Source: Rehabilitation Exchange Copyright belongs to the original author
Deep vein thrombosis refers to the thrombosis in the deep veins, causing complete or incomplete blockage of the lumen, obstruction of blood return, and a series of clinical symptoms.
“600” >1. Rehabilitation assessment
01
< p>Functional assessment
1. Sensory function assessment
2. Psychological Functional assessment
Patients with deep vein thrombosis often have anxiety and depression.
02Structural Assessment
< span>Different methods can be used as appropriate:
1. Circumference of both lower extremities
The horizontal circumference of 10 cm above the upper edge of the patella and 10 cm below the lower edge of the patella of both lower limbs was measured.
2. Angiography
You can directly observe the vein diameter and intraluminal conditions to understand the size and location of the embolism.
03Activity Rating
< /p>
Chronic deep vein thrombosis, obstruction or venous valve insufficiency can affect activities of daily living. The Barthel index can be used to evaluate activities of daily living.
II. Rehabilitation diagnosis
01 Dysfunction
1. Sensory dysfunction.
2. Motor dysfunction.
3. Psychological dysfunction.
02Structural abnormalities
1. Deep vein thrombosis Type
The following types can be diagnosed:
① Occlusive type: span>
In the early stage of the disease, the deep veins were blocked in the lumen, and the lower extremities were obviously swollen, accompanied by superficial vein dilatation.
② Partial recanalization type:
In the middle of the disease course, the deep veins are mainly occluded, accompanied by early recanalization. At this point, the swelling of the limbs is reduced, but the superficial veins are more dilated.
③ Recanalization type:
In the later stage of the disease, the deep veins are mostly or completely recanalized, and the lower limbs are clinically swollen Reduced but worsened with activity, with marked varicose veins, calf hyperpigmentation, and recurrent ulcers.
2. Swelling of lower extremities
The increased venous pressure at the distal end of the occlusion and the organization of the thrombus lead to valve insufficiency, resulting in pitting edema of the lower extremity. There is no local swelling and redness, and the skin temperature is normal. Swelling grades are often divided into grades I to II according to the extent and extent of involvement.
Grade I: There is obvious pitting edema in the feet and lower legs, which does not disappear after rest.
Grade II: In addition to degree I, it is accompanied by thigh edema and skin tension.
03Limited activity
1. Daily life Limited mobility.
2. Limited mobility.
04Limited participation
Patient occupation, Social interaction, leisure and entertainment may be limited, and the quality of life may decline.
Third, rehabilitation therapy
▼ Immediate goal:
Early detection Early treatment, according to the time of thrombus formation, choose appropriate drug therapy, physical therapy, surgical procedures, nursing methods, etc., to prevent the formation of fresh thrombus, facilitate the dissolution and organization of thrombus, promote lumen recanalization, and reduce the occurrence of pulmonary embolism Rate.
▼ Long-term goals:
Promote venous recanalization, improve local blood supply, control complications after deep vein thrombosis, such as lower limb swelling, skin pigmentation, and even ulcer formation, etc., restore limb function, and reduce lost labor capacity.
01Physiotherapy
Acute and venous In inflammation, physical therapy can reduce swelling, promote blood return, and control the further development of the disease. In the chronic phase, the collateral circulation can be strengthened and the thrombus organization can be promoted.
1. Acute Phase
When the disease recurs in the chronic phase and venous inflammation occurs.
Therapeutic methods: ultrashort wave, low energy laser, etc.
2. Chronic Phase
Stable disease.
Therapeutic methods: microwave therapy, resonant spark therapy, audio electrotherapy, direct current iontophoresis (5% to 10% potassium iodide or sodium iodide solution), ultrasound, shock wave therapy , magnetic therapy, pressure therapy, electric water bath.
02Exercise therapy
1. Supine position At the same time, the quadriceps femoris, biceps femoris, gastrocnemius and other muscle groups of the affected lower limb are isometrically contracted and isotonic.
2. Dorsiflexion and plantar flexion of the ankle and toe joints.
3. Concentric massage and massage, gentle massage from the distal end of the limb to the proximal end, can promote the return of venous blood and eliminate the swelling of the lower limb on the affected side.
4. Encourage the patient to get out of bed as appropriate.
03prevention >
Simple active activities in bed can improve blood circulation and prevent venous thrombosis of lower extremities.
● Lower extremity elevation: 20°-30° elevation of lower extremity is recommended;
● Ankle Pumps: Lie on your back, straighten your lower limbs, slowly repeat the foot step and hook with your feet, and keep your knees straight. 10/group, 3 groups/time, 2 times/day.
: Supine position, hips and knees flexed, feet on the bed, bilateral lower limbs do opening and closing movements at the same time; 10/group, 3 groups/time, 2 times/day .
alternately Leg extension: Supine position, flexion of hips and knees, alternating lower limbs on both sides to slowly straighten down; 10/group, 3 groups/time, 2 times/day.
strong
/span>
1. Leg Compression Stockings
Long Term Bedridden and hypercoagulable patients should wear lower extremity elastic stockings.
2. Elastic Bandages
Put a layer of burn cotton pad first, and wrap the bandage in a circular loop from the dorsum of the foot to the popliteal fossa and the root of the thigh, maintaining a certain strength when wrapping.
3. Low Frequency Electrotherapy
Low-frequency electrical stimulation acts on the calf muscles on the affected side to stimulate muscle contraction and improve venous blood return.
05Traditional Chinese Medicine
Traditional Chinese medicines such as promoting blood circulation and removing blood stasis, clearing away heat and removing dampness can be given to improve Local blood circulation therapy.
06Rehabilitation Nursing
Bed rest and elevation of the affected limb, avoid massage in acute stage , Drink plenty of water to avoid increased blood viscosity and aggravate thrombosis.
07Psychotherapy
Psychological counseling and comfort, and if necessary, drug treatment to adjust mood.
08Western Medicine
1. Thrombolytic therapy
If the course of disease does not exceed 3 days, thrombolytic therapy can be given, and the commonly used drug is urokinase.
2. Anticoagulation
If the course of disease has exceeded 3 days, this method should be used to prevent the growth of thrombus and promote venous recanalization. Unfractionated heparin or low molecular weight heparin, vitamin K antagonists (warfarin), indirect factor Xa inhibitors (fondaparinux sodium), direct factor Xa inhibitors (rivaroxaban), etc. are often used in anticoagulation therapy.