超声引导置管溶栓治疗下肢深静脉血栓

Ultrasound-guided catheter-directed thrombolysis therapy of lower extremity deep venous thrombosis

目的探讨超声引导置管溶栓治疗下肢深静脉血栓(DVT)的临床应用价值。方法收集55例下肢DVT患者,分为置管溶栓组(n=35)和对照组(n=20)。治疗前对所有患者均行超声检查以了解DVT情况。置管溶栓组:下腔静脉滤器置入术后,在超声引导下行患肢静脉置管,用微量泵持续向导管内给予尿激酶和肝素;对照组经静脉注射溶栓尿激酶和肝素进行全身治疗。治疗后所有患者均复查超声,观察疗效并进行比较。结果置管溶栓组所有患者置管成功,其中26例治愈,6例有效,3例无效,总有效率为91.43%(32/35)。对照组5例治愈,8例有效,7例无效,总有效率为65.00%(13/20)。两组疗效差异有统计学意义(χ2=12.99,P<0.05)。结论超声引导置管溶栓治疗下肢DVT特异性高、见效快、疗程短,是治疗下肢DVT的有效方法。

Objective To explore the clinical application of ultrasound-guided catheter-directed thrombolysis therapy of lower extremity deep venous thrombosis （DVT）. Methods A total of 55 patients with lower extremity DVT were enrolled and divided into catheter thrombolysis group （n= 35） and control group （n= 20）. All patients were examined by ultrasonography before treatment to observe the situation of DVT. In catheter thrombolysis group, after implantation of inferior vena cave filter, ultrasound-guided percutaneous catheter-directed thrombolysis was carried out, and urokinase and heparin were administered continuously by using a micro-pump. In control group, patients were treated with intravenous administration of urokinase and heparin. Ultrasonography was performed after thrombolysis therapy, and the curative effect of two groups were calculated and compared. Results In catheter thrombolysis group, all patients were catheterized successfully, recovery was obtained in 26 patients, effectiveness in 6, while ineffectiveness in 3 patients, and the total efficiency was 91.43%（32/35）. In control group, recovery was obtained in 5 patients, effectiveness in 8, while ineffectiveness in 7 patients, and the total efficiency was 65.00% （13/20）. There was statistical difference between two groups （X2= 12.99, P d0.05）. Conclusion Ultrasound-guided venous catheter thrombolysis for lower extremity DVT has high specificity, quick effect and short course of treatment, which can be used as an effective method for treatment of lower extremity DVT.