阶梯式治疗方案可改善急性肠系膜静脉血栓患者院内死亡风险

Improvement of in-hospital mortality in patients with acute mesenteric venous thrombosis treated by stepwise treatment

目的探讨阶梯式治疗在急性肠系膜静脉血栓(AMVT)中的治疗效果,并分析该方案对患者院内死亡率的影响。方法选取2014年10月至2017年10月收治的AMVT患者86例进行前瞻性研究,随机分为观察组和对照组,各43例。对照组患者采用常规抗凝、溶栓治疗;观察组患者采用阶梯式治疗,即将治疗分成3个阶段,首先行血管取栓术,其次为术后抗凝、溶栓治疗,最后行Ⅱ期手术。比较两组治疗效果,并采血测定两组治疗前后的血浆同型半胱氨酸(Hcy)、血浆叶酸(FA)、血清D-二聚体(D-D)及白细胞计数(WBC),记录两组院内死亡率。结果观察组血管再通率为97.67%,显著高于对照组的81.40%(P <0.05)。两组治疗前的血浆Hcy、FA水平比较差异无统计学意义(P> 0.05);观察组治疗后的血浆Hcy水平低于对照组,血浆FA水平高于对照组(P均<0.05)。两组治疗前的静脉血WBC、D-D水平比较差异无统计学意义(P> 0.05),观察组治疗后的WBC、D-D水平较显著低于对照组(P <0.05)。观察组无患者死亡,对照组死亡率为13.95%,两组比较差异有统计学意义(P <0.05)。结论阶梯式治疗能提高AMVT的临床疗效,降低院内死亡率,值得临床推广。

Objective To investigate the effect of stepwise treatment on acute mesenteric venousthrombosis AMVT and to analyze the effect of this protocol on hospital mortality. Methods Eighty-sixpatients with AMVT admitted to our hospital from October 2014 to October 2017 were selected forprospective study. They were divided into observation group and control group 43 cases each according todifferent treatment methods. The control group was treated with routine anticoagulation and thrombolytictherapy while the observation group was treated with stepped therapy which was divided into three steps thrombectomy followed by postoperative anticoagulation and thrombolytic therapy and finally stage IIsurgery. The therapeutic effects of the two groups were compared and plasma homocysteine Hcy plasmafolic acid FA serum D-dimer D-D and white blood cell count WBC were measured before and aftertreatment. The hospital mortality of the two groups was recorded. Results The rate of vascular recanalizationin the observation group was 97.67% which was higher than that of the control group 81.40% P 〈 0.05 .There was no significant difference in plasma Hcy and FA levels between the two groups before treatment P 〉 0.05 . After treatment the level of plasma Hcy in the observation group was significantly lower thanthat of the control group and the plasma FA level was significantly higher than that of the control group P 〈 0.05 . There was no significant difference in WBC and D-D levels between the two groups beforetreatment P 〉 0.05 . WBC and D-D levels in the observation group after treatment were significantly lowerthan those in the control group P 〈 0.05 . No death occurred in the observation group and the mortality ratein the control group was 13.95% and the difference between the two groups was significant P 〈 0.05 .Conclusion Stepwise treatment can improve the clinical effect of acute AMVT and reduce the mortality inhospital. It is worth popularizing in clinic.