超声造影定量分析技术对下肢深静脉血栓置管溶栓术的疗效评价

Evaluation of catheter-directed thrombolysis treatment for deep venous thrombosis of lower extremity with contrast-enhanced ultrasound quantitative analysis technique

目的探讨超声造影定量分析技术在评价下肢深静脉血栓置管溶栓术疗效中的应用价值。方法选取40例混合型或中央型急性下肢深静脉血栓患者,超声引导下行下腔静脉滤器植入及患侧腘静脉穿刺置管术,术后以60万U/d微注泵向溶栓导管持续推注尿激酶。分别在腘静脉置管术后1、3、5 d通过溶栓导管注入稀释的超声造影剂,观察患者下腔静脉内造影剂灌注情况;定量分析软件获取时间-强度曲线及相关灌注参数:达峰时间(TTP)、峰值强度(DPI)及曲线上升支斜率(C)。40例患者按治疗效果分为治愈组、显效组及有效组,对各组超声造影灌注参数进行比较。结果 40例患者中,治愈组18例,显效组13例,有效组9例。1术后组内不同时间点比较:各组术后5 d与术后1 d比较,TTP、DPI及C差异均有统计学意义(均P<0.01);术后3 d与术后1 d比较,DPI、C差异均有统计学意义(均P<0.05),TTP差异无统计学意义。2术后组间相同时间点比较:显效组、有效组与治愈组比较,术后3、5 d DPI、C差异均有统计学意义(均P<0.05);显效组与有效组比较,术后3 d DPI、C差异无统计学意义,术后5 d DPI、C差异均有统计学意义(均P<0.05)。结论超声造影定量分析技术能发现下肢静脉血栓患者血管再通后血流灌注的细微改变,超声造影灌注参数可作为评价下肢静脉血栓置管溶栓疗效的量化指标。

Objective To explore the value of contrast-enhanced ultrasound（CEUS）quantitative analysis technique in evaluating the effect of catheter-directed thrombolysis for deep venous thrombosis of lower extremity. Methods Ultrasound-guided implantation of inferior vena cava filters and ipsilateral popliteal vein catheterization were performed in 40 cases of acute mixed or central deep vein thrombosis,then urokinase with the dose of 600 000 U/d was continuously infused to dissolve the thrombus by micro-injection pump. Diluted contrast agent was infused through the catheter 1 d,3 d,5 d after the popliteal vein catheterization. The perfusion of the contrast agent in inferior vena cava was observed,the time-density curve（TIC）and perfusionrelated parameters[time to peak（TTP）,derived peak intensity（DPI）,slope of ascending curve（C）]were obtained by quantitative analysis software. Forty cases were divided into cured group,markedly effective group and effective group according to the treatment results,the CEUS parameters were compared among the groups. Results In 40 patients,there were 18 cases in cured group,13 cases in markedly effective group,9 cases in effective group. 1Intra-group comparison showed in all the groups,TTP,DPI and C had significant differences between 1 d and 5 d after treatment. From 1 d to 3 d,the DPI and C showed an increased tendency（P〈0.05）,however the difference of TTP was not statistically significant. 2Comparison among groups showed difference of DPI and C was significant 3 d and 5 d after treatment,DPI,and C showed significant difference between markedly effective group and effective group 5 d after treatment（P〈0.05）. All perfusion parameters showed no statistically significant difference between markedly effective group and effective group 3 d after treatment. Conclusion CEUS quantitative analysis technique can detect subtle changes of blood perfusion after revascularization in patients with deep vein thrombosis,and perfusion parameters can be used as quantitative indicators to evaluate effect of catheter-directed thrombolysis treatment for deep venous thrombosis.