置管溶栓在脑梗死合并DVT患者中的应用

Treatment of Catheter Thrombolysis for Acute Deep Venous Thrombosis in Patients with Cerebral Infarction

目的评价经腘静脉置管溶栓治疗脑梗死合并急性下肢深静脉血栓形成患者的临床应用价值。方法脑梗死合并急性下肢深静脉血栓患者34例,按患肢肌力高低分为两组,肌力较低组(0～Ⅱ级)23例,肌力较高组(Ⅲ～Ⅳ级)11例。所有患者在B超引导下经腘静脉置入溶栓导管,经溶栓导管持续泵入尿激酶10～14天,同时行抗凝治疗。监测凝血酶原时间、颅脑CT。结果溶栓疗效显著者30例,其中治愈12例,显效18例,有效4例,显效率88.2%,总有效率为100%,肌力较高组血管完全再通率高。所有病例均无肺动脉栓塞症及严重出血并发症。随访期间2例复发,均为肌力较低患者。结论对脑梗死伴下肢深静脉血栓形成的患者行置管溶栓治疗安全,效果良好。患肢肌力较低者易复发,需注意随访。

Objective To evaluate the clinical value of catheter thrombolysis for acute deep venous thrombosis（DVT） in patients with cerebral infarction（CI）.Methods 34 patients with CI suffered acute DVT were divided into two groups according to the muscle strength of the limb.Lower muscle strength group included 23 cases,higher muscle strength group included 11 cases.All patients were treated with catheter thromblysis of poplitealvein for urokinase infusing.PT series and brain CT were performed after thrombolysis.Results Clinical symptoms were all relieved（100%）,12 cases were completely cured,significantly improved in 18 cases,and improved in 4 cases.The percent of complete open was lower in lower muscle strength group.All patients had no pulmonary embolism and severe bleeding complications.Conclusion It is safe and effective method to catheter thrombolysis with low dose of urokinase for acute DVT with CI history.Lower muscle strength patients have higher recurrence risk,careful follow up is recommended.