Используют такие лекарственные средства:

Препараты назначают внутривенно в течение 10 дней. При этом необходим постоянный контроль за свертываемостью крови — каждые пару дней. Также назначают «Варфарин» в таблетках. Это лекарство могут назначить для применения в течение года. Еще показаны антиспастические лекарства против спазмов.

Терапия должна быть направлена на восстановление тканей и улучшение кровотока в нижних конечностях.

Если лечение не дает необходимого эффекта, может потребоваться хирургическое вмешательство. Удаление тромба из сосуда чаще всего происходит при закупорке бедренной и подколенной артерий. Тромбоэктомия может проводиться в экстренных случаях, когда становится ясно, что терапия не будет эффективной.

После операции больной находится под контролем врача, при этом, чтобы исключить застой крови в сосудах, показана на ранних сроках умеренная физическая активность.

Профилактика тромбоэмболии нижних конечностей

Если уже имела место закупорка артерий, необходимо:

  • Следовать рекомендациям врача.
  • Систематически принимать назначенные лекарственные средства.
  • Своевременно лечить болезни, повышающие риск развития тромбоза.
  • Регулярно делать УЗИ вен ног и таза.
  • Носить компрессионное белье.
  • Не находиться продолжительное время в одной позе.
  • Заниматься спортом.
  • Не поднимать тяжестей.
  • Отказаться от курения.
  • Придерживаться правильного питания.
  • Больше пить жидкости.

Только придерживаясь рекомендаций и здорового образа жизни, можно существенно снизить риск развития такого опасного заболевания, как тромбоэмболия глубоких вен нижних конечностей.

Тромбоэмболия нижних конечностей — это закупоривание кровеносных сосудов ног в результате отрыва тромба. Это нарушает ток крови и питание тканей кислородом, начинается ишемия клеточных тканей. В месте закупорки сосудов образуются сгустки крови, причиной которых может быть нарушение кровообращения, аортит, тромбофлебит, сердечная недостаточность и инфаркт, запущенная стадия варикоза, атеросклероз, сахарный диабет, сгущенность крови, наследственные патологии. Как правило, заболевание поражает нижний конечности. Эмболия верхних конечностей встречается довольно редко (тромбоз подключичной или подмышечной вены).

Механизм развития

Процесс поражения кровеносной системы проходит в 2 этапа:

  1. Образование самого сгустка на стенках кровеносных сосудов за счет тромбоцитов.
  2. Отрыв тромба от стенки сосуда и его перемещение по артериальной или венозной системе с последующей закупоркой полости сосуда в любой части организма (конечностях, легких, головном мозге, сердце).

Между тромбом и эмболом имеются важные отличия:

  1. Тромб прикреплен к стенке сосуда и неподвижен, а эмбол «путешествует» по кровеносной системе, вызывая вторичную закупорку вен и артерий.
  2. Тромб представляет собой сгусток фибриновых веществ и кровяных клеток, эмбол — это смесь патогенных микробов, жировых клеток и частичек воздуха.

Передвижение эмболического сгустка может быть спровоцировано сильным кашлем или чиханием, мерцательной аритмией, напряжением мышц во время акта дефекации, резкими движениями, повышенной температурой.

Главная опасность недуга в том, что плавающий тромб (эмбол) может перемещаться по артериям и вызвать закупорку жизненно важных артерий, перекрывая ток крови по ним.

Наиболее опасны тромбозы в бедренных артериях и развитие непроходимости сосудов таза.

Чаще всего болезнь поражает мелкие легочные артерии и вены ног. Закупоривание легочной артерии и ее разветвлений эмболами называется тромбоэмболией легочной артерии (ТЭЛА), которая в основном поражает крупные вены ног и таза.

Симптоматика заболевания

Симптомы варьируются в зависимости от того, где разместился сгусток крови, и размеров сосудов ног. Это могут быть:

  • приступы кашля;
  • снижение температуры;
  • острые боли в месте образования окклюзии;
  • отечность кожных покровов, которые приобретают синюшный цвет;
  • ослабление пульса.

Различают 4 стадии развития тромбоэмболических поражений кровеносных сосудов:

  1. Незначительные болевые ощущения при нагрузках, которые исчезают в состоянии покоя.
  2. Передвижения затруднены, нарушается чувствительность конечностей.
  3. Интенсивное проявление признаков тромбоэмболии артерий.
  4. Развитие гангрены нижних конечностей.

Тромбоэмболию характеризуют следующие симптомы:

  • онемение конечностей и колющие боли;
  • приступы резких болей;
  • ограничение передвижения по причине слабости в ногах;
  • холодные ноги, кожные покровы конечностей бледнеют и синеют;
  • снижение чувствительности;
  • сдавливающие боли в области грудной клетки, отдающие в лопатки и руки и усиливающиеся при кашле;
  • болевые ощущения в брюшной полости;
  • нарушение сердечной деятельности;
  • одышка;
  • гипотензия;
  • отсутствие пульсации вен;
  • дисфункции кишечника;
  • тошнота и судороги мышц;
  • мокрота с кровянистыми выделениями;
  • обморочное состояние.
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При отсутствии своевременного лечения исход может быть летальным. Отличительной особенностью недуга является то, что могут возникать повторные рецидивы на протяжении всей жизни (10-30% случаев).

