达肝素钠联合阿替普酶治疗产后下肢深静脉血栓形成的临床研究

Clinical study on dalteparin sodium combined with alteplase in treatment of deep venous thrombosis of lower limb

目的探讨达肝素钠联合阿替普酶治疗产后下肢深静脉血栓形成的临床疗效。方法选取2014年9月—2017年9月在渭南市妇幼保健院治疗的下肢深静脉血栓形成患者94例,随机分为对照组(47例)和治疗组(47例)。对照组静脉泵入注射用阿替普酶,20 mg加入生理盐水500 mL,14~20 mL/h。治疗组在对照组基础上皮下注射达肝素钠注射液,每次200U/kg,1次/d。两组均治疗6 d。观察两组患者临床疗效,比较治疗前后两组患者血液流变学指标、临床症状、炎性因子和细胞黏附因子变化。结果治疗后,对照组和治疗组总有效率分别为80.85%和97.87%,两组比较差异具有统计学意义(P<0.05)。治疗后,两组D-二聚体(D-D)、纤维蛋白原(FIB)、血浆黏度(CP)、红细胞聚集指数(RCAI)、超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、基质金属蛋白酶-9(MMP-9)、血小板内皮细胞黏附分子-1(PECAM-1)和血管细胞黏附分子-1(VCAM-1)水平均显著降低(P<0.05),且治疗组上述细胞因子水平明显低于对照组(P<0.05)。治疗后,两组肢体周径和色素沉着评分及溃疡面积均显著减少(P<0.05),且治疗后治疗组上述指标明显优于对照组(P<0.05)。结论达肝素钠联合阿替普酶治疗下肢深静脉血栓形成可显著改善患者临床症状,降低机体血液粘稠度,下调机体炎症反应和血管细胞黏附分子水平。

Objective To explore the clinical efficacy of dalteparin sodium combined with alteplase in treatment of deep venous thrombosis of lower limb. Methods Patients（94 cases） with deep venous thrombosis of lower limb in Weinan Maternal and Child Health Hospital from September 2014 to September 2017 were randomly divided into control（47 cases） and treatment（47 cases） groups. Patients in the control group were intravenous pumping administered with Alteplase for injection, 20 mg added into normal saline 500 mL, 14 — 20 mL/h. Patients in the treatment group were sc injection administered with Dalteparin Sodium Injection on the basis of the control group, once 200 U/kg, once daily. Patients in two groups were treated for 6 d. After treatment, the clinical efficacy was evaluated, and the hemorheological indexes, the clinical symptoms, the inflammatory factors and the cell adhesion factors in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the control and treatment groups was 80.85% and 97.87%, respectively, and there were differences between two groups（P〈0.05）. After treatment, the D-D, FIB, CP, RCAI, hs-CRP, IL-6, TNF-α, MMP-9, PECAM-1, and VCAM-1 levels in two groups were significantly decreased（P〈0.05）, and these cytokine levels in the treatment group after treatment were significantly lower than those in the control group（P〈0.05）. After treatment, the limb circumference scores, chromatosis scores and ulcer area in two groups were significantly decreased（P〈0.05）, and these clinical symptoms in the treatment group after treatment were significantly better than those in the control group（P〈0.05）. Conclusion Dalteparin sodium combined with alteplase has efficacy in treatment of deep venous thrombosis of lower limb can significantly improve the clinical symptoms, reduce blood viscosity, downregulate inflammatory and vascular cell adhesion molecule levels.