导管接触性溶栓联合机械碎栓治疗下肢深静脉血栓形成的效果及对凝血、纤维蛋白溶解指标的影响  

The effect of catheter-directed thrombolysis combined with mechanical thrombolysis in deep venous thrombosis of lower extremity and its effect on coagulation and fibrinolysis indexes

作　　者：马蓓洁 张静波[2] 蔡会欣[1] 戴冬雪[1] 刘丙木 胡晓娇 张丽楠 Ma Beijie;Zhang Jingbo;Cai Huixin;Dai Dongxue;Liu Bingmu;Hu Xiaojiao;Zhang Li'nan(Department of Medical Laboratory,Baoding First Central Hospital,Baoding 071000,Hebei,China;Department of Vascular Surgery,Baoding First Central Hospital,Baoding 071000,Hebei,China;Department of Intervention,Baoding First Central Hospital,Baoding 071000,Hebei,China)

机构地区：[1]保定市第一中心医院医学检验科,河北保定071000 [2]保定市第一中心医院血管外科,河北保定071000 [3]保定市第一中心医院介入科,河北保定071000

出　　处：《血管与腔内血管外科杂志》2021年第1期76-80,99,共6页Journal of Vascular and Endovascular Surgery

摘　　要：目的探讨导管接触性溶栓(CDT)联合机械碎栓方案治疗下肢深静脉血栓形成(DVT)的效果及对凝血、纤维蛋白溶解指标的影响。方法收集2018年1月至2020年6月保定市第一中心医院收治的120例下肢DVT患者临床资料,根据治疗方案的不同分为联合组(n=68)和对照组(n=52)。联合组患者采取CDT联合机械碎栓方案进行治疗,对照组仅采取CDT方案进行治疗,比较两组患者治疗前后的血栓弹力图参数血浆D-二聚体(D-D)、纤维蛋白原(Fib)、纤维蛋白降解产物(FDP)、溶栓再通效果。结果治疗3 d后,联合组患者的血管再通效果优于对照组(P<0.05);治疗7 d后,联合组的血管再通效果优于对照组,差异有统计学意义(P<0.05)。联合组患者因溶栓导致的相关并发症的总发生率为4.41%(3/68),低于对照组患者的19.23%(10/52)(P<0.05)。治疗7 d后,两组患者的R、K值均高于本组治疗3 d时,MA值、α角均低于本组治疗3 d时(P<0.05)。结论与单用CDT相比,CDT联合机械碎栓方案治疗下肢DVT的效果更优,且对患者凝血功能的影响更小,安全性更高。Objective To explore the effect of catheter-directed thrombolysis(CDT)combined with mechanical thrombolysis in deep venous thrombosis(DVT)of lower extremities and its effect on coagulation and fibrinolysis indexes.Method A total of 120 patients with lower extremities DVT admitted to Baoding First Central Hospital from January 2018 to June 2020 were divided into the combination group(n=68,treated with CDT combined with mechanical thrombolysis)and control group(n=52,treated with CDT).The thromboelastogram parameters,plasma D-dimer(D-D),fibrinogen(Fib),fibrin degradation products(FDP),thrombolytic recanalization of the two groups were compared before and after treatment.Result After treatment for 3 days and 7 days,the maximum amplitude(MA)andαangles of the combined group were higher than those of the control group,and the clotting time(K)was shorter than that of the control group.The difference was statistically significant(P<0.05);Fib and FDP were lower than before treatment,and after 7 days of treatment,the D-D,Fib and FDP of the two groups were lower than those of this group after 3 days of treatment,the difference was statistically significant(P<0.05).After 3 and 7 days of treatment,the recanalization of patients in the combined group was better than that in the control group,and the differences were of statistical significance(P<0.05).The total incidence rate of complications caused by thrombolysis in the combination group was 4.41%(3/68),which was lower than 19.23%(10/52)in the control group(P<0.05).Conclusion Compared with CDT alone,the CDT combined with mechanical thrombolysis is more effective in the treatment of lower extremity DVT,with smaller impact on coagulation function and higher safety.

关 键 词：导管接触性溶栓 机械碎栓 深静脉血栓形成 凝血 纤维蛋白原 

分 类 号：R543[医药卫生—心血管疾病]