AngioJet血栓清除联合导管接触溶栓术后血红蛋白尿鉴别诊断及出血分级管理策略

The clinical value of differential diagnosis of hemoglobinuria and bleeding grade management strategy after AngioJet thrombectomy combined with catheter-directed thrombolysis

目的 探讨AngioJet血栓清除联合导管接触溶栓(CDT)术后实施血红蛋白(Hb)尿鉴别诊断和出血分级管理策略的临床效果。方法 选取2018年6月至2020年5月在南京市第一医院接受AngioJet血栓清除术联合CDT治疗的急性中央型或混合型下肢深静脉血栓形成患者80例,随机分为试验组和对照组,每组40例。试验组依据术后Hb尿鉴别诊断评估出血风险,实施出血分级管理策略,对照组实施常规护理方案。评价实施出血分级管理策略的可行性、安全性和临床效果。结果 80例患者术前、术后24 h、48 h、72 h尿红细胞计数分别为(6.53±0.88)个/μL、(51.7±9.15)个/μL、(13.03±1.94)个/μL、(4.70±1.02)个/μL,Hb分别为0、(81.92±7.86) mg/L、(21.50±7.01) mg/L、(7.10±0.77) mg/L,差异有统计学意义(均P<0.01)。术后24 h、48 h、72 h纤维蛋白原、丙氨酸转移酶、天冬氨酸转移酶、肌酐、尿素氮、尿pH、尿比重指标与术前比较,差异无统计学意义(均P>0.05)。试验组、对照组分别有9例(22.5%)、17例(42.5%)发生轻微出血,0例、2例(5.0%)发生严重出血,组间差异有统计学意义(P=0.02);腿围消肿率分别为(88.12±20.16)%、(71.51±20.10)%,静脉通畅度分别为(85.25±20.41)%、(74.72±20.51)%,组间差异有统计学意义(均P<0.05)。试验组住院期间护理满意度和临床疗效高于对照组,差异有统计学意义(均P<0.05)。结论 AngioJet血栓清除术联合CDT术后通过Hb尿鉴别诊断和出血风险评估实施出血分级管理策略,有利于早期鉴别血尿,及时采取围手术期护理措施,提高疗效和患者满意度。

Objective To investigate the clinical value of differential diagnosis of hemoglobinuria and bleeding grade management strategy in patients with deep vein thrombosis(DVT) of the lower limbs after receiving AngioJet thrombectomy combined with catheter-directed thrombolysis(CDT) treatment. Methods A total of 80 patients with acute central type or mixed type DVT of the lower limbs, who were admitted to the Nanjing Municipal First Hospital of China to receive AngioJet thrombectomy plus CDT between June 2018 and May 2020, were enrolled in this study. The patients were randomly divided into study group and control group, with 40 patients in each group. In the study group, based on the differential diagnosis of postoperative hemoglobinuria, the bleeding risk was assessed and the bleeding grade management strategy was implemented, while in the control group routine postoperative nursing program was carried out. The feasibility, safety and clinical effectiveness of the implement of bleeding grade management strategy were evaluated. Results In the 80 patients, the preoperative, postoperative 24-hour, 48-houe and 72-hour urine red blood cell counts were(6.53±0.88)/μL,(51.7±9.15)/μL,(13.03±1.94)/μL and(4.70±1.02)/μL respectively,hemoglobinuria were 0,(81.92 ±7.86) mg/L,(21.50 ±7.01) mg/L and(7.10 ±0.77) mg/L respectively;the differences were statistically significant(all P<0.01). The postoperative 24-hour, 48-houe and 72-hour fibrinogen,alanine transferase, aspartate transferase, creatinine, urea nitrogen, urinary pH and urinary specific gravity were not significantly different from preoperative ones(all P>0.05). In the study group and the control group,minor bleeding was observed in 9 patients(22.5%) and 17 patients(42.5%) respectively, severe bleeding was seen in 0 patient(0.0%) and 2 patients(5.0%) respectively, the difference between the two groups was statistically significant(P=0.02);the swelling regression rates of leg were(88.12±20.16)% and(71.51±20.10)%respectively, the venous patency ratios were(85.25±20.41)% and(74.72±20.51)% respectively, the differences between the two groups were statistically significant(all P<0.05). The satisfaction with nursing and clinical efficacy during hospitalization in the study group were remarkably better than those in the control group, the differences between the two groups were statistically significant(all P<0.05). Conclusion On the basis of differential diagnosis of hemoglobinuria and the assessment of bleeding risk, the implementation of bleeding grade management strategy in patients with DVT of the lower limbs after receiving AngioJet thrombectomy plus CDT treatment can help early identify hematuria, promptly take perioperative nursing measures, and effectively improve curative efficacy and patient satisfaction.