下腔静脉滤器置入后大剂量尿激酶溶栓治疗下肢深静脉血栓形成

Thrombolysis for treating deep venous thrombosis by high-dose urokinase: the usefulness of preventive placement of inferior vena cava filter

目的 探讨下腔静脉滤器置入后大剂量尿激酶溶栓治疗下肢深静脉血栓形成的可行性。方法 1 3例经造影证实为左下肢深静脉血栓患者 ,先于下腔静脉内放置滤器 ,后在监护下经患者足背静脉加压推注尿激酶进行持续溶栓治疗 ,尿激酶 (UK)用量 90 0万U～ 1 60 0万U。疗效判断标准 :痊愈 :患者无症状 ,下肢造影示深静脉通畅 ;显效 :患者症状明显缓解 ,下肢造影示深静脉回流畅 ,但壁不光滑 ,血管内径 >70 % ;有效 :症状有所缓解 ,造影示血栓残留 ,血管内径 <70 % ;无效 :症状及下肢造影均无改善。结果 1 3只下腔静脉滤器均展开良好 ,无移位。其中 :痊愈 2例 ,显效 9例 ,有效 2例 ,无效 0例 ,溶栓过程中未出现肺动脉栓塞症状及出血现象。结论 下腔静脉滤器置入后经患肢浅静脉大剂量尿激酶溶栓治疗下肢深静脉血栓形成是安全。

Objective To investigate the feasibility and efficacy of high dose urokinase thrombolysis for treating lower limb deep venous thrombosis (DVT) after inferior vena caval (IVC) filter placement. Methods Thirteen patients of venographically proved DVT underwent preventive IVC filter placement for thrombolysis by high dose urokinase. Antegrade infusion of high dose urokinase was performed via the dorsalis pedis vein of the involved lower limb.The total dose of urokinase was 9 000 000～16 000 000 units, and the procedure of thrombolysis was performed in ICU ward where the patients were closely monitored clinically and laboratorially. Results A total of 13 IVC filters were successfully deployed without disposition and migration.The therapeutic effects were divided into four scales as follows: complete disappearance of the venous thrombosis and clinically asymptomatic ( n =2); remarkable recovery characterized by markedly improved clinical symptoms and venographically proved patent lumen in which the diameter was larger than 70%( n =9); effective treatment indicating improved symptoms to some degrees and venographically proved patent lumen in which the diameter was smaller than 70% ( n =2); and ineffective treatment ( n =0). No pulmonary embolism and hemorrhage occurred during the procedure of thrombolysis. Conclusion High dose urokinase for treating DVT is safe and effective after preventive placement of IVC filter.