经导管持续溶栓联合间歇性脉冲抗凝治疗急性下肢深静脉血栓的效果观察

Effect of cathter-directed thrombolysis combined with intermittent pulsed anticoagulation in the treatment of acute deep venous thrombosis of the lower extremity

目的:探讨经导管持续溶栓联合间歇性脉冲抗凝治疗对急性下肢深静脉血栓(DVT)的疗效。方法:回顾性分析37例下肢DVT病人的临床资料,根据尿激酶不同使用方法分为观察组和对照组。观察组将10万单位尿激酶溶入0.9%氯化钠注射液48 m L,以4~8 m L/h持续泵入,维持24 h,治疗期间应用低浓度肝素溶液脉冲式冲洗溶栓导管辅助置管溶栓,2~3次/天;对照组30 min内一次性用完,无肝素溶液和地塞米松使用。结果:治疗1、2周时,观察组病人下肢肿胀缓解度均优于对照组(P<0.01和P<0.05);治疗2周时,2组肿胀缓解度、疼痛程度和观察组静脉通畅度均明显优于治疗1周(P<0.01)。治疗后,2组病人动脉血氧分压和国际标准化比值均较治疗前明显改善(P<0.01),观察组动脉血氧分压明显高于对照组(P<0.01)。观察组病人治疗有效率为65.00%(13/20),与对照组的35.29%(6/17)差异无统计学意义(P>0.05)。37例病人共随访32例,随访时间90~360 d,观察组1例病人轻度肿胀(5.56%,1/18),对照组4例中度肿胀(28.57%,4/14),彩色多普勒超声超或下肢顺行深静脉造影检查显示瓣膜不同程度破坏,髂股静脉及腘静脉部分血栓残存或复发。结论:经导管持续溶栓联合间歇性脉冲抗凝治疗能缓解DVT病人下肢肿胀,改善静脉通畅度,并有助于减少血栓残存及复发。

Objective： To explore the effects of cathter-directed thrombolysis combined with intermittent pulsed anticoagulation in the treatment of acute deep venous thrombosis（ DVT） of the lower extremity. Methods： The clinical data of 37 patients with lower extremity DVT were retrospectively analyzed. The patients were divided into the observation group and control group according to the use of urokinase. The observation group was injected with 48 m L of 0. 9% saline injection containing 100 000 units of urokinase,4 to 8 m L/h,for 24 h,and treated additionally with low concentration of heparin pulsed flush thrombolytic catheter,2 to 3 times a day. The control group was injected within 30 min,and the heparin solution and dexamethasone were not used. Results： After 1 and 2 weeks of treatment,the remission degree of lower limb swelling in observation group was better than that in control group（ P〈0. 01 and P〈0. 05）. After 2 weeks of treatment,the remission degree of swelling and pain in two groups,and venous patency in observation group were significantly better than those after 1 week of treatment（ P〈0. 01）. After treatment,the arterial partial pressure of oxygen and international normalized ratio in two groups were significantly improved,and the arterial partial pressure of oxygen in observation group was higher than that in control group（ P〈0. 01）. The effective rate of treatment in observation group and control group were 65. 00%and 35. 29%,respectively,and the difference of which was not statistically significant（ P〉0. 05）. Among 37 patients,32 cases were followed up for 90 to 360 d,1 case with slight swelling in observation group and 4 cases with moderate swelling in control group were found. Doppler color ultrasound or lower extremity deep venography examination showed that the part of valve was damaged,and the thrombosis in femoral vein and popliteal vein remained or recurred. Conclusions： The cathter-directed thrombolysis combined with intermittent pulsed anticoagulation can relieve the swelling of lower extremity DVT,improve the venous patency,and reduce the survival and recurrence of thrombus.