不同治疗方法对下肢深静脉血栓发生肺栓塞影响的对比研究  

Deep venous thrombosis of lower extremities： effects of different treatment on the incidence of pulmonary embolism

作　　者：杨德华[1] 李剑[1] 何家安[1] 胡新华[1] 辛世杰[1] 段志泉[1] 徐克[2] 

机构地区：[1]中国医科大学附属第一医院血管甲状腺外科,沈阳110001 [2]中国医科大学附属第一医院放射线科,沈阳110001

出　　处：《中华外科杂志》2009年第23期1787-1789,共3页Chinese Journal of Surgery

基　　金：国家科技支撑计划课题资助项目（2007BA105804）

摘　　要：目的对比不同治疗方法对下肢深静脉血栓形成发生肺栓塞的影响。方法回顾性分析2002年8月至2008年6月201例下肢深静脉血栓形成患者，男性97例，女性104例；年龄24-83岁，平均60．4岁。其中血栓发生于左侧肢体174例，右侧24例，双侧3例。所有患者发病≤7d，入院时无肺栓塞，且均获得随访。按治疗方法分为：单独溶栓抗凝组，手术取栓后溶栓抗凝组及置入下腔静脉滤器后溶栓抗凝组。分别计算各组住院期间和随访期间3组肺栓塞的发生率。结果单独溶栓抗凝组住院期间有症状肺栓塞发生率为2．8％（3／107），下腔静脉滤器组、手术组无肺栓塞发生，3组间差异无统计学意义（P=0．425）。出院后随访6～72个月，平均24个月。随访期间单独溶栓抗凝治疗组及手术取栓组无肺栓塞发生，下腔静脉滤器组肺栓塞发生率为2．4％（1／42）且死于肺栓塞，3组间差异无统计学意义（P=0．656）。结论三种治疗方法对下肢深静脉血栓形成、发生有症状肺栓塞的影响并无差异，下腔静脉滤器的置入应严格掌握适应证。Objective To investigate the effects of the different treatments of deep venous thrombosis （DVT） of lower extremities on the incidence of the pulmonary embolism （PE）. Methods 201 patients （97 males and 104 females, mean age 60. 4 years ranged from 24 to 83） from August 2002 to June 2008 with DVT were retroepectively reviewed and divided into 3 groups based on different treatment, including anticoagulants plus thrombolytics alone （group 1 ）, thrombectomy plus anticoagulants plus thrombolytics （group 2） and anticoagulants plus thrombolytics after delivery of inferior vena cava （IVC） filter （group 3） respectively. One hundred and seventy-four cases had left lower limb DVT, 24 cases had right lower limb DVT and 3 cases had both sides of lower limb DVT. Different incidence of PE in different period （7-14 d in hospital and follow-up after discharge） were calculated. Effects of the three different treatment methods of DVT on the incidence of PE were studied. Results For in-patients, the prevalence of symptomatic PE was 2. 8% （ 3/107 ） in the group of receiving anticoagulants plus thrombolytics alone, but in the other two groups, no symptomatic PE happened. There was no significant difference in incidence of symptomatic PE among the 3 groups （ P = 0. 425 ）. For patients discharged, after 6 to 72-month follow-up （ mean 24-month） , we found that no PE happened in group 1 and group 2, while in group 3, the incidence of PE was 2. 4% （1/42）. There was also no significant difference （P =0. 656） among 3 groups. Conclusions There is no significant difference in relation to the incidence of PE in these 3 groups. Therefore vena cava filter imolantation should be stricted to ootomal indication.

关 键 词：肺栓塞 腔静脉滤器 静脉血栓形成 血栓切除术 

分 类 号：R654.3[医药卫生—外科学] R563.5[医药卫生—临床医学]