床旁彩色多普勒超声引导腘静脉置管溶栓疗法在下肢深静脉血栓治疗中的应用

Application of bedside color Doppler ultrasound-guided popliteal vein catheter thrombolytic therapy in treatment of lower extremity deep venous thrombosis

目的探讨床旁彩色多普勒超声引导置管溶栓法治疗下肢深静脉血栓(LEDVT)的可行性、有效性。方法回顾性分析25例接受床旁彩色多普勒超声引导腘静脉置管溶栓(超声置管溶栓组)及25例接受全身抗凝溶栓(全身抗凝溶栓组)的单侧LEDVT患者的资料。对比观察2组临床治愈率、住院时间及双侧肢体周径差。结果 2组患者溶栓有效率均为100%,超声置管溶栓组中22例、全身抗凝溶栓组中8例达到临床治愈(通畅率66%~100%),2组临床治愈率[88.00%(22/25)vs 32.00%(8/25)]差异有统计学意义(χ~2=16.333,P<0.001)。超声置管溶栓组患者住院时间[(12.32±1.49)天]短于全身抗凝溶栓组[(16.44±2.95)天;t=-6.426,P<0.001]。治疗前2组间膝上及膝下15cm双侧肢体周径差的差异均无统计学意义(P均>0.05),治疗后超声置管溶栓组小于全身抗凝溶栓组(P均<0.05)。2组患者治疗后双侧肢体周径差均较治疗前明显减小(P均<0.05)。结论床旁彩色多普勒超声引导腘静脉置管溶栓及全身抗凝溶栓治疗LEDVT均疗效确切,且超声置管溶栓优于全身抗凝溶栓。

Objective To evaluate the feasibility of beside color Doppler ultrasound-guided popliteal vein catheter in treatment of lower extremity deep venous thrombosis （LEDVT）. Methods Data of 50 patients with unilateral LEDVT were reviewed, including 25 cases underwent beside color Doppler ultrasound-guided catheter thrombolytic therapy （catheter thrombolytic group） and 25 cases underwent systemic thrombolysis and anticoagulant therapy （anticoagulant thrombolysis group）. The cure rate, hospitalization time and the bilateral diameter differences were compared between the 2 groups.Results Thrombolytic effective rate was 100% in both the 2 groups. Thirty patients were clinical cured, including 22 cases in catheter thrombolytic group and 8 cases in anticoagulant thrombolysis group. The cure rates were significantly different between the 2 groups （88.00%[22/25] vs 32.00%[8/25], χ2=16.333, P〈0.001）. The hospitalization time of catheter thrombolytic group （[12.32±1.49] days） was shorter than that of anticoagulant thrombolysis group （[16.44±2.95] days; t=-6.426, P〈0.001）. The diameter differences between LEDVT side and contralateral side of the upper and lower 15 cm form knees in catheter thrombolytic group showed no statistical difference compared with anticoagulant thrombolysis group before the treatment （both P〉0.05）, while of catheter thrombolytic group were smaller than those of anticoagulant thrombolysis group after the treatment （both P〈0.05）. And the bilateral diameter differences before the treatment were larger than those after the treatment in both groups （all P〈0.05）. Conclusion Both of beside color Doppler ultrasound-guided catheter thrombolytic therapy and systemic thrombolysis and anticoagulant therapy can be used to treat LEDVT, while the efficacy of ultrasound-guided catheter thrombolytic therapy is better.