Наиболее подвержены тромбоэмболии следующие категории:

  • люди, ведущие малоподвижный образ жизни;
  • заядлые курильщики;
  • люди, имеющие профессии, связанные с тяжелым трудом или чрезмерными физическими нагрузками;
  • люди с избыточным весом;
  • беременные или перенесшие сложные роды, операции;
  • женщины, употребляющие гормональные противозачаточные средства;
  • пожилые (после 60 лет).

Клиника тромбоэмболии

Этиология развития тромбоэмболии артерий нижних конечностей в большинстве случаев протекает быстро, с ярко выраженной симптоматикой. Появляется внезапная острая боль в конечности, кожа на ноге бледнеет, пульсация артерии не прощупывается. Наблюдается непроходимость сосудов.

Постепенно на коже возникают белесые пятна, наблюдается эффект «мраморной кожи». Из-за происходящих процессов закупоривания сосудов появляется ощущение онемения и покалывания в ноге до полной потери чувствительности. Обтурация сосудов переходит в фазу омертвения клеток и начало гангренозного процесса. При отсутствии инфекции область гангрены высыхает и становится плотной. В случае наличия инфекционных заболеваний омертвевшие части подвергаются язвенному разрушению, происходит интоксикация организма, сопровождающаяся повышением температуры и уровня лейкоцитов в крови.

Диагностика заболевания

Диагностировать заболевание очень сложно, так как развитие тромбоза происходит постепенно. Первичные клинические признаки патологии размыты, могут соответствовать разным недомоганиям, вследствие чего определение болезни основывается на визуальном осмотре и интервьюировании пациента. Также проводят общий и биохимический анализы крови.

Для уточнения диагноза применяют следующие виды исследования:

  1. Допплерография — звуковая диагностика на предмет наличия тромбов.
  2. Осциллография — измерение пульсовых колебаний стенок артерий или вен при искусственной компрессии и декомпрессии сосудов с помощью специального манжета. С помощью осциллографа анализируется проходимость крупных артерий, колебания уровня давления, эластичность стенок сосудов.
  3. Реография — исследование качества кровообращения артерий путем графической регистрации изменений электропроводимости сосудов при пульсации крови.
  4. Ангиография артерий нижних конечностей — основана на вводе в артерии через катетер контрастной жидкости с последующей рентгенограммой. Данная процедура позволяет определить состояние и проходимость кровеносных сосудов.

Точное диагностирование и определение локализации кровяных сгустков позволяет назначить адекватное лечение и значительно облегчает процесс устранения тромбоэмболических пробок.

Методы лечения тромбоэмболии

Как оказать первую помощь? Как только появляются симптомы нарушения сосудистого кровообращения ног, необходимо принять меры для нормализации кровотока в венах конечностей.

Больного нужно положить на ровную поверхность и вызвать скорую помощь.

Строго противопоказаны активные движения, прогревания или растирания онемевших конечностей.

В медицинском учреждении применяются следующие средства:

  1. Для снижения свертываемости крови и предупреждения образования тромбов назначаются тромболитические препараты, антикоагулянты, обезболивающие средства и спазмолитики для снятия спазмов артерий (Папаверин, Но-шпа, Атропин и др.).
  2. Тромболитики разрушают уже образовавшиеся в сосудах тромбы. Это препараты Альтеплаза, Актилизе, Тенектеплаза и др.
  3. Антикоагулянты предупреждают сгущение крови и образование бляшек (Аспирин, Гепарин, Кардиомагнил и др.).

Экстренное лечение поражений сосудов ног тромбами заключается только в срочной операции по удалению кровяной пробки из полости вены или артерии.

Хирургическое вмешательство в зависимости от характера и локализации тромбоза проводится различными методами, основные из которых:

  1. Прямой — вскрытие артерии в месте образования окклюзии с целью ее удаления.
  2. Кроссэктомия — рассечение или прокол места образования кровяного сгустка (подкожной вены).
  3. Введение кава-фильтра в полость сосудов нижних конечностей.
  4. Эндоваскулярный — предусматривает удаление сгустка путем ввода в полость сосуда катетера.
  5. Прошивание полой вены ноги — применяют при невозможности удаления блуждающего тромба. Суть способа состоит в сужении сосуда путем прошивки с целью предотвращения проникновения тромба в жизненные артерии.
  6. Ампутация конечностей — при гангренозном поражении ног.

После хирургической операции больному необходимо провести реабилитационное лечение для регенерации тканей и нормализации кровообращения в прооперированной конечности.

Профилактические меры

Для предупреждения развития такого опасного заболевания, как тромбоэмболия артерий нижних конечностей, требуется соблюдение профилактических мер:

  1. Во избежание рецидива необходимо регулярно и постоянно принимать лекарства, прописанные врачом (тромболитические препараты и антикоагулянты).
  2. Проводить своевременное лечение заболеваний, которые могут спровоцировать тромбоэмболию (атеросклероз, сердечная недостаточность, густота и высокая свертываемость крови, сахарный диабет и др.).
  3. Соблюдать специальную диету, направленную на уменьшение холестерина в крови.
  4. Заниматься спортом, особенно при малоподвижном образе жизни.
  5. Вести здоровый образ жизни — это отказ от алкоголя и табачных изделий, жирной, острой и соленой пищи.
  6. Контролировать вес.

Нельзя проводить лечение тромбоэмболии самостоятельно. Необходимо сразу обращаться к специалистам. Закупорка сосудов на ногах и поздно принятые меры по ее устранению могут привести к ампутации конечностей или к летальному исходу.

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