导管溶栓治疗对急性深静脉血栓形成转归的影响  

Outcome comparisons of anticoagulation, systematic thrombolysis and catheter-directed thrombolysis in the treatment of lower extremity acute deep venous thrombosis

作　　者：张智辉[1] 单臻[2] 王文见[2] 李晓曦[2] 王深明[2] 

机构地区：[1]广州医学院第二附属医院血管外科,510260 [2]中山大学附属第一医院血管外科

出　　处：《中华医学杂志》2013年第29期2271-2274,共4页National Medical Journal of China

摘　　要：目的探讨抗凝、系统溶栓与导管溶栓治疗下肢急性深静脉血栓形成（DVT）的远期疗效及对深静脉血栓后综合征（PTS）的影响。方法随访2005年1月至2009年12月在中山大学附属第一医院及广州医学院第二附属医院血管外科收治的下肢急性DVT患者（152例）的临床资料，根据治疗方法分为单纯抗凝组（A组）、系统溶栓联合抗凝组（B组）和导管溶栓联合抗凝组（C组）。随访时行静脉彩超或下肢顺行静脉造影了解患肢静脉通畅情况，用Villalta评分法调查各组患者PTS的发生率，用CIVIQ一2调查表研究各组患者的生活质量，分析各组患者出院后抗凝时间及弹力袜使用情况。结果（1）A、B、c3组患者静脉通畅率分别为69．1％、70．8％、85．1％，c组与A组差异有统计学意义（P〈0．05），C组虽然高于B组，但差异尚无统计学意义（P〉0．05），A、B两组间差异无统计学意义（P〉0．05）。（2）A、B、C3组PTS的发生率分别为56．8％、54．2％、38．3％，C组与A、B两组间差异有统计学意义（P〈0．05），A、B两组问的差异无统计学意义（P〉0．05）。（3）A、B、C3组CIVIQ-2评分为20±14、20±12、17±11，C组较A、B两组分数低，但差异尚无统计学意义（P〉o．05）。（4）A、B、C3组出院后平均抗凝及弹力袜时间差异无统计学意义（P〉0．05）。结论与单纯抗凝及系统溶栓相比较，导管溶栓联合抗凝能降低急性下肢DVT转归为胛s的发生率，改善临床症状，提高生活质量。Objective To explore the outcomes of anticoagulation, systematic thrombolysis and catheter-directed thrombolysis （ CDT ） in the treatment of lower extremity acute deep venous thrombosis （DVT）. Methods The clinical data of 152 patients with lower extremity acute DVT from January 2005 to December 2009 were analyzed retrospectively. They were divided into single antieoagulation group （A）, systematic thrombolysis plus anticoagulation group （B） and CDT plus antieoagulation group （C）. Follow-up studies were performed to inquire about patient symptoms, check the status of affected extremities and examine venous pateney with venous uhrasonography or anterograde venous radiography. The incidence rate of post-thrombotic syndrome （PTS） was evaluated with the Villalta score while the quality of life with CIVIQ-2 questionnaire. And the post-discharge anticoagulation time and use of compression stockings were analyzed in each group. Results （ 1 ） The venous patency rate was 69. 1% , 70. 8 % , 85. 1% in groups A, B and C respectively. The differences was significant between groups A and C （P 〈 0. 05 ）. The differences was insignificant between groups C and B （ P 〉 0. 05 ）. And the venous pateney rate of group C was higher than that of group B. The difference was insignificant between groups A and B （P 〉 0. 05 ）. Such remodeling effects as venous valvular destruction and intravenous wall thickening were observed in PTS patients with venous ultrasonography and anterograde venous radiography. （2） The incidence of PTS was 56. 8%, 54. 2% , 38.3% in groups A, B and C. Compared with groups A and B, the difference was significant in group C （ P 〈 0. 05 ）. The difference was insignificant between groups A and B （ P 〉 0. 05 ）. （ 3 ） CIVIQ-2 score was 20. 2 ±14.4, 20. 1 ± 12. 5,16. 6 ± 11.0 in groups A, B and C. Compared with groups A and B, the difference was insignificant in group C （P 〉 0. 05 ）. And it was lower in group C than groups A and B. （4） The differ

关 键 词：深静脉血栓形成 抗凝 溶栓 深静脉血栓形成后综合征 

分 类 号：R654.4[医药卫生—外科学]