不同给药方法在下肢深静脉血栓导管溶栓过程中的对比研究  

Comparative study of different drug delivery methods in the catheter-directed thrombectomy for deep venous thrombosis in lower extremities

作　　者：陈海瑞 张剑平 王孝高[2] 王颖 余朝文[2] 卢冉[2] 陈世远[2] 孙勇[2] 官泽宇[2] CHEN Hai-rui;ZHANG Jian-ping;WANG Xiao-gao;WANG Ying;YU Chao-wen;LU Ran;CHEN Shi-yuan;SUN Yong;GUAN Ze-yu(Department of Vascular Surgery of Taihe County People's Hospital,Fuyang,Anhui 236000,China)

机构地区：[1]太和县人民医院血管外科,安徽阜阳236000 [2]蚌埠医学院第一附属医院血管外科,安徽蚌埠233004

出　　处：《中华全科医学》2021年第5期782-785,共4页Chinese Journal of General Practice

基　　金：安徽省教育厅重点项目(KJ2019A0327);蚌埠市科技创新指导类项目(20200343);蚌埠医学院自然科学基金重点项目(BYKY1862ZD);蚌埠医学院科技发展基金项目(BYKF1886);蚌埠医学院教学研究重点项目(2020fyjyxm14)。

摘　　要：目的探索不同给药方法在下肢深静脉血栓(deep venous thrombosis, DVT)导管直接溶栓(Catheter-directed thrombectomy, CDT)过程中疗效的差别。方法选择2017年1月-2020年1月太和县人民医院血管外科收治的46例DVT患者,按CDT治疗过程中的尿激酶给药方法分为24 h持续给药组(23例)及间断给药组(23例),监测血浆D-二聚体含量、纤维蛋白原数值,统计尿激酶总用量,通过下肢肿胀消退程度及深静脉造影来观察疗效。结果持续给药组较间断给药组患者血浆D-二聚体数值升高更明显,溶栓后第2天较入院时前后差值分别为(81.87±12.32)mg/L、(63.53±15.75)mg/L,差异有统计学意义(P<0.001);持续给药组总尿激酶用量更少,为(328±65)万单位,与间断给药组的(445±31)万单位比较差异有统计学意义(P<0.001);持续给药组下肢肿胀消退更佳,溶栓治疗前后患者的小腿周径前后差值为(1.27±0.54)cm,与间断给药组的(2.13±0.78)cm比较差异有统计学意义(P<0.001);造影图片证实持续给药组血管腔内血栓溶解更多,静脉通畅评分为(4.74±1.55)分,与间断给药组的(6.68±1.32)分比较差异有统计学意义(P<0.001)。结论以CDT方法治疗DVT过程中尿激酶持续给药较间断给药患者的D-二聚体数值升高幅度更明显、尿激酶用量更少、患者小腿肿胀消退更佳,有更好的临床疗效。Objective To explore the therapeutic effects of different drug delivery methods for catheter-directed throm-bectomy(CDT)of deep venous thrombosis(DVT).Methods Forty-six patients with DVT admitted to the Department of Ventilators of Taihe County People's Hospital from January 2017 to January 2020 were selected and divided into 24-hour continuous administration group(23 cases)and intermittent administration group(23 cases)according to the method of urokinase administration during CDT treatment.Plasma D-dimer content and fibrinogen value were monitored,and the to-tal dosage of urokinase was counted.The efficacy was observed through the degree of lower limb swelling regression and deep venous angiography.Results The increase of plasma D-dimer value was more obvious in the continuous adminis-tration group than in the intermittent administration group,and the difference on the second day after thrombolysis were(81.87±12.32)mg/L and(63.53±15.75)mg/L,respectively,with statistically significant difference(P<0.001).The amount of total urokinase in the continuous administration group was lower[(328±65)million units]than that in the intermittent administration group[(445±21)million units],with statistical significance(P<0.001).The lower extremity swelling subsided better in the continuous administration group,and the difference of calf circumference before and after thrombolytic therapy were(1.27±0.54)cm and(2.13±0.78)cm in the intermittent administration group(P<0.001),respectively.Angiography images confirmed that thrombolysis in the vascular lumen was more in the con-tinuous administration group.The venous patency score(4.74±1.55)was statistically significant compared with that of the intermittent administration group(6.68±1.32,P<0.001).Conclusion Compared with intermittent administra-tion of D-dimer,CDT method in the treatment of DVT with continuous administration of urokinase has more value.The amount of urokinase is less,patients have better lower leg swelling subsidence and the clinical effect is better.

关 键 词：下肢深静脉血栓 导管直接溶栓 血浆D-二聚体 下肢深静脉造影 

分 类 号：R543.6[医药卫生—心血管疾病]