中央型急性期下肢DVT置管溶栓与外周溶栓的比较

Outcomes of anticoagulation and thrombolysis for acute deep venous thrombosis via central venous catheter and peripheral venous injection

目的:比较中央型急性期DVT经外周静脉溶栓与局部置管溶栓治疗的效果,以指导临床治疗。方法:通过回顾性分析我院及江苏南通大学附属医院2010年9月～2012年7月期间收治的共42例下肢深静脉血栓形成患者的临床资料,按照治疗方法分为置管溶栓组(A组)、外周溶栓组(B组)。其中外周溶栓组共20例,左侧13例,右侧6例,双侧1例。置管溶栓组共22例,左侧15例,右侧6例,双侧1例。通过监测患者临床症状,测量下肢周径变化比较两组治疗效果。结果:置管溶栓治疗方法具有平均起效时间快、总溶栓疗程短、溶栓药物总剂量低、并发症发生率及PTS发生率低等优点,而远期复发率与外周溶栓组无明显差异。结论:置管溶栓治疗方法优于外周溶栓治疗。

Objective：To compare the curative efficacy of anticoagulation and thrombalysis for acute deep venous thrombosis（DVT） via central ve- nous catheter management or peripheral venous management for summaryof the clinica! experience. Methods：The clinical data were reviewed in 42 patients with DVT undergone treatment respectively in our institution and the Affiliated Hospital of Nantong University between Sept. 2010 and Jul. 2012. The patients were randomized into either group A（ n = 22;15 were symptoms of left lower extremity ,6 of right and 1 of both extremities） by thrombolytic therapy via central venous catheter or group B （n = 20;13 were acute episode of left lower limb, 6 of right and 1 of both lower limbs. ） managed with peripheral venous anticoagulation and thrombolys- is. Two groups of patients were assessed for the curative efficacy by ob- serving the relief of clinical symptoms and measuring the changes of the limb circumference. Results ： Thrombolytic therapy for acute DVT via cen- tral venous catheter demonstrated advantages by earlier effects, shortened therapy duration, requirement of lower drug dosage, fewer incidence of complications and risk of developing the postthrombotic syndrome（PTS） , yet the risks of long-term relapse remained similar for two approaches. Conclusion ： Treatment of acute DVT by venous catheter procedure is su- perior to that with simple peripheral venous injection.