导管溶栓在髋部术后并发下肢深静脉血栓形成的临床应用

Application of catheter-directed thrombolysis in deep vein thrombosis of the lower extremity hip after hip surgery

目的评价应用经皮导管腔内灌注溶栓技术（CDT）治疗髋部术后并下肢深静脉血栓形成的安全性与有效性。方法将57例患者例随机分为治疗组（30例）和对照组（27例）。治疗组应用CDT技术以尿激酶首次剂量25万u脉冲式推注，其后3万-4万U／h维持，总量为350万～560万U；同时再经溶栓导管持续泵入低分子肝素12500～25000U／24h；注射体液速度80—100ml／h，连续应用5～7d。对照组采取患肢抬高35°，经患肢足背静脉留置针穿刺，以尿激酶60～80万u＋生理盐水250ml／24h静脉点滴溶栓，总量为350～560万U；在溶栓的同时以低分子肝素20000U＋生理盐水500ml／24h持续患肢静脉泵入抗凝治疗，疗程5—7d，结果治疗组治愈23例，有效5例，无效2例，总有效率为93．3％。对照组治愈17例，有效6例，无效4例，因并发肺栓塞经治疗无效而死亡1例，总有效率为85．1％。两组经统计学处理，治愈率比较差异有统计学意义（P〈0．05）。结论CDT治疗髋部术后并发DVT安全有效，但髋部术后早期预防可降低DVT发病率、及时有效的诊治可减少肺栓塞的发生。

Objective To evaluate the safety and effectiveness of percutaneous catheter infusion thrombolytic techniques（CDT） in treatment of deep venous thrombosis of the lower extremity after hip surgery. Methods Fifty-seven patients were randomly divided into treatment group （30 cases）and con- trol group（27 cases）. CDT technology was applicated in treatment group, the first dose of urokinase with 250 000 U of pulse injection, followed by 30 000 to 40 000 U / h maintenance, a total of 3 500 000 - 5 600 000 U. At the same time, tow molecular weight heparin with 12 500 -25 000 U/24 h was contin- uously infused by thrombolysis catheter, injection fluid velocity was 80 -100 ml/h, continuous use of 5 -7 d. The control group adopted the affected limb elevation of 35 degrees, the limb dorsalis pedis vein indwelling needle, with urokinase 600 000 - 800 000 U and saline 250 ml/24 h, intravenous thrombolys- is, a total of 3 500 000 -5 600 000 IU, in the thrombolytic therapy at the same time, with low molecular weight heparin saline 20 000 IU ＋ 500 ml/24 h, persistent limb vein pump into the anticoagulant thera- py, course of 5 -7 d. Results The treatment group 23 cases were cured, 5 cases effective, 2 cases in- effective. The total efficiency was 93.3%. In the control group, 17 cases were cured, 6 cases were effec- tive, 4 cases were invalid（ because of complicated with pulmonary embolism after treatment and1 died） , the total efficiency was 85.1%. Both groups after statistical processing, the cure rate difference was sig- nificant （P 〈 0.05）. Conclusions CDT treatment after hip surgery complicated with DVT is safe and effective, but after hip surgery in early prevention can reduce the incidence of DVT, timely and effective treatment may reduce the occurrence of pulmonary embolism.