尿激酶快速泵入在导管溶栓治疗急性下肢深静脉血栓中的临床研究  

Rapid pumping of urokinase in the catheter-directed thrombolysis for the management of acute deep vein thrombosis

作　　者：李文东 刘晨[1] 姜坤[2] 乔彤[1] 冉峰[1] 刘澄[1] 刘昭[1] 李承龙[2] 李晓强 Li Wendong;Liu Chen;Jiang Kun;Qiao Tong;Ran Feng;Liu Cheng;Liu Zhao;Li Chenglong;Li Xiaoqiang(Department of Vascular Surgery,the Affiliated Drum Tower Hospital,Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院血管外科,210008 [2]苏州大学附属第二医院血管外科

出　　处：《中华血管外科杂志》2018年第4期204-207,共4页Chinese Journal of Vascular Surgery

基　　金：国家自然科学基金(81770483、81800418);江苏省自然科学基金青年项目(BK20180125).

摘　　要：目的探讨尿激酶快速泵入在导管溶栓(CDT)治疗急性下肢深静脉血栓形成(DVT)中的作用。方法回顾性分析2016年1月至2018年1月期间符合纳入及排除标准的行CDT治疗急性下肢DVT的患者资料,比较分析尿激酶快速泵入和24h持续泵入两种给药方式的溶栓效果、并发症和血栓形成后综合征(PTS)的发生情况。结果共纳入146例患者,其中快速泵入组52例,持续泵入组94例。快速泵入组及持续泵入组的总溶栓时间比较,差异有统计学意义[(4.90±1.25)d比(5.52±1.60)d,P=0.011];两组纤维蛋白原减少比较,差异有统计学意义[(1.99±1.01)g/L比(2.48±1.25)g/L,P=0.015];D-二聚体达峰速度比较,差异有统计学意义[(7.63±2.60)mg·L^-1·d^-1比(6.61±1.16)mg·L-1·d^-1,P=0.009]。两组在D-二聚体浓度峰值、血小板计数、尿激酶用量、并发症发生率及PTS发生率等方面比较差异无统计学意义(P>0.05)。结论CDT治疗急性下肢DVT时,快速泵入尿激酶是一种安全有效的治疗方式,与持续泵入相比,其在对纤维蛋白原影响、缩短导管溶栓时间、一般并发症的发生方面存在优势,但对PTS的预防无明显差异。ObjectiveTo investigate the role of rapid pumping of urokinase in catheter-directed thrombolysis (CDT) for the management of acute deep vein thrombosis (DVT) .MethodsBetween January 2016 and January 2018, patients who were diagnosed with acute lower extremity DVT and performed with CDT were included in this retrospective study. Those patients were divided into two groups via the different ways of urokinase usage. Data including the effects of thrombolysis, complications and post-thrombotic syndrome (PTS) incidence rate were compared to find out the proper way of urokinase usage for acute DVT.ResultA total of 146 patients were involved in this study. Among them, 52 cases were performed with rapid pumping of urokinase. The duration of thrombolysis in the two groups were (4.90±1.25) days and (5.52±1.60) days, respectively (P=0.001) . Reduction of fibrinogen concentration were (1.99±1.01) g/L and (2.48±1.25) g/L respectively (P=0.015) . The speed of D-dimer promotion were (7.63±2.60) mg·L-1·d^-1 and (6.61±1.16) mg·L^-1·d^-1, respectively (P=0.009) . But it had no effect on concentration of D-dimer, platelet account, dosage of urokinase and complications and PTS incidence.ConclusionThe way of rapid pumping urokinase in CDT is a safe and effective way to remove the acute thrombosis. Compared with continuity thrombolysis, it has less impairment on fibrinogen. It could shorten the duration of thrombolysis but had no effect on complications and PTS.

关 键 词：下肢深静脉血栓形成 尿激酶 导管溶栓 

分 类 号：R54[医药卫生—心血管疾病]