急性脑梗死合并小腿肌间静脉血栓的临床研究进展

Clinical Research Progress of Acute Cerebral Infarction Complicated with Calf Muscular Venous Thrombosis

摘要: 脑梗死后患者因肢体功能障碍、长期卧床及血液高凝状态，下肢静脉血栓形成风险显著升高。其中，肌间静脉血栓(Calf Muscle Vein Thrombosis, CMVT)作为远端深静脉血栓(Deep Vein Thrombosis, DVT)的最常见亚型，在卒中后人群中的真实负担被严重低估。CMVT的自然病程具有双向性：多数可自溶或稳定，但部分可向近端延展，继而诱发肺栓塞(Pulmonary Embolism, PE)。当前国内外指南对脑梗死合并CMVT的防治策略缺乏精准推荐，临床在“预防血栓进展”与“避免颅内出血转化”之间面临两难决策。本文系统回顾近期高质量实证研究，聚焦脑梗死特异性背景下CMVT的流行病学特征、病理机制、诊断策略及临床管理争议，旨在为构建兼顾血栓清除与出血安全的个体化方案提供循证依据。

Abstract: The risk of lower extremity venous thrombosis is significantly increased in patients with cerebral infarction due to limb dysfunction, long-term bed rest and hypercoagulable state. Among them, Calf Muscle Vein Thrombosis (CMVT), as the most common subtype of Deep Vein Thrombosis (DVT), is seriously underestimated in the post-stroke population. The natural course of CMVT is bidirectional: most of them can autolyze or stabilize, but some can extend to the proximal end, which in turn induces pulmonary embolism (PE). The current guidelines at home and abroad lack accurate recommendations for the prevention and treatment strategies of cerebral infarction combined with CMVT, and there is a dilemma between “preventing thrombosis progression” and “avoiding intracranial hemorrhage transformation”. This article systematically reviews recent high-quality empirical studies, focusing on the epidemiological characteristics, pathological mechanisms, diagnostic strategies, and clinical management disputes of CMVT in the context of cerebral infarction specificity, in order to provide evidence-based evidence for the construction of individualized programs that take into account the safety of thrombus removal and bleeding.