导管接触溶栓和外周静脉系统溶栓治疗下肢深静脉血栓形成的疗效观察

Comparative study of catheter-directed thrombolysis and peripheral systemic thrombolysis for deep leg venous thrombosis

目的比较导管接触溶栓和外周静脉系统溶栓治疗下肢深静脉血栓形成的临床疗效。方法回顾性分析2012年1月至2016年6月曲靖市第二人民医院收治的73例下肢深静脉血栓形成患者的临床资料,依据治疗方式不同分为观察组(n=42)和对照组(n=31),观察组给予导管接触溶栓治疗,对照组给予外周静脉系统溶栓治疗。2组均给予基础抗凝治疗。比较2组患者的溶栓治疗效果,治疗前后患侧大腿、小腿的周径差值,溶栓并发症的发生情况、远期深静脉通畅状况和瓣膜功能。结果 2组患者经治疗后,临床症状均明显改善,观察组显效36例,有效6例;对照组显效24例,有效7例。与对照组比较,观察组患者的溶栓时间短、尿激酶总量少、并发症的发生率和深静脉瓣膜功能保存率低,而治疗前后患肢的大腿、小腿周径差值大,差异均有统计学意义(P<0.05)。结论对于下肢深静脉血栓形成的治疗,导管接触溶栓比经外周静脉系统溶栓的效果好,可以缩短治疗时间,减少溶栓药物用量,减少溶栓并发症的发生率,但是存在瓣膜功能保存率低的缺点。

Objective To compare the clinical effect of catheter-directed thrombolysis and peripheral systemic thrombolysis for deep leg venous thrombosis. Methods From January 2012 to June 2016, the clinical data of 73 cases of deep leg venous thrombosis were analyzed retrospectively. 73 cases were divided into observation group （42 cases） and control group （31 cases）. Basic anticoagulation treatment was given in the two groups. Besides, the cases in observation group were taken catheter-directed thrombolysis and the cases of control group were taken peripheral systemic thrombolysis. The thrombolysis effect, circumference difference between thigh and shank before and atter treatment, complication, long-term unobstructed rate of deep vein and valvular function were compared in two groups. Results ARer treatment in two groups, the clinical conditions were improved obviously. In observation group, 36 cases were significantly effective and 6 cases effective. In control group, 24 cases were significantly effective and 7 cases effective. Compared with control group, observation group had shorter thrombolytic time, smaller urokinase amount, lower incidence rate of complication and lower preserving rate of valvular function. The circumference difference between thigh and shank was great before and after treatment. There were significant difference （P〈 0.05）. Conclusion Compared with peripheral systemic thrombolysis, the efficacy of catheter- directed thrombolysis for deep venous thrombosis is better. Catheter-directed thrombolysis can shorten the time of treatment, reduce the dosage and reduce the incidence rate of complication. However, it has a lower preserving rate of valve.