标准化操作在下肢深静脉血栓形成经导管接触溶栓治疗中的临床意义

Clinical significance of standardized operation in transcatheter contact thrombolysis of deep venous thrombosis of lower extremity

目的评价标准化操作在下肢深静脉血栓形成经导管接触溶栓治疗过程中,对预防问题发生、降低并发症及改善临床治疗效果的意义。方法回顾性分析276例下肢深静脉血栓患者经导管溶栓治疗治疗的临床资料。将实施标准化操作前治疗的患者归为A组(124例),将实施标准化操作后治疗的患者归为B组(152例),比较2组出现问题及并发症的发生率。结果A组问题发生率32.26%(40/124)显著高于B组问题发生率5.26%(8/152)(P<0.05)。经导管接触溶栓治疗过程中最常见的问题表现为溶栓导管移位,A组有21例(16.94%),B组有3例(3.29%)。最严重错误操作的问题表现为A组1例溶栓导管、抗凝微泵、血管鞘三通、尿激酶微泵错误连接,直接导致血栓沿导管生长,延长溶栓时间。B组未发生明显的出血并发症(0/152),显著低于A组并发症发生率8.06%(10/124),其中最严重的并发症问题表现为A组1例未及时发现头痛头晕等脑出血早期征象。结论下肢深静脉血栓形成经导管接触溶栓治疗时,标准化操作可以降低问题的发生并可以提高临床治疗效果。

Objective To evaluate value of standard procedure in catheter-directed thrombolysis(CDT)for deep venous thrombosis(DVT)of lower extremity patients.Methods A total of 276 louer extremity DVT patients treated with CDT in our hospital were analyzed retrospectively.One hundred and twenty-four DVT patients treated with CDT before standard procedure performed were defined as group A,152 DVT patients treated with CDT after standard procedure performed were defined as group B.The incidence rate,complications were compared between two groups.Results The incidence rate of group A was significantly higher than group B,32.26%(40/124)vs 5.26%(8/152)(P<0.05).The most common problem of catheterization was catheter displacement.There were 21 cases(16.94%)in group A and 3 cases(3.29%)in group B(152 cases).The most serious misoperation was 1 case in group A whose thrombolysis catheter,anticoagulant micropump,vascular sheath triple connection,urokinase micropump were connected incorrectly,which directly led to thrombus growth along the catheter and the thrombolysis time prolonging.There was no major bleeding complication in group B,which was significantly lower than 10 cased(8.06%)of group A(P<0.05).The most serious complication was a case of group A who had early signs of cerebral hemorrhage,such as headache,dizziness.Conclusion Standard procedure in CDT for DVT patients may lower incidence rate,prevent complications,improve clinic outcomes.