超声影像对置入伞形滤器治疗下肢深静脉血栓的疗效评估

Assessment of the curative efficacy of the placed umbrella-shape filter in treating deep venous thrombosis of lower extremities by using ultrasound image

目的:探讨超声影像对置入伞形滤器治疗下肢深静脉血栓疗效的评估价值。方法:对2018年10月至2022年10月于北京大学第三医院延庆医院收治的85例下肢深静脉血栓患者的临床资料进行回顾性分析,依据患者的治疗效果和临床症状改善情况将其分为治愈组(38例)、显效组(27例)和有效组(20例),所有患者均接受置入伞形滤器以及患侧腘静脉穿刺,连接溶栓导管与微量泵,将尿激酶泵入。所有患者接受超声造影检查,于术后1、3及5d经溶栓导管注入经过稀释的超声造影剂,分析超声造影的灌注情况,采用超声造影定量分析软件获取时间-强度曲线(TIC)、达峰时间(TTP)、峰值强度(DPI)、曲线上升支斜率(C)等。对比患者术后1、3和5d各项定量参数。结果:治疗后患者的管壁内膜缩小(82例)、血管压缩性较好(58例)以及管腔内回声清晰(61例)相较于治疗前有明显改善,差异均有统计学意义(χ^(2)=52.407、61.917、74.518,P<0.05);治疗总有效率为100%;治愈组、显效组及有效组患者术后5d的TTP、DPI及C分别为治愈组(14.02±5.41)s、(-10.77±3.22)s、(4.91±1.33)dB/s,显效组(17.95±7.41)s、(-13.87±4.01)s、(4.11±1.20)dB/s与术后1d比较差异均有统计学意义(治愈组:t=11.615、-22.122、-16.112,P<0.001;显效组:t=8.820、-13.073、-10.804,P<0.001;有效组:t=6.791、-7.725、t-6.633,P<0.05);术后3d 3组患者DPI、C比术后1d高,而TTP则比术后1d低,差异均有统计学意义(治愈组:t=-18.857、-12.387、-7.254、-7.435,P<0.001;有效组:t=-5.076、-6.919,P<0.05);术后5d治愈组和显效组患者的DPI、C均比有效组高,差异均有统计学意义(t_(DPI)=12.219、7.457,t_(C)=4.826、2.530,P<0.05)。结论:对下肢深静脉血栓可选用置入伞形滤器后置管溶栓治疗的方法,置入的伞形滤器可对血栓进行有效拦截,并可在静脉内长时间留置。还可在下腔静脉造影剂时观察灌注情况及直观反映下肢深静脉患者经置入伞形滤器后置管溶栓治疗后静脉的再通情况。

Objective:To explore the assessment value of ultrasound images for the curative effect of placed umbrella-shaped filters in treating deep vein thrombosis in the lower limbs.Methods:A retrospective analysis was conducted on the clinical data of 85 patients with deep vein thrombosis of the lower extremities who admitted to Peking University Third Hospital Yanqing Hospital from October 2018 to October 2022.Based on the treatment effect and the improvement of clinical symptoms,the patients were divided into a cure group(38 cases),a significant effect group(27 cases)and an effective group(20 cases).All patients underwent the placement of an umbrella-shape filter and popliteal vein puncture on the affected side,and the urokinase was pumped into the body after a thrombolytic catheter was connected to micro pump.All patients underwent contrast-enhanced ultrasound examination,and the diluted ultrasound contrast agent was injected through a thrombolytic catheter on the 1st,3rd and 5th day after surgery,so as to analyze the perfusion situation of ultrasound contrast.Time intensity curve(TIC),time to peak(TTP),density peak intensity(DPI)and ascending branch slope(C)of the curve were obtained by using ultrasound contrast quantitative analysis software.And then,the quantitative parameters of patients among the 1st,3rd and 5th day after surgery were compared.Results:Compared with these before treatment,the reduction of the intima of the wall(82 cases),the better vascular compression(58 cases)and the clear echo in the lumen(61 cases)were significantly improved after treatment,and the differences were statistically significant(χ^(2)=52.407,61.917,74.518,P<0.05),respectively.The total effective rate was 100%.The TTP,DPI and C of the cure group,the significant effect group and the effective group were respectively(14.02±5.41)s,(-10.77±3.22)s and(4.91±1.33)dB/s on the 5th day after surgery.The TTP,DPI and C of the significant effect group[(17.95±7.41)s,(-13.87±4.01)s and(4.11±1.20)dB/s]on the 5th d after surgery were significantly different from those on the 1st day after surgery(cure group:t=11.615,-22.122,-16.112,P<0.001,significant effect group:t=8.820,-13.073,-10.804,P<0.001,effective group:t=6.791,-7.725,-6.633,P<0.05),respectively.The DPI and C of the three groups on the 3rd day after surgery were significantly higher than those on the 1st d after surgery,while the TTP was significantly lower than that on the 1st day after surgery,and the differences were statistically significant(cure group:t=-18.857,-12.387,-7.254,-7.435,P<0.001,effective group:t=-5.076,-6.919,P<0.05),respectively.The DPI and C on the 5th d after surgery in the cure group and the significant effect group were significantly higher than those in the effective group(t_(DPI)=12.219,7.457,t_(C)=4.826,2.530,P<0.05),respectively.Conclusion:The deep vein thrombosis of the lower extremities can choose the method of thrombolysis treatment after the umbrella-shape filter is placed,which can effectively intercept the thrombosis and can be indwelled in the vein in a long time,and which can also observe perfusion during inferior vena cava contrast,and which can also intuitive appear the recanalization of the veins after umbrella-shape filter is placed in patients with deep vein thrombosis of the lower extremities after the treatment of catheter thrombolysis.