下肢静脉曲张医学课件

VaricoseveinofLowerLimb 承德卫生学校外科教研室李树东 Varicosity VaricoseveinsarecommonLocation varicocele esophagealvarices hemorrhoids legvarices Varicosityoflowerlimb 是指下肢浅静脉 因血液回流障碍而引起的静脉扩张和迂曲为主要表现的一种疾病 greatsaphenousvein Anatomyandpathophysiology Therearetwovenoussystemsinthelegs deepveins superficialveins perforatingveins Perforatingveins Veinvalves Inthenormalsituation valvesintheveinwallkeepbloodflowingtowardtheheart greenarrows Whenthevalvesaredamaged bloodcanflowbackwards redarrows dilatingtheveinandpoolingintheleg Classification primaryandsecondary Primaryvaricoseveins superficialveinsvaricose veinwall defect diminishedelasticity valvularincompetenceSecondaryvaricoseveins secondarytodeepveins destructionordysfunctionofvalvesbytrauma deepvenousthrombosis ornontraumaticproximalvenousobstruction pregnancy pelvictumor Whenvalvesofthedeepandperforatingveinsaredisrupted chronicvenousstasischangesmayaccompanysuperficialvaricosities Aggravatefactors PregnancyProlongedstandingObesityStraining Chronicconstipation urinaryretention chroniccoughsurgeryortraumatotheleg Theseconditionsinterruptthenormalbloodflowchannels Age mostelderlyindividualsshowsomedegreeofvaricoseveinoccurrence Clinicalfeatures Mostvaricoseveinsareasymptomatic Dilated tortuoussuperficialveinsinthelowerextremitiesThelegsoftenacheandfeelheavyanditchy Onemayhaveseverepainuponstandingorevenhavecrampsinthelegsatnight Mildankleedema Symptomscanintensifyafteralongdayofstandingonone sfeet Symptomsrelievedbylegelevation Pigmentation ulceration andedemaofthelowerlegsuggestsecondaryvaricoseveins 五期 Superficialthrombophlebitis Varicoseveinsarepronetodevelopingsuperficialthrombophlebitis whichisabloodclotalongwithinflammationofasegmentofvein Tendernessandpaininthevaricosevein alongwithrednessandswelling Feelhardorfirm Complicatios Pain heaviness inabilitytowalkorstandforlonghours DermatitisBleeding lifethreateningbleedfrominjurytothevaricoseveinUlcer nonhealingvaricoseulcercouldthreatenlimbamputation Developmentofcarcinomainlongstandingvenousulcers Coagulationofbloodinvaricoseveinscausesuperficialthrombosis deepveinthrombosis DVT PulmonaryEmbolism PE Test Brodie Trendelenburgtest 大隐静脉瓣膜功能试验 greatersaphenousandperforatingveinsPerthes 深静脉通畅试验 Diagnositcstudies duplexultrasoundvenography aduplexultrasoundexaminationtofocusspecificallyontheproblemveins Treatmentprinciple Relievediscomfortpreventoramelioratethecomplicationsofvenousstasisimprovetheappearanceoftheextremity andifpossible eliminatethecauseofthevaricositiestopreventprogressionofthedisease Nonoperativemanagement Improvevenousreturnandreducepressureinvaricosesuperficialveins Encouragewalking Avoidingprolongedsittingandstanding Elevatedtheleg wearingofgraduatedcompressionstockings Stocking Veingymnasticsinthebarefootpark Injectionsclerotherapy Producespermanentfibroticobliteration 管腔闭塞 ofcollapsedveins 3 sodiumtetradecylsulfate 十四烷基硫酸钠 Radiofrequencyclosure radiofrequencyablation thesurgeoninsertsacatheterintothevaricoseveinthroughasmallpuncture Thecatheterisusedtodeliverradiofrequencyenergytothewallofthevein whichcausestheveintocontractandsealitselfshut Thenearbyveinsthentakeovertheflowofvenousbloodfromthelegs Complications bruising burns paraesthesia clinicalphlebitis slightlyhigherratesofdeepveinthrombosis pulmonaryembolism Radiofrequencyclosure Beforeandafter Beforeandafter Endovascularlasertreatment EVLT Usesalaserwireorfiberthatisinserteddirectlyintothevein Energytransmittedfromalaserheatsthevaricoseveinandsealsitshut Thepatientcangobacktoworkthenextday althoughasupportstockingmustbewornfortwoweeksafterthelaserprocedure Afterbefore lasertechnologyinthetreatmentofvaricoseveins Surgicaltherapy LigationandstrippingofvaricoseveinsComplications deepveinthrombosis pulmonaryembolism woundinfection bleeding NursingDiagnoses AlteredtissueperfusionrelatedtovenousvalveincompetencePainrelatedtoedemaandmusclecrampingRiskforactivityintolerancerelatedtolegdiscomfortBodyimagedisturbancerelatedtodisfigurementofleg Nursinginterventions Goal promotevenousreturnfromlowerextremities Activity walkeveryhours Discourageprolongedsitting standing sittingwithcrossedlegs Position elevatelegs 30 40degree q2 3h atleast15 30minures ElasticstockingsConstrictinggarments tightsocks girdles Nursinginterventions AvoidingtraumaSkiniskeptclean dryanfsoftSignsofulcerationareimmediatelyreportedthethedoctor Postoperativecare Position elevatelegs 30degree 18outof24habovelevelofheart for1wkActivity after24h walkingPain medicationNochairsittingtopreventvenouspoolingthrombusformationBleeding chec