静脉曲张 · 腿上的青筋为什么鼓起来

参考文献 · 10

1. Youn, Y. J., & Lee, J. (2019). Chronic venous insufficiency and varicose veins of the lower extremities. Korean Journal of Internal Medicine, 34(2), 269-283. Advancing age, family history, prolonged standing, obesity, smoking, sedentary lifestyle, lower extremity trauma, prior venous thrombosis, high estrogen states and pregnancy are all considered risk factors. The main pathophysiological cause is ambulatory venous hypertension, caused by venous valve reflux, venous flow obstruction, or both: the venous pressure of the foot vein in the standstill position without skeletal muscle contraction is as high as 80 to 90 mmHg; in a subject with competent venous valves this pressure decreases to less than 30 mmHg during ambulation, but in a patient with CVI the decrease with leg movements is attenuated. If valves in the perforator veins are incompetent, the high pressures generated in the deep veins by calf-muscle contraction can be transmitted to the superficial system and to the microcirculation in skin. In the standing position, blood in the leg veins must overcome gravity and intra-abdominal pressure to return; normal venous valves are typically bicuspid and unidirectional, and their dysfunction causes venous reflux; the number of valves increases from proximal to distal; the great saphenous vein has at least six valves. The calf muscle pump, called the peripheral heart, squeezes the veins on contraction and pumps blood upward in keeping with the one-way valves; during ambulation it empties the venous system and the pressure within the veins decreases. Superficial vein reflux accounts for 90% of patients presenting with CVI; the deep venous system carries approximately 90% of the venous blood flow of the legs. Venous leg discomfort (dull ache, throbbing or heaviness after prolonged standing) is relieved by any measure that lowers venous pressure, such as elevation of the leg, compression stockings, or walking; leg edema begins around the ankle and varies with the time of day. Varicose veins are dilated, bulging, superficial veins at least 3 mm in diameter that become progressively more tortuous and enlarged; patients are often asymptomatic; they cause pain if superficial thrombophlebitis develops and can cause prolonged bleeding. Conservative management includes compression stockings, weight reduction, regular walking exercise and stopping smoking; compression stockings oppose the hydrostatic forces of venous hypertension, but approximately half of patients cannot continue compression therapy, for reasons such as tightness and warmth; coexisting arterial insufficiency limits their use (full text PMC6406103; PMID 30360023). 10.3904/kjim.2018.230
2. NHS. (2024). Varicose veins (page last reviewed 1 July 2024). Varicose veins are swollen, twisted veins under the skin, usually on the legs; they are common and not usually serious. They may cause pain, aching or heaviness, skin changes such as itching, colour changes or dry scaly skin, and swollen ankles or legs; symptoms may be worse after standing for a long time and better when resting with the legs up; they may get worse without treatment, usually very slowly over several years. They are different from spider or thread veins, small red, blue or purple veins that are usually harmless. Do: keep to a healthy weight, put your legs up when possible, exercise regularly such as running or walking to improve blood flow, moisturise dry, flaky or itchy skin, try not to injure your legs to help prevent bleeding; don't stand or sit for long periods unless your feet are raised; don't smoke. See a GP if you have pain, itching or swelling, a sore on the leg that has not healed after 2 weeks, or they are getting worse; ask for an urgent GP appointment or NHS 111 if varicose veins are bleeding. Treatment for appearance alone is not usually available on the NHS. A specialist usually confirms with duplex ultrasound; endothermal ablation is usually the first choice; compression stockings are offered only if procedures are not suitable or not needed, are not suitable with problems in the arteries, and the right type should be chosen with a doctor or pharmacist. In pregnancy, compression stockings may be used but procedures are not usually recommended, and varicose veins often get better or go away after the baby is born. Varicose veins happen when the valves that control blood flow in the vein do not work properly, so blood builds up and puts pressure on the vein, which makes it swell and twist; more likely in women, older people, overweight people, in pregnancy, with a lot of time standing or sitting, family members with varicose veins, or previous DVT. Complications include bleeding, varicose eczema, venous leg ulcers, superficial vein thrombosis (hard, painful veins) and DVT. www.nhs.uk/conditions/varicose-veins
