3种经足背浅静脉顺流溶栓方法在下肢DVT治疗中的应用效果比较  

Comparison of application effects of three downstream thrombolysis through superficial dorsal pedal veins in the treatment of deep venous thrombosis of lower extremity

作　　者：李燕[1] 葛静萍[1] 尹媛媛 顾建平[1] Li Yan;Ge Jingping;Yin Yuanyuan;Gu Jianping(Interventional Vascular Department,Nanjing First Hospital,Nanjing Medical University,Nanjing 210006,China)

机构地区：[1]南京医科大学附属南京医院介入血管科,210006

出　　处：《中华现代护理杂志》2020年第26期3629-3633,共5页Chinese Journal of Modern Nursing

基　　金：国家自然科学基金(81871463);南京市科技发展计划项目(201803006)。

摘　　要：目的比较3种经足背静脉顺流溶栓方法在治疗下肢DVT中的应用效果及舒适度。方法回顾性分析2014年1月-2018年10月南京医科大学附属南京医院120例下肢DVT患者资料,分为无干预组(对照组)、硅胶止血带组(试验组Ⅰ)和肢体压力带组(试验组Ⅱ)各40例。3组每日溶栓药物相同。对照组未实施其他干预;试验组Ⅰ在患肢内踝骨性标志上方15 cm处结扎止血带,经下肢静脉造影确定浅静脉血流完全阻止,深静脉内血流充分显影;试验组Ⅱ在患肢内踝骨性标志上方15 cm处使用肢体压力带,经数字减影血管造影(DSA)确定浅静脉完全阻止、深静脉充分显影时的最佳气囊充气压力值。2个试验组在同一部位结扎(止血带)或充气(肢体压力带)时间为15 min,放松时间为15 min,不间断轮换交替进行。比较3组患者的患肢消肿率、血栓清除率及患肢舒适度。结果试验组Ⅱ患者的患肢消肿率为(83.40±8.91)%、血管通畅率为(86.25±20.61)%,均优于对照组和试验组Ⅰ患者,差异有统计学意义(F值分别为3.767、4.675;P<0.05);治疗后10 d试验组Ⅱ患者的血栓清除率为(96.50±2.78)%,对照组为(83.38±3.77)%,试验组Ⅰ为(87.13±2.71)%,3组比较差异有统计学意义(F=13.019,P<0.01)。试验组Ⅱ患者的患肢舒适度为87.5%(35/40),试验组Ⅰ为20.0%(8/40),差异有统计学意义(χ^2=36.656,P<0.01)。结论经足背顺流溶栓治疗下肢DVT中,使用定时、定压的肢体压力带阻止浅静脉血流可获得更好的溶栓疗效,且患者舒适度更高。Objective To compare the application effects and comfort of three downstream thrombolysis through superficial dorsal pedal veins in the treatment of deep venous thrombosis(DVT)of lower extremity.Methods From January 2014 to October 2018,data of 120 patients with DVT who treated in Nanjing First Hospital of Nanjing Medical University were retrospectively analyzed.They were divided into the non-intervention group(the control group),silicone tourniquet group(the experimental group I)and limb pressure band group(the experimental groupⅡ),with 40 cases in every group.The daily thrombolytic drugs were the same in the three groups.No other intervention was carried out in the control group.In the experimental groupⅠ,a tourniquet was ligated 15 cm above the osseous mark of the medial malleolus of the affected limbs,the superficial vein blood flow was completely blocked by the lower limb venography,and the blood flow in the deep vein was fully developed.In the experimental groupⅡ,limb pressure bands were used 15 cm above the osseous mark of the medial malleolus of the affected limb,DSA angiography was used to determine the optimal airbag inflation pressure value when the superficial vein was completely blocked,and the deep vein was fully developed.For the two experimental groups,ligation(tourniquet)or inflation(limb pressure band)at the same site was performed for 15 min,and relaxation time was 15 min,alternately without interruption.The detumescence rate of affected limb,clearance rate of thrombosis and comfort of affected limb were compared among the 3 groups.Results In experimental groupⅡ,the detumescence rate of affected limb was(83.40±8.91)%and the venous patency was(86.25±20.61)%,which were better than those of the control group and the experimental group I,and the differences were statistically significant(F=3.767,4.675;P<0.05).10 days after treatment,the clearance rate of thrombosis of the experimental groupⅡ,the control group and the experimental group I were respectively(96.50±2.78)%,(83.38±3.77)%and

关 键 词：深静脉血栓形成 下肢 足背顺流溶栓 肢体压力带 硅胶止血带 浅静脉血流阻止 舒适度 

分 类 号：R473.6[医药卫生—护理学]