单纯导管溶栓与导管溶栓联合猪尾管碎栓治疗非慢性期下肢深静脉血栓形成的疗效比较  

Comparative analysis of clinical efficacy of catheter thrombolysis alone and catheter thrombolysis combined with pigtail catheter crushing thrombus in the treatment of non-chronic deep venous thrombosis

作　　者：王祥魁 倪良宏 陈乐天 郑智涛 卢冉[2] 高涌[2] Wang Xiangkui;Ni Lianghong;Chen Letian;Zheng Zhitao;Lu Ran;Gao Yong(Department of Vascular Surgery,Huaibei Miners General Hospital,Huaibei 235000,China;Department of Vascular Surgery,the First Affiliated Hospital of Bengbu Medical College,Bengbu 233004,China)

机构地区：[1]淮北市矿工总医院血管外科,淮北235000 [2]蚌埠医学院第一附属医院血管外科,蚌埠233004

出　　处：《中华解剖与临床杂志》2022年第11期786-791,共6页Chinese Journal of Anatomy and Clinics

基　　金：安徽省教育厅重点项目(KJ2019A0327)。

摘　　要：目的比较导管接触性溶栓(CDT)与CDT联合猪尾管碎栓治疗非慢性期下肢深静脉血栓形成(DVT)的安全性及早期临床疗效。方法回顾性队列研究。纳入2020年1月—2021年12月安徽省淮北矿工总医院血管外科接受腔内手术治疗的非慢性期下肢DVT患者55例,其中男28例,女27例,年龄33~83(65.8±12.4)岁;左下肢34例,右下肢21例;病程1~26(9.7±5.5)d;急性期36例,亚急性期19例。按治疗方案不同分为2组:联合组27例采取CDT联合猪尾管碎栓方案进行治疗,对照组28例仅采取CDT方案进行治疗。观察指标:比较2组患者近期(术后1周)临床疗效、尿激酶用量、溶栓时间、住院时间及出血并发症;术后随访12个月,采用Villalta评分表评估2组患者血栓后综合征(PTS)的严重程度。结果2组患者基线资料比较差异均无统计学意义(P值均>0.05)。所有患者的技术成功率为100%。联合组近期临床有效率为92.59%(25/27),优于对照组的67.86%(19/28);联合组疗效Ⅰ级2例、Ⅱ级9例、Ⅲ级16例,对照组分别为9例、10例、9例,组间比较差异有统计学意义(Z=-2.42,P=0.016)。尿激酶用量、溶栓时间、住院时间在联合组分别为(188.2±41.5)万U、(3.7±0.7)d和(7.9±1.2)d,分别低于对照组的(262.1±34.0)万U、(6.6±0.6)d和(14.0±2.0)d,差异均有统计学意义(t=7.23、17.10、13.85,P值均<0.001)。术后发生出血并发症联合组2例、对照组4例,差异无统计学意义(χ^(2)=0.15,P=0.699)。术后12个月,联合组发生PTS 7例,其中轻度2例、中度3例、重度2例,对照组发生PTS10例,其中轻度3例、中度3例、重度4例,2组比较差异无统计学意义(Z=-0.81,P=0.416)。结论对于非慢性期DVT患者,单纯CDT和CDT联合猪尾管碎栓治疗都是安全有效的。联合组方案早期临床有效率更高,同时还能够缩短治疗时间、减少溶栓药物的用量,节约治疗成本,适合在基层医院推广。Objective This study aimed to compare the safety and early clinical efficacy of catheter directed thrombolysis(CDT)and CDT combined with pigtail catheter crushing thrombus in the treatment of non-chronic deep venous thrombosis(DVT).Methods A retrospective cohort study was conducted.From January 2020 to December 2021,55 patients(28 males and 27 females)with non-chronic deep vein thrombosis who underwent endovascular surgery in the Department of Vascular Surgery of Huaibei Miners General Hospital were included,aged 33-83(65.8±12.4)years.Among them,34 cases were left lower limb and 21 were right lower limb.The course of disease lasted 1-26(9.7±5.5)days,including 36 patients in the acute phase and 19 patients in the subacute phase.The patients were divided into two groups in accordance with different treatment schemes.The combined group(27 patients)was treated with CDT combined with pigtail catheter crushing thrombus,and the control group(28 patients)was treated with CDT only.The observation indices,namely,recent clinical efficacy,dosage of urokinase,thrombolytic time,length of hospital stay,and bleeding complications,of the two groups were compared.At 12 months of follow-up,Villalta scale was used to evaluate the severity of post-thrombotic syndrome(PTS)in both groups.Results No significant difference was found in the baseline data between the two groups(all P values>0.05).The technical success rate for all patients was 100%.The recent clinical effective rate was 92.59%(25/27)in the combination group,and the efficacy was gradeⅠ,Ⅱ,Ⅲin 2,9,16 patients,respectively,better than the 67.86%(19/28)in the control group,and the efficacy was gradeⅠ,Ⅱ,Ⅲin 9,10,9 patients,respectively,and the difference was statistically significant(Z=-2.42,P=0.016).The dosage of urokinase,the thrombolytic time,and the length of hospital stay in the combination group were(1882±415)×103 U,(3.7±0.7)days,and(7.9±1.2)days,respectively,lower than the(2621±340)×103 U,(6.6±0.6)days,and(14.0±2.0)days in the control group,respectiv

关 键 词：静脉血栓形成 机械碎栓 导管接触性溶栓 疗效 

分 类 号：R543.6[医药卫生—心血管疾病]