3. NHS. (2026). DVT (deep vein thrombosis) (page last reviewed 30 April 2026). DVT is a blood clot in a vein, usually in the leg, and can be dangerous; get medical help as soon as possible. Symptoms: throbbing pain in 1 leg (rarely both), usually in the calf or thigh; swelling in 1 leg; red, blue or darkened skin around the painful area; swollen veins. Ask for an urgent GP appointment or NHS 111 if you think you have DVT. Call 999 or go to A&E if you have DVT symptoms such as pain and swelling and feel short of breath or have chest pain: clots can travel to the lungs (pulmonary embolism), which can be life-threatening; do not drive yourself to A&E. DVT is more likely with varicose veins, age over 60, overweight, smoking, previous DVT, oestrogen-containing contraception or HRT, cancer, pregnancy or a baby in the previous 6 weeks, surgery or hospital stay, and long journeys of more than 4 hours. If a doctor thinks you have DVT you should be referred to hospital within 24 hours for an ultrasound scan. Prevention: stay active, take regular walks, drink plenty of fluids, and do not sit still for long periods. www.nhs.uk/conditions/deep-vein-thrombosis-dvt
4. Gwozdzinski, L., Pieniazek, A., & Gwozdzinski, K. (2024). Factors influencing venous remodeling in the development of varicose veins of the lower limbs. International Journal of Molecular Sciences, 25(3), 1560. Varicose veins are more common in women than men; contributing factors include age over 50, related to ageing of the vein walls (the veins lose elasticity and stiffen) and valves, a sedentary lifestyle, obesity and smoking, and familial predisposition; in women, female hormones can lead to stretching of the walls of the veins. Genetic influence on the remodelling of vessel walls has been demonstrated. Chronic venous insufficiency is caused by abnormalities in the wall structure and dysfunction of the venous valves; primary varicose veins are a consequence of venous dilatation and valvular failure without previous deep vein thrombosis. With properly functioning valves, contraction of the calf muscle compresses the vein and pumps blood upwards; during walking the calf muscle pump lowers the pressure in the veins, and valve dysfunction leads to reverse flow (venous reflux). Damage to the valves leads to slow flow or stagnation of blood in varicose veins, leading to hypoxia and inflammation in the vessel wall, with remodelling of the wall (altered collagen I to collagen III ratio, matrix metalloproteinases) (full text PMC10855638; PMID 38338837). 10.3390/ijms25031560
5. Pannier, F., Noppeney, T., Alm, J., Breu, F. X., Bruning, G., Flessenkämper, I., et al. (2022). S2k guidelines: diagnosis and treatment of varicose veins. Der Hautarzt, 73(Suppl 1), 1-44. German consensus (S2k) guideline. Varicose vein disease is a degenerative disease of the vein wall in the superficial veins of the legs in which, under the influence of a range of factors (e.g., pregnancy, orthostatic stress), varicose veins develop over the course of life; a primary varicose vein is not in itself a life-changing disease. Basic risk factors are advanced age, female sex, pregnancies and positive family history; a genetic disposition is assumed. Complications include superficial vein thrombosis and variceal bleeding, for which prompt treatment shall be sought. The most common symptoms are heaviness, swelling, itching and occasional pain after standing or sitting for long periods. Basic treatment includes putting the leg up and activating the muscle pump in the ankle region by adequate exercise, plus compression; compression reduces venous symptoms such as heaviness and swelling. Pregnancy affects the leg veins through functional, structural and hormonal changes; up to 40% of all pregnant women present a new or progressing varicose vein; a prophylactic effect of compression to prevent varicose veins in pregnancy has not been proved, but compression can improve the symptoms; invasive treatment during pregnancy should be indicated only in exceptional cases (full text PMC9358954; PMID 35438355). 10.1007/s00105-022-04977-8
6. Tüchsen, F., Hannerz, H., Burr, H., & Krause, N. (2005). Prolonged standing at work and hospitalisation due to varicose veins: a 12 year prospective study of the Danish population. Occupational and Environmental Medicine, 62(12), 847-850. A random sample of 2939 men and 2708 women aged 20-59 employed in Denmark were followed for 12 years (40 hospitalisations for varicose veins among men, 71 among women), adjusting for smoking, BMI, heavy lifting and, for women, number of children. For jobs requiring standing or walking at least 75% of working time, the relative risk was 1.75 (95% CI 0.92 to 3.34) for men and 1.82 (1.12 to 2.95) for women; pooled 1.78 (1.19 to 2.68). Conclusion: prolonged standing at work constitutes an excess risk of hospital treatment due to varicose veins and accounts for more than one fifth of all cases of working age (abstract, PMID 16299093). 10.1136/oem.2005.020537
