尿激酶联合导管溶栓治疗急性下肢DVT疗效及对相关凝血指标的影响

Efficacy of Urokinase and catheter thrombolysis in Treating Acute Lower Limb DVT and Its influence on Coagulation Index

目的研究尿激酶联合导管溶栓治疗急性下肢DVT临床疗效及其对相关凝血指标的影响。方法回顾性分析2015年6月至2017年6月收治的52例急性下肢DVT患者,分为导管溶栓组(30例)和系统溶栓组(22例),采用SPSS 21.0统计软件对数据进行分析,血栓溶解率、双侧下肢周径差和凝血指标以(x±s)表示,采用独立t检验;不良反应和临床体征以百分比(%)表示.采用χ2检验,P<0.05表示差异有统计学意义。结果两组患者术前静脉通畅评分、双侧下肢大小腿周径差、临床症状、凝血指标均无显著差异(P>0.05);导管溶栓组术后静脉通畅评分(8.5±2.0)少于系统溶栓组(12.4±2.9),P=0.000;血栓溶解率(56.2±26.0)优于系统溶栓组(39.9±23.9),差异有统计学意义(P=0.011)。导管溶栓组术后双侧大腿中段、小腿中段周径差明显少于系统溶栓组(P<0.05);导管溶栓组术后下肢水肿发生率、下肢疼痛发生率、皮肤色泽改变率等均优于系统溶栓组(P<0.05);导管溶栓组牙龈出血发生率(3.3%)显著少于系统溶栓组(27.3%),不良反应总发生率(6.6%)少于系统溶栓组(50.0%),差异有统计学意义(P=0.001);术后PT、APTT、TT值较系统溶栓组显著升高(P<0.05),而FIB值较系统溶栓组显著降低(P<0.05)。结论尿激酶联合导管溶栓治疗急性下肢DVT较系统溶栓治疗具有更好的临床疗效且不良反应发生率低,对凝血指标影响显著。

Objective To investigate the efficacy of urokinase and catheter thrombolysis in treating acute lower limb DVT and influence on coagulation indexes. Methods A retrospective analysis was performed in 52 patients with acute lower limb DVT from June 2015 to June 2017, who were divided into catheter thrombolysis group （n =30） and system thrombolytic group （n =22）. Statistical analysis were performed by using SPSS 21.0 software. Measurement data, such as thrombolytic rate, circumference difference of bilateral lower limb and blood coagulation index were expressed as x±s , and were examined by using independent t test. Count data such as adverse reactions and clinical signs are expressed as a percentage （%） and were examined by chi square test. A P value 〈0.05 was considered as statistically significant difference. Results There was no significant difference of preoperative venous patency scoring, circumference difference of bilateral lower limb, clinical symptoms and coagulation index between two groups （P 〉0.05）. Intravenous patency scoring of 8.5±2.0 in catheterized thrombolytic group was significantly lower than 12.4±2.9 in the systemic thrombolytic group, （ P =0.000）. The thrombolytic rate of 56.2±26.0 in catheterized thrombolytic group was better than 39.9±23.9 in systemic thrombolysis group, with statistically significant difference （P=0.011）. The difference of the median diameter between the middle thigh and the lower leg in catheterized thrombolytic group was significantly lower than that in the systemic thrombolytic group （ P 〈0.05）. The rate of postoperative lower extremity edema, the incidence of lower extremity pain and the rate of skin color change in the catheterized thrombolytic group were superior than those in the systemic thrombolytic group respectively （P 〈0.05）. The incidence of gingival bleeding in catheter thrombolytic group （3.3%） was significantly lower than 27.3% in systemic thrombolysis group, the incidence of total adverse reactions （6.6%） was lower than 50.0% in system thrombolytic group, with statistically significant difference （P =0.001）. The PT, APTT and TT in catheterized thrombolytic group were significantly higher than those in systemic thrombolysis group respectively （ P 〈0.05）, however FIB in catheterized thrombolytic group were significantly lower （ P 〈0.05）. Conclusion Urokinase and catheter thrombolysis in treating acute lower extremity DVT could achieve better clinical efficacy with lower incidence of adverse reactions and it has a significant effect on the coagulation index.