不同入路置管溶栓与单纯抗凝治疗急性下肢深静脉血栓形成的对比研究  

Comparison of efficacy of catheter-directed thrombolysis by different approaches and anticoagulation in treating acute lower extremity deep vein thrombosis

作　　者：赵晶[1] Zhao Jing(Department of Peripheral Vascular,Shenyang Second Chinese Medicine Hospical,Liaoning 110101,China)

机构地区：[1]沈阳市第二中医医院暨辽宁省血栓病中西医结合医疗中心周围血管科,沈阳110101

出　　处：《中华血管外科杂志》2021年第4期272-276,共5页Chinese Journal of Vascular Surgery

摘　　要：目的比较不同入路置管溶栓与单纯抗凝药物治疗急性期下肢深静脉血栓形成(DVT)的疗效。方法回顾性分析沈阳市第二中医医院周围血管科2018年6月至2019年6月期间收治的60例急性期下肢DVT患者,根据不同治疗方法分为置管溶栓组(CDT组,30例)和抗凝药物组(药物组,30例)。CDT组按照置管方式分为顺行CDT组(15例)和逆行CDT组(15例)。比较分析各组消肿率、住院时间、溶栓时间、静脉通畅改善度、6个月的髂股静脉通畅率、12个月血栓形成后综合征发生率。组间比较采用t检验和χ^(2)检验。结果与药物组相比,CDT组的住院时间较短[(14.20±1.00)d比(10.30±2.47)d,t=7.91,P<0.01],静脉通畅改善度[(47.80±9.38)%比(77.83±10.11)%,t=11.92,P<0.01]和6个月髂股静脉通畅率(33.30%比76.70%,χ^(2)=11.38,P<0.01)较高,12个月PTS发生率较低(60.00%比30.00%,χ^(2)=5.45,P=0.02),差异均有统计学意义;消肿率差异无统计学意义[(85.14±6.27)%比(87.49±4.75)%,t=1.63,P=0.10]。顺行CDT组与逆行CDT组溶栓时间[(3.53±1.31)d比(4.60±1.40)d,t=2.13,P=0.04]、静脉通畅改善度[(84.54±7.03)%比(71.11±8.21)%,t=4.84,P<0.01]、6个月髂股通畅率(93.30%比60.00%,χ^(2)=4.65,P=0.03)、12个月PTS发生率(13.30%比46.70%,χ^(2)=3.96,P=0.04)比较,差异均有统计学意义;消肿率差异无统计学意义[(88.21±5.19)%比(86.77±4.32)%,t=0.83,P=0.41]。结论置管溶栓较抗凝药物治疗急性期下肢DVT更安全、有效。经患侧大隐静脉顺行置管优于经健侧股静脉或经右颈内静脉逆行置管溶栓。Objective To compare the efficacy of catheter-directed thrombolysis(CDT)by different approaches and anticoagulation(AC)in treating acute lower extremity deep vein thrombosis(DVT).Methods A retrospective analysis on 60 patients with acute lower extremity DVT in Shenyang Second Chinese Medicine Hospital of from June 2018 to June 2019 was performed.Patients were divided into CDT group(n=30)and AC group(n=30)according to different therapeutic methods.The patients in CDT group were divided into anterograde CDT group(n=15)and retrograde CDT group(n=15)by different catheterization methods.The differences in detumescence rate,hospitalization time,thrombolysis time,venous patency improvement,patency rate of iliofemoral vein at 6 months and post-thrombotic syndrome(PTS)incidence at 12 months between the two groups were analyzed.Chi-square test and t-test were used for group comparison.Results Compared with AC group,in CDT group,the hospitalization time was shorter[(14.20±1.00)d vs.(10.30±2.47)d,t=7.91,P<0.01],the venous patency improvement and patency rate of iliofemoral vein at 6 months were higher[(47.80±9.38)%vs.(77.83±10.11)%,t=11.92,P<0.01;33.30%vs.76.70%,χ^(2)=11.38,P<0.01,respectively],the PTS incidence at 12 months was lower(60.00%vs.30.00%,χ^(2)=5.45,P=0.02).There was statistical difference between the two groups.The difference of detumescence rate between the two groups was not statistically significant[(85.14±6.27)%vs.(87.49±4.75)%,t=1.63,P=0.10].In anterograde CDT group and retrograde CDT group,the thrombolysis time[(3.53±1.31)d vs.(4.60±1.40)d,t=2.13,P=0.04),venous patency improvement[(84.54±7.03)%vs.(71.11±8.21)%,t=4.84,P<0.01),the patency rate of iliofemoral vein at 6 months(93.30%vs.60.00%,χ^(2)=4.65,P=0.03)and PTS incidence at 12 months(13.30%vs.46.70%,χ^(2)=3.96,P=0.04)were compared.The difference showed statistical significance between the two groups.The difference of detumescence rate between the two groups was not statistically significant[(88.21±5.19)%vs.(86.77±4.32)%,t=0.83,P=0.41].Co

关 键 词：下肢深静脉血栓形成 置管溶栓 大隐静脉 抗凝治疗 

分 类 号：R543.6[医药卫生—心血管疾病]