7. Araujo, D. N., Ribeiro, C. T., Maciel, A. C., Bruno, S. S., Fregonezi, G. A., & Dias, F. A. (2023). Physical exercise for the treatment of non-ulcerated chronic venous insufficiency. Cochrane Database of Systematic Reviews, 6, CD010637. Five RCTs with 146 participants compared an exercise programme with no structured exercise; data could not be combined and all evidence was very low certainty; there was no clear difference in signs and symptoms at six months, and the review was uncertain whether exercise improves venous refilling time, quality of life or calf strength. Authors' conclusions: there is currently insufficient evidence to assess the benefits and harms of physical exercise in people with chronic venous disease (abstract, PMID 37314059). 10.1002/14651858.CD010637.pub3
8. Knight Nee Shingler, S. L., Robertson, L., & Stewart, M. (2021). Graduated compression stockings for the initial treatment of varicose veins in people without venous ulceration. Cochrane Database of Systematic Reviews, 7, CD008819. 13 studies with 1021 participants; studies were small, could not be pooled, and the certainty of the evidence was low to very low. All four studies comparing stockings with no or placebo stockings that reported symptoms found a subjective improvement, but not always analysed between randomised arms and so subject to bias; itching and irritation were the main side effects, none severe; one study reported low compliance due to discomfort, application and appearance; compression tights were increasingly rejected by pregnant women as their pregnancy progressed. Authors' conclusions: there is insufficient high-certainty evidence to determine whether or not compression stockings are effective as the sole and initial treatment of varicose veins in people without healed or active venous ulceration, or whether any type of stocking is superior to any other type (abstract, PMID 34271595). 10.1002/14651858.CD008819.pub4
9. Tan, M., Campbell, B., Parsi, K., & Davies, A. H. (2024). Management of bleeding varicose veins. Phlebology, 39(4), 273-275. International Union of Phlebology one-page guideline. Bleeding from varicose veins is a potentially life-threatening complication that is not uncommon; risk is increased with atrophic skin over the veins or veins under an ulcer; risk factors for death include anticoagulation and frailty, and elderly patients who live alone are at high risk. First aid: lie or sit down with the leg elevated; apply pressure to the bleeding site with the hands, then a pad and compressive bandage if available, not removed until medical review; then seek help via a general practitioner or an emergency ambulance. Bleeding varicose veins need urgent referral to a vascular specialist and treatment of the underlying venous disease, because bleeding can recur (full text PMC10993626; PMID 38053359). 10.1177/02683555231219548
10. Gloviczki, P., Lawrence, P. F., Wasan, S. M., Meissner, M. H., Almeida, J., Brown, K. R., et al. (2024). The 2023 Society for Vascular Surgery, American Venous Forum, and American Vein and Lymphatic Society clinical practice guidelines for the management of varicose veins of the lower extremities. Part II. Journal of Vascular Surgery: Venous and Lymphatic Disorders, 12(1), 101670. For symptomatic varicose veins with superficial truncal reflux, compression therapy is suggested for primary treatment if ambulatory status or medical conditions warrant a conservative approach or the patient prefers it; for candidates for intervention, superficial venous intervention is recommended over long-term compression stockings. Graduated stockings can narrow the superficial veins and decrease reflux and venous hypertension; the 13-trial Cochrane review found improvement in symptoms but subject to bias. In asymptomatic C2 disease, weight control, compression stockings and avoiding prolonged standing may be beneficial (consensus); in the Edinburgh Vein Study 31.9% of people with varicose veins progressed to chronic venous insufficiency over 13 years, with family history, previous DVT and obesity as risk factors for progression. Superficial vein thrombosis, while traditionally thought benign, may progress to DVT in 6% to 44% of patients, and anticoagulation is recommended. Bleeding from varicose veins appears in about 4% of patients presenting with varicose veins, often from small veins at the ankle with surrounding skin pigmentation and induration or from an ulcer, sometimes on exposure to warm water or after minor trauma; fatal haemorrhage is uncommon but not entirely rare, mostly in older people living alone, with mobility impairment, fragile skin or an ulcer near the ankle, or on anticoagulant or antiplatelet drugs. For acute bleeding, leg elevation and direct compression should be attempted first; prompt referral to a venous specialist; patients and families should be taught leg elevation and simple compression; the danger of applying venous tourniquets, which increase venous pressure, has often been emphasized (full text PMC11523430; PMID 37652254). 10.1016/j.jvsv.2023.08.011