导管溶栓术治疗急性下肢深静脉血栓的效果及护理  

Effects and Nursing of Patients with Acute Lower Limb Deep Venous Thrombosis Treated with Catheter-directed Thrombolysis

作　　者：成咏[1] 葛伶俐[1] 余枫[1] 乔慧娜[1] 

机构地区：[1]上海交通大学医学院附属第九人民医院血管外科,上海200011

出　　处：《解放军护理杂志》2011年第14期42-44,53,共4页Nursing Journal of Chinese People's Liberation Army

摘　　要：目的探讨导管溶栓术(catheter directed thrombolysis,CDT)治疗急性下肢深静脉血栓的效果和护理措施。方法回顾性分析2008年6月至2011年3月43例行导管溶栓术治疗急性下肢深静脉血栓患者的临床资料,其中髂静脉血栓6条、髂股静脉血栓10条、全肢型血栓27条,均采用Unifuse溶栓导管,经小隐静脉途径28例、胫后静脉7例、大隐静脉6例、大隐静脉-交通静脉2例,插入血栓内用尿激酶、肝素进行抗凝、溶栓治疗,并观察疗效及总结护理体会。结果经顺行静脉造影确认所有患肢静脉通畅度均明显改善,患肢症状明显好转。43例患者均未发生严重并发症,仅6例患者发生一般性出血现象,包括穿刺处渗血3例、尿路出血2例、眼底出血1例,经对症处理后出血缓解。结论 CDT治疗下肢深静脉血栓早期疗效显著。术前做好心理护理、完善各项准备,术后密切观察病情、加强并发症的观察及处理是确保导管溶栓术成功的关键。Objective To explore the clinical effects and nursing experience of patients with acute lower limb deep venous thrombosis（DVT） treated with catheter directed thrombolysis（CDT）.Methods A retrospective analysis was conducted on the data of 43 patients with acute lower extremity DVT treated by CDT from June 2008 to March 2011.Thrombosis involved 6 iliac veins,10 iliofemoral veins and 27 low limb veins.Unifuse thrombolysis catheters were inserted through small saphenous vein in 28 cases,posterior tibial vein in 7 cases,great saphenous vein in 6 cases and great saphenous-perforator vein in 2 cases.All the patients got anticoagulation and thrombolytic therapy with urokinase and heparin.Results Significant improvements in the patency rate of limb veins and limb symptoms were confirmed by the anterograde venography.There were no serious complications in 43 cases.Minor bleeding occurred in 6 patients which included：3 cases of puncture bleeding,2 cases of urinary bleeding and 1 case of retinal hemorrhage.Due to early detection and timely observation,all of patients got recovery after hemorrhage.Venous patency improvement and symptom relief were confirmed by venography after CDT.Conclusion CDT plays an effective role in the early treatment of lower limb DVT.The keys to a successful treatment include comprehensive preoperative preparation,close observation after thrombolysis,intensive observation and treatment of complications.

关 键 词：导管溶栓术 深静脉血栓形成 并发症 护理 

分 类 号：R543.6[医药卫生—心血管疾病]