下肢深静脉血栓介入治疗局部肝素化并疗效评估  

Locoregional Heparinization for Patients with Deep Venous Thrombosis:Safety and Efficacy Evaluation

作　　者：李海洋[1] 马聪[1] 肖恩华[1] 肖煜东[1] 林跃丽[1] LI Haiyang;MA Cong;XIAO Enhua(Radiology Intervention Department, the Second Xiangya Hospital of Central South University, Changsha, Hunan Province 410011, P. R. China)

机构地区：[1]中南大学湘雅二医院放射介入科

出　　处：《临床放射学杂志》2018年第4期689-692,共4页Journal of Clinical Radiology

摘　　要：目的探讨下肢深静脉血栓介入治疗局部肝素化的有效性。方法对26例单侧下肢深静脉血栓患者采取经腘静脉介入导管溶栓治疗,从腘静脉处置入溶栓导管及血管鞘,分别持续微量泵入尿激酶及肝素,每4-6 h分别从溶栓导管及手臂静脉抽血监测患者凝血功能,主要监测活化部分凝血活酶时间（APTT值）及纤维蛋白原（FIB）,根据结果调整药物剂量。结果患者全身APTT值大都维持在30-50 s之间,局部APTT值在前24 h大于180 s,24-48 h在50-70 s之间,48 h后随着血栓溶栓的进程,全身APTT值与局部血栓段APTT值逐渐趋于一致。且患者不同时间段APTT值局部与全身比较差异有统计学意义。1个月后随访,26例患者疼痛及肿胀均明显好转,重复静脉造影显示22例血管完全再通,部分再通4例。结论监测局部肝素化既可有效治疗静脉血栓,又可减少抗凝并发症的发生,该方法值得推广。Objective To investigate the efficacy of interventional treatment of local heparin in deep vein thrombosis of lower extremities. Methods Twenty-six patients with unilateral lower extremity deep venous thrombosis were treated with transcatheter venous catheter thrombolysis. From the iliac veins,thrombolysis catheters and vascular sheaths were placed and urokinase and heparin were pumped continuously,every 4-6 h. Thrombolysis catheter and arm vein blood sampling to monitor the coagulation function of patients,mainly monitoring the activated partial thromboplastin time（ APTT value） and fibrinogen（ FIB）,according to the results of adjusting the drug dose. Results The APTT values of the patients were mostly maintained between 30 and 50 s. The local APTT values were greater than 180 s in the first 24 h and between 50 and 70 s in 24 to 48 h. The thrombolysis progressed after 48 h. The APTT value of the whole body gradually converged with the APTT value of the local thrombus segment. There were significant differences in APTT values between the local and whole body at different time intervals. After one month follow-up,pain and swelling were significantly improved in 26 patients. Repeated venography showed complete revascularization in 22 patients and partial recanalization in 4 patients.Conclusion The monitoring of local heparinization can effectively treat venous thrombosis and reduce the occurrence of anticoagulant complications. This method is worthy of promotion.

关 键 词：下肢深静脉血栓 介入性溶栓 局部肝素化 

分 类 号：R445.1[医药卫生—影像医学与核医学] R543.6[医药卫生—诊断学]