从5年随访结果评价置管溶栓治疗下肢深静脉血栓形成的疗效

Effects of catherter-directed thrombolysis in treatment of patients with deep venous thrombosis by analysis of 5-year follow up results

目的比较置管溶栓和系统溶栓治疗下肢深静脉血栓形成(DVT)患者远期发生血栓后综合征(PTS)的差异。方法回顾性收集2012年1月至2015年1月期间南充市中心医院收治的单侧下肢DVT患者,根据溶栓方式分为置管溶栓组和系统溶栓组,比较2组患者的近期血栓溶解率、溶栓并发症及随访5年时的PTS发生情况。结果本研究共纳入患者137例,其中系统溶栓组58例,置管溶栓组79例,2组患者的性别、年龄、病程、血栓类型等基线资料比较差异无统计学意义(P>0.05)。均完成抗凝溶栓治疗。置管溶栓组近期血栓溶解率高于系统溶栓组[(78.6±16.3)%比(27.3±12.1)%,t=21.14,P<0.001];系统溶栓组和置管溶栓组的总体并发症发生率比较差异无统计学意义(32.8%比21.5%,χ^(2)=2.18,P=0.134)。116例完成5年随访(置管溶栓组74例,系统溶栓组42例),置管溶栓组PTS的发生率较系统溶栓组降低(35.1%比88.1%,χ^(2)=30.28,P<0.001)且置管溶栓组即使发生了PTS其严重程度也较系统溶栓组轻(Z=16.52,P<0.001)。结论从本研究结果看,置管溶栓能提高下肢DVT患者的血栓溶解率,降低远期PTS发生率及其严重程度。

Objective To compare the differences of incidence rate and severity of postthrombotic syndrome(PTS)of patients with lower extremity deep venous thrombosis(DVT)treated by catherter-directed thrombolysis(CDT)or via peripheral vein thrombolysis(PVT).Methods The patients with unilateral lower extremity DVT who had received anticoagulant and thrombolytic therapy in the Nanchong Central Hospital from January 2012 to January 2015 were collected.These patients were divided into CDT group and PVT group according to the different thrombolysis methods,and then the thrombolytic rates,thrombolytic complications,and the incidence rate and severity of PTS of 5-year follow up results were calculated and compared.Results A total of 137 cases of DVT were collected,79 in the CDT group and58 in the PVT group.There were no significant differences in the gender,age,course of disease,thrombus type,and other baseline data between the two groups(P>0.05).The thrombolytic rate of the CDT group was(78.6±16.3)% and PVT group was(27.3±12.1)%,the difference was significant(t=21.14,P<0.001).The rate of thrombolytic complications between the PVT group and CDT group had no statistical significance(32.8% versus 21.5%,χ^(2)=2.18,P=0.134).The 5-year follow up was completed in 116 cases,74 patients from the CDT group and 42 patients from the PVT group respectively,the result showed that the incidence rate of the PTS in the CDT group was lower than that in the PVT group(35.1% versus 88.1%,χ^(2)=30.28,P<0.001),and the severity of PTS in the CDT group was milder than that in the PVT group too(Z=16.52,P<0.001).Conclusion From the results of this study,CDT is able to increase thrombolytic rate and effectively reduce incidence rate and severity of PTS.