不同途径溶栓治疗急性左下肢深静脉血栓的临床研究

Clinical study in different ways of the thrombolysis for left lower extremity deep venous thrombosis

目的比较外周静脉和导管直接溶栓治疗左下肢深静脉血栓(DVT)的疗效。方法左下肢髂股型血栓40例,随机分为两组,每组20例。A组:经患侧腘静脉置管溶栓(CDT);B组:经患侧足背静脉溶栓。结果治疗后A组和B组患肢髌骨上、下15cm肢围差分别为(0.7±0.7)cm和(2.3±1.1)cm、(0.6±0.5)cm和(1.5±0.7)cm,两组肢围差异有统计学意义(P〈0.05)A组下腔静脉滤器捕获血栓4例,B组下腔静脉滤器无血栓。A组血浆D-二聚体(DD)浓度3~4d达高峰,其后下降至正常,而B组DD达峰时间延迟,7d后未降至正常。治疗后深静脉造影检查示A组病人有效率80%,4例髂总静脉阻塞者采用静脉内支撑B组病人有效率45%。结论 CDT治疗DVT的疗效优于外周静脉溶栓;动态观察D二聚体变化可正确评估溶栓的临床疗效。

Objective To evaluated the results of two different ways of thrombolysis for left Lower Extremity Deep Venous Thrombosis.Methods 40 cases of Iliofemoral DVT were randomly divided into two groups.Patients in Group A(n=20) were treated with catheter direct thrombolysis(CDT)through the popliteal vein and patients in Group B(n=20)with thrombolysis through the dorsum pedis vein.Results After treatments,the subtraction of extremity circumstances15 cm above and below the patella in the involved and uninvolved in Group A,B were 0.7±0.7 cm and 2.3±1.1 cm,0.6±0.5cm and l.5±0.7 cm respectively.There was significantly different in the subtractions between group A and B after treatments(P<0.05).Massive emboli were captured in the inferior vena cava filter in 4 patients in Group A compared with none in Group B.The concentration of DD in Group A was raised to the peak level in the third or fourth day and decreased to the normal level fast later.Instead,the concentration of DD in Group B was raised and didn' t returned to normal in the 7th day.Venography of deep venous showed the effective rate(P<0.05)in Group A(80%) was higher than that in Group B(45%).Conclusion The results of CDT for DVT were better than that of thrombolysis through the peripheral vein.Dynamic measurement of DD could be a reliable method to evaluate the outcome of thrombolysis.