导管接触溶栓联合经外周静脉系统溶栓治疗骨科术后急性混合型深静脉血栓疗效分析

Analysis of the therapeutic effects of catheter-directed thrombolysis combined with peripheral venous thrombolysis in the treatment of mixed acute deep venous thrombosis after orthopedic surgical operation

目的探讨CDT联合经外周静脉系统溶栓治疗骨科术后急性混合型深静脉血栓形成的治疗效果和应用价值。方法回顾性分析解放军总医院第六医学中心和解放军东部战区海军医院2006年1月至2016年2月骨科术后急性混合型深静脉血栓形成患者112例的临床资料,其中,CDT联合经外周静脉系统溶栓患者48例(A组),单纯CDT 31例(B组),单纯经外周静脉系统溶栓治疗33例(C组)。分析患者不同溶栓时间的下肢周径变化、血栓清除率和总有效率以比较三组治疗效果。结果 A组、B组大腿消肿时间较C组均短,A组小腿消肿时间较B、C组均短(P<0.05),B组小腿消肿时间较C组长(P<0.05),提示A组下肢消肿效果最好。A组在溶栓3、5 d后血栓清除率高于B组(P<0.05),溶栓不同时间点A组、B组血栓清除率均高于C组(P<0.05),提示A组血栓清除最快。溶栓总有效率A组、B组均高于C组(P<0.05)。结论 CDT联合经外周静脉系统溶栓治疗骨科术后急性混合型深静脉血栓形成,较单纯应用CDT术经外周静脉系统溶栓方法,具有起效快、临床效果佳、血栓清除率及溶栓总有效率高的优点,可优先选择。

Objective To investigate the therapeutic effects and application value of catheter-directed thrombolysis(CDT)combined with peripheral venous thrombolysis in the treatment of the mixed acute deep venous thrombosis after orthopedic surgical operation.Methods Clinical data of 112 patients suffering from acute deep venous thrombosis after orthopedic surgical in Sixth Medical Center of PLA General Hospital and Navy Hospital of Eastern Theater Command from January 2006 to February 2016 were analyzed retrospectively.Among them,48 patients were treated by CDT combined with peripheral venous thrombolysis(group A),31 by CDT only(group B)and 33 by peripheral venous thrombolysis only(group C).The therapeutic effects of the three groups were compared by analyzing the circumference of patients’lower limbs in different times after thrombolysis therapy,thrombus removal rate and the total effective rate.Results The detumescence time of patients’thighs of group A and B was shorter than that of group C.The detumescence time of patients’legs of group A was shorter than that of group B and C(P<0.05)and the time of group B was longer than that of group C(P<0.05),which showed that the detumescence time of patients’lower limbs was shortest in group A.Three to five days after thrombolysis,the thrombus removal rate of Group A was higher than that of group B(P<0.05).In all the time after thrombolysis,the thrombus removal rate of Group A and B was higher than that of group C(P<0.05),which showed that the thrombus clearance was fastest in group A.The total effective rate of group A and B was higher than that of group C(P<0.05).Conclusion The therapeutic effects of CDT combined with peripheral venous thrombolysis is fast,effective,high thrombus removal and total effective rate compared with CDT or peripheral venous thrombolysis only in the treatment of acute deep venous thrombosis after orthopedic surgical,which can be a preferential choice.