机械性血栓抽吸联合导管接触性溶栓治疗急性混合型下肢深静脉血栓的疗效与安全性  

Efficacy and safety of mechanical thrombus aspiration combined catheter-directed thrombolysis in acute mixed lower extremity deep vein thrombosis

作　　者：杨铮[1] 张宏光[1] 张亮[1] 赵磊[1] 牛海光 郭欣 范忠臣[1] 索青霞 Yang Zheng;Zhang Hongguang;Zhang Liang;Zhao Lei;Niu Haiguang;Guo Xin;Fan Zhongchen;Suo Qingxia(Department of Vascular Surgery,the No.2 Hospital of Baoding,Baoding 071051,Hebei,China;Department of Gynaecology,Baoding Maternal and Child Health Hospital,Baoding 071051,Hebei,China)

机构地区：[1]保定市第二医院血管外科,河北保定071051 [2]保定市妇幼保健院妇科,河北保定071051

出　　处：《血管与腔内血管外科杂志》2022年第10期1186-1191,共6页Journal of Vascular and Endovascular Surgery

基　　金：保定市科技计划项目(1951ZF009)。

摘　　要：目的探讨机械性血栓抽吸联合导管接触性溶栓(CDT)治疗急性混合型下肢深静脉血栓(DVT)的疗效及安全性。方法收集2020年3月至2022年5月于保定市第二医院接受治疗的117例急性混合型下肢DVT患者的临床资料,并根据治疗方案的不同将患者分为联合组(n=63,接受机械性血栓抽吸联合CDT治疗)和对照组(n=54,仅接受CDT治疗)。比较两组患者的血栓清除率、静脉通畅评分、静脉通畅率、尿激酶总量、溶栓持续时间、住院时间、D-二聚体水平;比较两组患者的血红蛋白水平、肌酐水平、谷丙转氨酶水平、凝血酶原时间,以及是否发生死亡、肺栓塞、大出血、血管夹层或穿孔、感染等并发症。结果治疗后,两组患者均达到Ⅱ级以上的血栓清除率,且两组患者的血栓清除率分级情况比较,差异无统计学意义(P>0.05);治疗后,两组患者的静脉通畅评分、D-二聚体水平均较本组治疗前降低,且联合组患者的静脉通畅评分、D-二聚体水平、静脉通畅率均低于对照组患者,尿激酶总量少于对照组患者,溶栓持续时间、住院时间均短于对照组患者,差异均有统计学意义(P<0.05)。治疗后住院期间,联合组5例患者发生出血现象,其中,穿刺点渗血3例,血尿2例;对照组6例患者发生出血现象,其中,穿刺点渗血和血尿各3例;两组患者的出血情况比较,差异无统计学意义(P>0.05)。出院前末次复查结果显示,两组患者的血红蛋白水平、肌酐水平、谷丙转氨酶水平、凝血酶原时间比较,差异均无统计学意义(P>0.05)。两组患者均未发生死亡、肺栓塞、大出血、血管夹层或穿孔、感染等。结论机械性血栓抽吸联合CDT治疗急性混合型下肢DVT安全、有效,值得临床推广。Objective To explore the efficacy and safety of mechanical thrombus aspiration combined catheterdirected thrombolysis(CDT)in the treatment of acute mixed lower extremity deep vein thrombosis(DVT).Method Clinical data of 117 patients with acute mixed lower extremity DVT who were treated in the No.2 Hospital of Baoding from March 2020 to May 2022 were collected and the patients were divided into combination group(n=63,received mechanical thrombus aspiration+CDT)and control group(n=54,received CDT).The thrombus clearance rate,scores of venous potency,venous potency rate,urokinase,duration of thrombolysis,length of hospital stay,D-dimer level,hemoglobin level,creatinine level,alanine aminotransferase level,prothrombin time,complications of death,pulmonary embolism,major hemorrhage,vascular dissection or perforation,and infection were compared between the two groups.Result After treatment,patients in both groups achieved grade II or higher thrombus clearance and there was no significant difference for the classification of thrombus clearance rate between the two groups(P>0.05);the score of venous potency and D-dimer level decreased after treatment,and the score of venous potency,D-dimer level,venous potency rate,urokinase,duration of thrombolysis,length of hospital stay in the combination group were lower than those in the control group,and the differences were statistically significant(P<0.05).During hospitalization after treatment,there were 5 cases of hemorrhage,in which there were 3 cases of staxis in puncture point and 2 cases of hematuria;there were 6 cases of hemorrhage,with 3 cases each of staxis in puncture point and hematuria in control group,without significant difference between the two groups(P>0.05).There was no significant difference in the levels of hemoglobin,creatinine,alanine aminotransferase and prothrombin time between the two groups at the last visit before discharge(P>0.05).No death,pulmonary embolism,massive hemorrhage,vascular dissection or perforation,or infection occurred in either group of

关 键 词：机械性血栓抽吸 导管接触性溶栓 下肢深静脉血栓 有效性 安全性 

分 类 号：R543[医药卫生—心血管疾病]