Deep vein thrombosis refers to the formation of thrombosis in deep veins, resulting in complete or incomplete obstruction of the lumen, obstruction of blood return, and a series of clinical symptoms.
The clinical incidence of deep vein thrombosis is high. When the treatment effect is not satisfactory, deep vein obstruction of the lower limbs or venous valve insufficiency may be left.
1. Rehabilitation assessment
01
functional assessment
1. Assessment of sensory function
2. Assessment of psychological functions
Patients with deep vein thrombosis often experience anxiety and depression.
02Structural Assessment
Different methods may be used as appropriate:
1. Circumference of both lower limbs
Measure the horizontal circumference of both lower limbs 10cm above the upper edge of the patella and 10cm below the lower edge of the patella. Compare the two sides and compare the time before and after.
2. Vascular color ultrasound examination
The vein diameter and intraluminal conditions can be directly observed to understand the size and location of the embolism.
03Activity evaluation
Chronic phase deep vein thrombosis, obstruction or venous valve insufficiency can all affect the ability to carry out daily life activities. The Barthel index can be used to evaluate the ability to carry out daily life activities.
2. Rehabilitation diagnosis
01 Dysfunction
1. Sensory dysfunction.
2. Movement dysfunction.
3. Psychological dysfunction.
02Structure abnormality
1. Classification of deep vein thrombosis
The following types can be diagnosed:
① Occlusive type:
In the early stage of the disease, there is intraluminal obstruction of the deep veins, obvious swelling of the lower limbs, and dilation of the superficial veins.
② Partial recanalization type:
In the middle stage of the disease, the deep veins are mainly occluded, accompanied by early recanalization. At this time, the limb swelling is reduced, but the superficial veins are more dilated.
③ Recanalization type:
Later in the course of the disease, most or all of the deep veins are recanalized. Clinically, the swelling of the lower limbs is reduced but worsens after activity, and obvious varicose veins, calf pigmentation and recurrent ulcers appear.
2. Swelling of lower limbs
The venous pressure at the distal end of the obstruction increases and the thrombus organizes, leading to valve insufficiency, causing pitting edema of the lower limbs. There is no redness in the swollen area, and the skin temperature is normal. Swelling is often graded into grades I to II based on the degree and scope of involvement.
Degree I: There is obvious pitting edema in the feet and calves, which does not disappear after rest.
Grade II: In addition to grade I, it is also accompanied by thigh edema and skin tension.
03Activities are restricted
1. Limited ability to carry out activities of daily living.
2. Limited mobility.
04Participation is limited
Patients’ occupation, social interactions, and leisure and entertainment may be limited, and their quality of life may be reduced.
3. Rehabilitation treatment
▼ Short-term goals:
Early detection and early treatment, based on the formation time of thrombus, select 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 recanalization of the lumen, and reduce pulmonary embolism. incidence rate.
▼ Long-term goals:
Promote vein recanalization, improve local blood supply, control complications after deep vein thrombosis, such as lower limb swelling, skin pigmentation, and even ulcer formation, restore limb function, and reduce lost working ability.
01Physical therapy
In the acute phase and when venous inflammation occurs, physical therapy can reduce swelling, promote blood return, and control the further development of the disease. In the chronic phase, collateral circulation can be strengthened and thrombosis organized.
1. Acute phase
Or when the condition recurs in the chronic phase and venous inflammation occurs.
Treatment methods: ultra-short wave, low-energy laser, etc.
2. Chronic phase
Stable condition.
Treatment 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, and electric water bath.
02Exercise therapy
1. In the supine position, the quadriceps femoris, biceps femoris, gastrocnemius and other muscle groups of the affected lower limb perform isometric contraction and isotonic movements.
2. Dorsiflexion and plantar flexion of ankle and toe joints.
3. Centripetal massage and massage, gentle massage from the distal end to the proximal end of the limb, can promote venous blood return and eliminate swelling of the affected lower limb.
4. Encourage the patient to get out of bed and move around as appropriate.
03Prevention
You can perform simple active activities in bed to improve blood circulation and prevent venous thrombosis in the lower limbs.
● Raise the lower limbs: It is recommended to raise the lower limbs 20°-30°;
●Ankle pump exercise: Lie on your back, straighten your lower limbs, slowly repeat foot-stepping and hooking movements with both feet, and keep the knee joint straight. 10/group, 3 groups/time, 2 times/day.
● Knee flexion and extension: Lie on your back, flex your hips and knees, keep your hip joints in a flexed position, and alternately straighten your calves on both sides; 10 exercises/group, 3 groups/time, 2 times/day.
● Hip rotation: Lie on your back, bend your hips and knees, step on the bed with both feet, and perform opening and closing movements of both lower limbs at the same time; 10 exercises/group, 3 groups/time, 2 times/day.
● Alternate leg extension: Lie on your back, bend your hips and knees, alternately slowly extend your lower limbs downward; 10 exercises/group, 3 groups/time, 2 times/day.
04Auxiliary tools
1. Lower limb compression stockings
Patients who are bedridden for a long time and have hypercoagulable blood should wear lower limb elastic stockings.
2. Elastic bandage
First put a layer of burnt cotton pad, and wrap the bandage in a circular motion from the instep to the popliteal fossa and the root of the thigh, maintaining a certain strength when wrapping.
3. Low frequency electrical therapy
Low-frequency electrical stimulation acts on the calf muscles on the affected side, stimulating muscle contraction and improving venous blood return.
05TCM treatment
Traditional Chinese medicines such as promoting blood circulation, removing blood stasis, clearing heat and diuresis can be given to improve local blood circulation.
06Rehabilitation care
Rest in bed and elevate the affected limb. Do not massage in the acute stage and drink plenty of water to avoid increasing blood viscosity and aggravating thrombosis.
07Psychotherapy
Psychological counseling and comfort, and drug treatment to adjust emotions when necessary.
08 Western medicine treatment
1. Thrombolytic therapy
If the disease duration does not exceed 3 days, thrombolytic treatment can be given, and the commonly used drug is urokinase.
2. Anticoagulant therapy
If the course of the disease exceeds 3 days, this method should be used to prevent thrombus growth and promote venous recanalization. Anticoagulation therapy often uses unfractionated heparin or low molecular weight heparin, vitamin K antagonists (warfarin), indirect factor Xa inhibitors (fondaparinux), direct factor Xa inhibitors (rivaroxaban), etc.