小功率正反向交替踏车运动干预深静脉血栓形成后综合症的临床应用及超声监测价值初探

Application of low-power forward and reverse alternating treadmill to intervention of deep vein thrombosis syndrome and initial research of ultrasound monitoring

目的探讨小功率正、反向交替踏车运动干预深静脉血栓形成后综合症(PTS)疗效及超声监测的临床价值。方法采用前瞻性研究分析2015年2月—2018年2月郑州市中心医院收治的深静脉血栓后综合征(PTS)患者临床资料,按纳入标准入选47例。随机分成3组:①零干预组10人接受常规药物抗凝治疗;②干预组(37人)在常规治疗的基础上采用小功率踏车运动干预[A组(18人)接受正向干预,B组(19人)接受正、反向交替干预)]。8周后,比较三组不同时段Villatal改善率(临床疗效指标)、病变部位血管内径、血流速度、瓣膜功能不全率、血管内膜异常率及管腔内回声异常率(病变血管形态学指标),与临床疗效作相关性分析。采用QOL评价干预后效果。结果均获6~8个月随访。三组基线资料均衡(P>0.05)。8周后,与干预前组内对照,零干预组Villatal score改善不显著(P>0.05),A、B组存在明显改善(P<0.05);与A组对照,B组改善显著(P<0.01)。半年随访:与8周对照,零干预组有加重趋势(P<0.05),A组改善不显著(P>0.05),B组则仍有继续改善趋势(P<0.05)。8周多普勒追踪对比:零干预组时相性动态监测形态学指标变化不明显(P>0.05),A、B组出现病变部位血管内径、血流速度、瓣膜功能不全率明显变化(P<0.05),B组出现血管内膜、管腔内异常率也明显改善(P<0.05)。Pearson相关分析显示:病变部位血管内径、血流速度与患者病情存在正相关:r病变部位血管内径=0.791,P<0.001;r血流速度=0.802,P<0.001。瓣膜功能不全率、血管内膜异常率及管腔内回声异常率与患者病情存在负相关:r瓣膜功能不全率=-0.758,P<0.001;r血管内膜异常率=-0.799,P<0.01;r管腔内回声异常率=-0.819,P<0.01。8周后,零干预组QOL改善不明显(P>0.05),A、B组均得到改善(P<0.05);6月后随访,与干预8周对照,0干预组、A组无继续改善(P>0.05),B组仍存在继续改善(P<0.05)。零干预组随访期间,新增DVT1例,病情轻度恶化2例;A组出现肌筋膜炎(MPS)、延迟性肌肉酸痛(DOMS)2例,B组1例,无新增DVT病例,无死亡病例。结论小功率双向交替踏车训练能系统化、集束化改善PTS患肢静脉回流障碍;CDUS动态监测对PTS病情转归有重要的评估价值。

Objective To explore the effect of low-power forward and reverse treadmill exercise on deep vein thrombosis syndrome(PTS)and the clinical value of ultrasound monitoring.Methods The clinical data of patients with deep vein thrombosis syndrome(PTS)admitted to Zhengzhou Central Hospital from February 2015 to February 2018 were analyzed,and 47 patients were selected according to the inclusion criteria.Randomly divided into 3 groups:①10 people in the zero intervention group received conventional anticoagulant therapy;②Intervention group(37 people)used low-power treadmill exercise intervention on the basis of conventional treatment[group A(18 people)received positive intervention,group B(19 people)received positive and reverse alternating intervention)].After 8 weeks,the Villatal improvement rate(clinical efficacy index),vessel inner diameter,blood flow velocity,valvular dysfunction rate,endovascular abnormality rate,intraluminal echo abnormality rate,and clinical efficacy of the three groups at different periods were analyzed and compared.QOL was used to evaluate the effect after intervention.Results All were followed up for 6-8 months.The baseline data of the three groups were balanced(P>0.05).After 8 weeks,compared with the control in the pre-intervention group,the Villatal score in the zero-intervention group was not significantly improved(P>0.05),and there was a significant improvement in the A and B groups(P<0.05);compared with the A group,the B group was significantly improved(P<0.01).Half-year follow-up:Compared with 8 weeks,the zero-intervention group had a trend of aggravation(P<0.05),the improvement in group A was not significant(P>0.05),and the trend in group B continued to improve(P<0.05).8-week Doppler tracking comparison:The phase dynamic monitoring morphological indicators of the zero intervention group did not change significantly(P>0.05),and the vessel diameter,blood flow velocity,and valvular dysfunction rate of the lesion sites in the A and B groups changed significantly(P<0.05),the abnormal rate of vascular intima and lumen in group B was also significantly improved(P<0.05).Pearson correlation analysis showed that there was a positive correlation between the inner diameter of the blood vessel at the lesion site and blood flow velocity and the patient’s condition:r inner diameter of the lesion site=0.791,P<0.001;r blood flow velocity=0.802,P<0.001.The rate of valvular insufficiency,the rate of vascular intimal abnormality,and the rate of luminal echogenicity are inversely related to the patient’s condition:r valve dysfunction rate=-0.758,P<0.001;r vascular endometrial abnormality rate=-0.799,P<0.01;R intraluminal echo anomaly rate=-0.819,P<0.01.After 8 weeks,the QOL improvement in the zero intervention group was not significant(P>0.05),and the A and B groups were improved(P<0.05);after 6 months of follow-up,compared with the 8 week intervention,the zero intervention group and A group did not continue to improve(P>0.05),group B still continued to improve(P<0.05).During the follow-up period of the zero intervention group,one new DVT case was reported,and two patients had mildly worsened disease;two cases had myofasciitis(MPS)and delayed muscle soreness(DOMS)in group A,and one case in group B.There were no new DVT cases and no deaths in group B.Conclusion Low-power two-way alternating treadmill training can systematically and bundlely improve venous return disorder in the limbs of PTS;CDUS dynamic monitoring has important evaluation value for the disease outcome of PTS.