抗凝与静脉溶栓治疗早期肠系膜上静脉血栓形成的效果及安全性比较研究

Comparative Study on the Efficacy and Safety of Anticoagulation and Intravenous Thrombolysis in the Treatment of Early Superior Mesenteric Venous Thrombosis

目的对比观察抗凝与静脉溶栓治疗肠系膜上静脉血栓形成的效果及安全性。方法选取我院2016年4月—2018年1月就诊的肠系膜上静脉血栓形成早期患者84例,按治疗方法不同分为抗凝组43例和静脉溶栓组41例,另取同期健康志愿者40例作为对照组。抗凝组和静脉溶栓组予禁食、胃肠减压、纠正电解质紊乱、抑制消化液分泌及营养支持等治疗,在此基础上抗凝组予低分子肝素5000~7500U每12h1次皮下注射,7d为1个疗程,连用4个疗程;静脉溶栓组在肠系膜血管造影后经导管注射尿激酶80万U,第2日改为尿激酶30万U/次、每日两次静脉注射,疗程1周,后改为华法林每日2~5mg口服,连用4周。比较抗凝组和静脉溶栓组治疗前及对照组D-二聚体、病变段肠系膜上静脉管径、同型半胱氨酸、叶酸和维生素B12水平,抗凝组和静脉溶栓组治疗前后上述指标变化情况,以及临床疗效和治疗安全性。结果抗凝组和静脉溶栓组治疗前D-二聚体、同型半胱氨酸均显著高于对照组,病变段肠系膜上静脉管径小于对照组,叶酸和维生素B12水平均低于对照组(P<0.05或P<0.01);治疗后,抗凝组和静脉溶栓组D-二聚体、同型半胱氨酸水平降低,病变段肠系膜上静脉管径增大,叶酸和维生素B12水平升高,且抗凝组上述指标改善程度均优于静脉溶栓组(P<0.05或P<0.01)。抗凝组治疗总有效率为90.70%高于静脉溶栓组的75.61%(P<0.05)。抗凝组治疗期间总不良反应发生率及复发率均低于静脉溶栓组(P<0.05)。结论肠系膜上静脉血栓形成患者D-二聚体、同型半胱氨酸水平升高,叶酸和维生素B12水平降低;早期予抗凝治疗的效果优于静脉溶栓,可降低D-二聚体、同型半胱氨酸水平,升高叶酸和维生素B12水平,增加病变段管径,且不良反应少,复发率低。

ObjectiveTo compare the efficacy and safety of anticoagulation and intravenous thrombolysis for superior mesenteric venous thrombosis (MVT).MethodsWe selected eighty-four patients with MVT who were treated in the Department of General Surgery of the Third Hospital of Tangshan City and the General Surgery of the Affiliated Hospital of North China University of Technology from April 2016 to January 2018.According to different treatment methods, they were divided into anticoagulation group ( n =43) and intravenous thrombolysis group ( n =41).In the meantime, 40 healthy volunteers who underwent physical examination were selected as the control group.Anticoagulation group and intravenous thrombolysis group were treated with fasting, gastrointestinal decompression, electrolyte imbalance correction, inhibition of digestive juice secretion and nutritional support.On this basis, low molecular weight heparin (LMWH, 5000-7500 U) was injected subcutaneously every 12 hours for 4 consecutive courses (7 day in a course) in the anticoagulation group.The intravenous thrombolysis group was injected with 80,000 U of urokinase via catheter after mesenteric angiography, which was changed to 300,000 U urokinase twice daily for 1 week the next day, and then warfarin (2 to 5 mg orally) daily for 4 weeks.The levels of D-dimer, superior mesenteric vein diameter, homocysteine, folic acid and vitamin B 12 were compared among anticoagulation group and intravenous thrombolysis group before treatment and control group, as well as the changes of the above indexes before and after treatment in anticoagulation group and intravenous thrombolysis group.In addition, clinical effect and safety were compared.ResultsBefore treatment, D-dimer and homocysteine were higher in anticoagulation group and intravenous thrombolysis group than in control group, whereas superior mesenteric vein diameter, folic acid and vitamin B 12 levels were smaller or lower in anticoagulation group and intravenous thrombolysis group than in control group ( P < 0.05 or P <0.01).After treatment, D-dimer and homocysteine were lower in anticoagulation group and intravenous thrombolysis group, while superior mesenteric vein diameter, folic acid and vitamin B 12 levels were larger or higher.The improvement of these indexes in anticoagulation group was better than that in intravenous thrombolysis group ( P < 0.05 or P <0.01).The total effective rate of anticoagulation group was 90.70%, which was higher than that (75.61%) of intravenous thrombolysis group ( P <0.05).The incidence of adverse reactions and recurrence rate were lower in anticoagulation group than in intravenous thrombolysis group ( P <0.05).ConclusionD-dimer and homocysteine levels in patients with superior MVT were increased, while folic acid and vitamin B 12 levels were decreased.Early anticoagulation therapy is better than intravenous thrombolysis, which can reduce the level of D-dimer and homocysteine, increase folic acid and vitamin B 12 levels and the diameter of the lesions, In addition, there are fewer adverse reactions and low recurrence rate.