外科手术并发下肢深静脉血栓溶栓治疗方案

Thrombolytic Therapy for Deep Venous Thrombosis of Lower Limb Complicated by Surgical Treatment

目的分析球囊扩张辅助经导管直接溶栓(CDT)治疗外科手术并发下肢深静脉血栓(DVT)临床疗效及安全性,为临床外科手术并发下肢深静脉血栓患者的治疗方案选择提供参考.方法 2013年2月至2014年3月昆明市西山区人民医院普外科、妇产科及骨科手术术后并发下肢深静脉血栓形成患者60例临床资料,按治疗方式分为2组,一组采用传统抗凝溶栓药物治疗设为A组37例,另一组采用球囊扩张辅助CDT治疗设为B组23例,比较2组患者入组前基线资料、治疗后临床疗效及并发症,治疗前后血浆D-二聚体、Wells临床评分的变化、2组住院时间、尿激酶用量.结果 2组患者性别、年龄、手术类型、累计下肢情况、下肢周径差、内科合并症、入组前血浆二聚体水平、Wells评分比较差异无统计学意义(P>0.05);A组治愈23例(62.2%),总有效率83.80%,B组治愈17(73.9%)、总有效率91.3%,2组总有效率比较差异无统计学意义(P>0.05);B组尿激酶用量、血尿、皮下出血率明显低于A组(P<0.05);A组住院时间6~14(8.6±2.47)d,B组5~15 d(6.1±1.19)d,B组住院时间明显低于B组,组间差异有统计学意义(P<0.05);2组患者治疗后血浆D-二聚体、Wells评分均较治疗前明显降低(P<0.05),且B组明显低于A组(P<0.05).结论 CDT治疗外科手术并下肢深静脉血栓患者具有住院时间短、并发症率低、溶栓药物用量低的优势,但并不能根本改善患者的临床总有效率.对于欠发达地区,采用传统治疗方式治疗DVT仍不失为良好选择.

Objective To analyze the clinical efficacy and safety of balloon assisted transcatheterthrombolysis （CDT ） in treatment of lower extremity deep venous thrombosis （DVT ） complicated by surgery,and providea reference for the selection of clinical treatment in patients with surgery of lower extremity deep venousthrombosis. Methods The clinical data of 60 cases of deep venous thrombosis in the department of general surgeryand Department of orthopedics, obstetrics and gynecology of our hospital from February 2013 to March 2014 wereanalyzed. The enrolled patients were divided into two groups,37 cases in A group were treated with the traditionaltreatment of anticoagulation and thrombolysis, 23 cases in B group were given balloon dilatation therapy assistedCDT . Then we compared two groups in the baseline data, clinical effect and complications after treatment before and after treatment, the plasma D- two dimer, Wells clinical score changes, hospitalization time, dosage ofurokinase. Results There was no significant difference between the two groups in terms of gender, age, type ofoperation, cumulative lower limb condition, lower extremity diameter, internal medicine complication, plasmatwo aggregation level and Wells score before admission （P 〉0 . 05） . A group was cured in 23 cases （62.2% ）,the total effective rate was 83.80%, B group was cured 17 （73.9%）, total effective rate was 91.3%, and thetotal effective rate of the two groups was not statistically significant （P 〉 0.05） . The dosage of urokinase, the rateof hematuria and subcutaneous hemorrhage in group B were significantly lower than those in groupA （P 〈 0.05） .The hospitalization time of group A was 6-14 （8.6 ＋ 2.47） days, the B group was 5-15 days （6.1 ＋ 1.19）days,and the hospitalization time of groupB was lower than that of groupB, the difference between the two groupswas statistically significant （ P〈 0.05）. The plasma D- two, and Wells scores of the two groups were significantlylower than those before treatment （ 〈 0.05） , and the B group was significantly lower than that of the A group （ P〈 0.05） . Conclusions CDT has the advantages of short hospitalization time, low complication rate and lowdosage of thrombolytic drugs in surgical treatment of patients with deep vein thrombosis, but it can not improve theoverall effective rate of patients. For underdeveloped areas, the traditional treatment of DVT is still a good choice.