低分子肝素钙辅以大腔导管血栓抽吸术对深静脉血栓患者血液流变学、凝血功能、炎症因子及治疗安全性的影响

Effects of Low Molecular Weight Heparin Calcium Combined with Large Lumen Catheter Thrombus Aspiration on Hemorheology,Coagulation Function,Inflammatory Factors and Treatment Safety in Patients with Deep Venous Thrombosis

目的探讨低分子肝素钙辅以大腔导管血栓抽吸术对深静脉血栓(deep venous thrombosis,DVT)患者的血液流变学、凝血功能、炎症因子及治疗安全性的影响。方法选取2019年3月至2021年3月保定市第四中心医院收治的150例DVT患者进行研究,随机分为观察组、对照组,各75例。对照组给予大腔导管血栓抽吸术治疗,观察组在对照组基础上增加低分子肝素钙治疗。综合评估两组患者的临床疗效、血液流变学指标、凝血功能指标、炎症因子、治疗安全性。结果观察组总有效率为93.33%(70/75),对照组总有效率为81.33%(61/75),观察组高于对照组,差异有统计学意义(P<0.05)。两组患者治疗后血液流变学指标均低于治疗前,且治疗后观察组全血黏度、血浆黏度、红细胞变形指数等血液流变学指标均低于对照组,差异均有统计学意义(P<0.05)。两组患者治疗后凝血指标较治疗前均有显著改善,且治疗后观察组活化部分凝血活酶时间(activeated partial thromboplasting time,APTT)、凝血酶原时间(prothrombin time,PT)、凝血酶时间(thrombin time,TT)均高于对照组,纤维蛋白原(fibrinogen,FIB)浓度低于对照组,差异有统计学意义(P<0.05)。两组患者治疗后炎症因子水平均显著低于治疗前,且治疗后观察组炎症因子超敏C反应蛋白(high-sensitivity C-reactive protein,hs-CRP)、Toll样受体4(toll like receptor 4,TLR4)、前列素E2(prostaglandin E2,PGE2)浓度均低于对照组,差异有统计学意义(P<0.05)。治疗期间观察组与对照组不良反应发生率比较,差异无统计学意义[10.67%(8/75)vs.8.00%(6/75),P>0.05]。结论低分子肝素钙辅以大腔导管血栓抽吸术对DVT患者溶栓效果良好,改善患者的血液流变学、凝血功能和炎性反应,治疗安全性较好,可临床推荐。

Objectives To investigate the hemorheology,coagulation function,inflammatory factors and therapeutic safety of low molecular weight heparin calcium combined with large lumen catheter thrombus aspiration in treatment of patients with deep venous thrombosis(DVT).Methods Totally 150 patients with DVT treated in The Fourth Central Hospital of Baoding City from March 2019 to March 2021 were randomly divided into observation group and control group,with 75 cases in each group.Control group was treated with large lumen catheter thrombus aspiration,and observation group was treated with low molecular weight heparin calcium on the basis of control group.The clinical efficacy,hemorheological indexes,coagulation function indexes,inflammatory factors and treatment safety of the two groups were comprehensively evaluated.Results The total effective rate was 93.33%(70/75)in observation group and 81.33%(61/75)in control group,which was higher in observation group than in control group(P<0.05).After treatment,the levels of hemorheological indexes such as whole blood viscosity,plasma viscosity and erythrocyte deformation index in observation group were lower than those in control group(P<0.05).After treatment,activeated partial thromboplasting time(APTT),prothrombin time(PT)and thrombin time(TT)in observation group were higher than those in control group,and fibrinogen(FIB)was lower than those in control group(P<0.05).After treatment,the levels of inflammatory factor such as high-sensitivity C-reactive protein(hs-CRP),toll like receptor 4(TLR4)and prostaglandin E2(PGE2)in observation group were lower than those in control group(P<0.05).During the treatment,the incidence of adverse reactions in observation group and control group had no significant difference[10.67%(8/75)vs.8.00%(6/75),P>0.05].Conclusions Low-molecular heparin calcium supplemented with large-lumen catheter thrombus aspiration has a good effect on thrombolysis in patients with DVT,which can improve the patient′s hemorheology and coagulation function,reduce the level of inflammatory factors,and has a good treatment safety.