不同途径抗凝溶栓治疗下肢深静脉血栓的实验研究  

Three different ways of anticoagulation and thrombolysis for the treatment of lower extremity deep venous thrombosis

作　　者：余超[1] 吴性江[1] 韩建明[1] 

机构地区：[1]南京大学医学院临床学院(南京军区南京总医院)解放军普通外科研究所,江苏南京210002

出　　处：《医学研究生学报》2007年第10期1033-1036,I0004,共5页Journal of Medical Postgraduates

基　　金：南京军区南京总医院科研基金重点课题资助项目(批准号:2005050)

摘　　要：目的:通过建立兔下肢深静脉血栓模型,研究不同途径抗凝、溶栓治疗兔下肢深静脉血栓的疗效,同时动态观察D-二聚体(DD)值变化对溶栓疗效判断的意义。方法:采用结扎法建立深静脉血栓模型,将36只新西兰兔随机分为3组,每组12只。A组:经患侧腘静脉置管抗凝溶栓;B组:经患侧股动脉置管抗凝溶栓;C组:经外周静脉系统抗凝溶栓。每组均给予尿激酶500U/(kg.h)、肝素钠10 u/(kg.h),微量泵静脉持续滴注24 h,分别于给药前和给药后4、8、12、16、20和24 h测定血浆DD值。24 h后造影观察血管再通情况,并观察有无颅内出血、肺栓塞等严重并发症的发生。结果:给药后A、B、C三组的DD水平均出现先上升后下降的变化;A组在12 h达到高峰,24 h后恢复至溶栓前水平;B、C组均在20 h时达到高峰,随后出现下降,24 h后仍明显高于溶栓前水平。三组在治疗前DD水平差异无统计学意义(P>0.05),A组在4、8、12、20、24 h与B、C组相同时间点比较的差异均有统计学意义(P<0.05);而B、C两组在各相同时间点比较的差异均无统计学意义(P>0.05)。血管造影:A组在24 h后造影有效率100%,B组有效率为50%C组比有效率为41.7%;A组与B组或C组比较的差异均有统计学意义(P<0.05),而B组与C组差异无统计学意义(P>0.05)。三组均无颅内出血及肺栓塞表现。结论:经腘静脉导管直接抗凝、溶栓对于下肢深静脉血栓的近期治疗效果优于经外周静脉系统抗凝溶栓及经股动脉置管溶栓;动态观察DD值变化可以作为溶栓给药指导及治疗效果的评价指标。Objective： To investigate the effect of three different ways of thrombolysis and anticoagulation for the treatment of lower extremity deep venous thrombus （DVT） in rabbit DVT models and predict the significance of dynamic monitor of serum D-Dimer （DD） in the thrombolysis therapy. Methods ：The DVT animal model was constructed by ligation. Thirty-six New Zealand rabbits were divided into three groups ： Group A （ the thrombolysis catheter placed through the popliteal vein）, Group B （ the thrombolysis catheter entered through the femoral artery） and Group C thrombolysis and anticoagulation used directly through the peripheral vein. All the three groups received the same dose of urokinase and heparin through the micro pump. The serum DD was tested before and 4 h, 8 h, 12 h, 16 h, 20 h and 24 h after the ad- ministration. Venogramphy was performed 24h later to observe the possibility of intracranial hemorrhage, pulmonary embolism and other serious complications. Results：The serum DD was first increased and later decreased in all the three groups. Group A reached the peak at 12h of administration and returned to the pre-administration level at 24h. Group B and C reached the peak at 20h and decreased later, but remained higher than pre-administration. The serum DD was shown to be significantly different （ P 〈 0.05 ） at 4 h, 8 h, 12 h, 20 h and 24 h between Groups A and B or C, but not between Groups B and C. There was no statistic difference （ P 〉 0.05 ） among the three groups before the treatment. Venogramphy showed 100% recanalization in Group A, 50% in Group B and 41.7% in Group C with significant differences （ P 〈 0.05 ） between Groups A and B or C, but not between Groups B and C （P 〉 0.05 ）. No intracranial bleeding or pulmonary embolism were found in the three groups. Conclusion： By using thrombolysis catheter through the popliteal vein, the thrombolysis and anticoagulation therapy has a better short-term outcome compared with that through the femoral artery or the

关 键 词：深静脉血栓 溶栓 抗凝 D-二聚体 

分 类 号：R543.6[医药卫生—心血管疾病]