CDT联合机械碎栓治疗DVT的疗效及对血浆抗凝因子水平的分析

Therapeutic Effect of CDT Combined with Mechanical Disruption on DVT and Analysis of Plasma Anticoagulant Levels

探讨置管溶栓术（CDT）联合机械碎栓治疗下肢深静脉血栓形成（DVT）的疗效及对血浆抗凝因子水平的分析。选取2014年3月至2016年8月本院收治的89例DVT患者，随机分为对照组和观察组。对照组患者采用单纯置管溶栓术治疗，观察组患者采用置管溶栓术和机械碎栓联合治疗。检测并分析两组患者的治疗效果和血浆抗凝因子水平变化。结果显示，两组患者治疗后彩色多普勒超声影像显示血管通畅情况较治疗前明显改善，观察组患者血管通畅情况明显优于对照组（p〈0．05）。观察组患者大腿中段和小腿中段消肿率均明显优于对照组（p〈0．05）。两组患者治疗后血浆D-二聚体（D-dimer,D—D）水平较治疗前明显下降，蛋白C（protein C，PC）、蛋白S（protein S，PS）活性较治疗前明显提高（p〈0．05）。观察组患者治疗后D-D水平明显低于对照组，PC、PS活性明显高于对照组（p〈0．05）。随访1年后观察组患者DVT发生率（0．00％）N显低于对照组（9．52％），CEAP分级优于对照组（p〈0．05）。置管溶栓术联合机械碎栓治疗下肢深静脉血栓形成疗效显著，可有效降低DVT患者血浆中D-D水平，并增加PC、PS的活性。

The study aimed to investigate the therapeutic effect of catheter directed thrombolysis （CDT） combined with mechanical disruption on the treatment of deep venous thrombosis （DVT） in lower extremity and the analysis of plasma anticoagulant levels. 89 DVT patients treated in our hospital from March 2014 to August 2016 were selected and randomly divided into control group and observation group. Patients in the control group were treated with simple catheterization and thrombolysis. Patients in the observation group were treated with catheterization and mechanical disruption. The therapeutic effect and the level of plasma anticoagulant factors in both groups were detected and analyzed. The results showed that color Doppler ultrasound showed significant improvement of vascular patency in both groups after treatment compared with those before treatment. The vascular patency in the observation group was significantly better than that of the control group （p〈0.05）. In the obser- vation group, the swelling reduction rate in the middle of the thigh and in the middle of leg were significantly better than those in the control group （p〈0.05）. After treatment, plasma D-dimer （D-dimer, DD） levels in both groups were significantly lower than those before treatment, whereas activities of protein C （PC） and protein S （PS） were on the contrary （p〈0.05）. The D-D level in the observation group was significantly lower than that in the control group, while the activities of PC and PS in the observation group were obviously higher than those in the control group （p〈0.05）. One year after follow-up, the incidence of DVT in the observation group （0.00%） was significantly lower than control group （9.52%）, and CEAP classification was superior to the control group （p〈0.05）. Catheter thrombolysis and mechanical disruption had significant curative effect on treatment of deep venous thrombosis of lower extremities, which might effectively reduce the plasma D-D level and increase the activity of PC and PS in DVT patients.