低分子肝素联合普通肝素在下肢深静脉血栓形成导管直接溶栓中的应用  

Application of low molecular weight heparin combined with unfractionated heparin in direct thrombolysis of lower extremity deep vein thrombosis

作　　者：王颖 王孝高[2] 官泽宇[2] Ayoade Philip Adegoke 高涌[2] 余朝文[2] 陈世远[2] 卢冉[2] WANG Ying;WANG Xiaogao;GUAN Zeyu;Ayoade Philip Adegoke;GAO Yong;YU Chaowen;CHEN Shiyuan;LU Ran(Department of Biochemistry and Molecular Biology,Laboratory Medical School of Bengbu Medical College,Bengbu,Anhui 233000,China;不详)

机构地区：[1]蚌埠医学院检验医学院生化与分子生物学教研室,安徽蚌埠233000 [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》2023年第4期568-571,共4页Chinese Journal of General Practice

基　　金：安徽省教育厅重点项目(KJ2019A0327);安徽省科技攻关项目(201904a07020020);安徽省卫生健康委科研重点项目(AHWJ2021a016);蚌埠医学院教学研究重点项目(2020fyjyxm14);蚌埠医学院自然科学重点项目(2020byzd67);蚌埠市科技创新指导类项目(20200343)。

摘　　要：目的 探索不同抗凝方案在下肢深静脉血栓形成(deep venous thrombosis, DVT)导管直接溶栓治疗(catheter-directed thrombectomy, CDT)过程中的溶栓疗效。方法 将2021年3月—2022年2月蚌埠医学院医院第一附属医院血管外科收治的35例下肢DVT患者,采用随机数字表法分为低分子肝素(low molecular weight heparin, LMWH)+小剂量普通肝素(unfractionated heparin, UFH)脉冲应用组(观察组,18例)及单独低分子肝素组(对照组,17例),通过动态监测血浆D-二聚体来评估血栓溶解情况,治疗完成后通过测量手术前后下肢周径的差值及下肢静脉通畅评分分析疗效。结果 观察组与对照组的血浆D-二聚体在溶栓过程中(第3天)升高情况为(78.26±11.57)mg/L、(66.06±12.31) mg/L(t=3.020,P=0.005);溶栓后患肢膝下15 cm周径差值为(1.43±0.34)cm、(2.48±0.63)cm(t=6.185,P<0.001);患肢下肢静脉通畅评分为(5.34±0.90)分、(7.29±1.19)分(t=5.235,P<0.001);尿激酶用量为(302.22±20.45)万U、(381.17±27.59)万U(t=9.656,P<0.001),上述数据对比差异均有统计学意义。结论 低分子肝素+小剂量普通肝素脉冲在DVT的CDT中疗效是确切的、安全的,可在下肢DVT临床治疗中推广应用。Objective To explore the clinical efficacy of different anticoagulation regimens during catheter-directed thrombectomy(CDT)in deep venous thrombosis(DVT)of the lower extremities.Methods A total of 35 DVT patients admitted to the Department of Vascular Surgery of the First Affiliated Hospital of Bengbu Medical College Hospital from March 2021 to February 2022 were selected.They were randomly divided into a low molecular weight heparin+small dose unfractionated heparin pulse group(observation group,18 cases)and a low molecular weight heparin application group merely(control group,17 cases)by a random number table method.Thrombolysis effect was assessed by dynamic examination of plasma D-dimer.After treatment completed,the curative effect was analyzed by measuring the difference in the circumference of the lower limbs before and after the operation and the venous patency score.Results The plasma D-dimer in the observation group and control group increased during the thrombolysis process(day 3)were(78.26±11.57)and(66.06±12.31)mg/L(t=3.020,P=0.005).The circumference of 15 cm below the knee joint were(1.43±0.34)and(2.48±0.63)cm(t=6.185,P<0.001);the lower extremity venous patency score was 5.34±0.90 and 7.29±1.19(t=5.235,P<0.001);the dosage of urokinase were(302.22±20.45)×104 and(381.17±27.59)×104 units(t=9.656,P<0.001).The comparison of the above two groups of data was statistically significant.Conclusion The efficacy of low molecular weight heparin combined with small dose unfractionated heparin pulse anticoagulation of CDT in DVT is excellent and safe.It should be popularized and applied in clinical treatment of lower extremity DVT.

关 键 词：深静脉血栓形成 溶栓 肝素抗凝 导管直接溶栓 

分 类 号：R543.6[医药卫生—心血管疾病]