下腔静脉滤器联合导管溶栓治疗下肢深静脉血栓形成的临床效果探究

Clinical effect of inferior vena cava filter combined with catheter thrombolysis on deep venous thrombosis of lower extremity

目的探究下腔静脉滤器置入联合导管溶栓治疗对下肢深静脉血栓形成(deep venous thrombosis,DVT)患者预后的影响,并分析其临床价值。方法选取2015年4月至2017年4月本院收治的94例下肢DVT患者为研究对象。采用随机数表法将入选患者分别纳入观察组和对照组,每组各47例,观察组患者接受可回收下腔静脉滤器联合导管溶栓治疗,对照组患者接受常规抗凝、溶栓治疗。比较两组患者治疗效果、患肢消肿率、患肢溶栓率、肢体周径差和静脉通畅度评分、治疗后6个月和12个月髂股静脉闭塞率和色素沉着率。结果观察组47例患者均成功置入下腔静脉滤器。出院时,观察组患者治疗总有效率、大腿消肿率、小腿消肿率、溶栓率均显著高于对照组(均P < 0.05)。两组患者出院前大腿周径差、小腿周径差、静脉通畅度评分均显著低于本组治疗前(均P < 0.05),观察组患者出院前上述指标均显著低于对照组(均P < 0.05)。两组患者均获12 ~ 18个月的有效随访,中位随访时间为16个月。两组患者出院后6个月和12个月髂股静脉闭塞率、色素沉着率比较差异均无统计学意义(均P > 0.05)。结论较传统抗凝、溶栓治疗方案而言,可回收下腔静脉滤器置入联合导管溶栓治疗下肢DVT的效果更为确切,且安全性较好,值得推广。

Objective To investigate the effect of inferior vena cava filter implantation and removal combined with catheter thrombolysis on the prognosis of patients with deep venous thrombosis(DVT) of lower extremity and to analyze its clinical value. Method 94 patients with DVT of lower extremity admitted to our hospital from April 2015 to April 2017 were included in this prospective control study. The patients were divided into observation group and control group with 47 cases in each group. Observation group patients received retrievable inferior vena cava filter combined with catheter thrombolysis, while control group patients received routine anticoagulation and thrombolysis. The therapeutic effect, swelling reduction rate, thrombolytic rate, circumference difference and venous patency score, the occlusion rate and pigmentation rate of iliofemoral vein 6 months and 12 months after treatment were compared between the two groups. Result The inferior vena cava filters were successfully implanted in 47 patients in observation group. At discharge, the total effective rate, the rate of thigh swelling, calf swelling and thrombolysis in observation group were significantly higher than that of control group(all P < 0.05). The thigh circumference difference, calf circumference difference and the scores of venous patency of the two groups before discharge were all lower than those before treatment(all P < 0.05), the above indexes of observation group before discharge were significantly lower than those of control group(all P < 0.05). Both groups were followed up for 12 to 18 months, with a median follow-up period of 16 months. There were no significant differences in occlusion rate and pigmentation rate of iliofemoral vein between the two groups 6 months and 12 months after discharge(all P > 0.05). Conclusion Compared with the traditional anticoagulant and thrombolytic therapy, retrievable inferior vena cava filter placement combined with catheter thrombolytic therapy for DVT of lower extremity is more effective, the security is relatively good and worthy of promotion.