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临床疗效  

Clinical efficacy of mechanical thrombus aspiration combined with catheter-contact thrombolysis in the treatment of acute mixed lower extremity deep vein thrombosis

作　　者：王倩竹 张磊[1] 宋福晨 朱美冬 葛玮婧 Wang Qianzhu;Zhang Lei;Song Fuchen;Zhu Meidong;Ge Weijing(Department of Vascular Surgery,Yueyang Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai University of Traditional Chinese Medicine,Shanghai 200443,China)

机构地区：[1]上海中医药大学附属岳阳中西医结合医院血管外科,上海200443

出　　处：《血管与腔内血管外科杂志》2023年第6期716-720,725,共6页Journal of Vascular and Endovascular Surgery

基　　金：国家科技部“中医药现代化研究”重点专项(2019YFC1711604);上海申康医院发展中心临床科技创新项目(SHDC12019X33)。

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(LEDVT)的临床疗效。方法选取2019年8月至2022年1月上海中医药大学附属岳阳中西医结合医院收治的82例急性混合型LEDVT患者作为研究对象,根据随机数字表法按1:1比例将分为对照组(n=41,采用CDT治疗)和观察组(n=41,采用机械性血栓抽吸联合CDT治疗)。比较两组患者的临床疗效,围手术期指标,手术前后的大腿、小腿周径差、腘静脉血流速度、股静脉血流速度、蛋白C(PC)水平、蛋白S(PS)、D-二聚体(D-D)水平,并发症发生率及术后6个月血栓后综合征(PTS)发生率。结果观察组患者总有效率为92.68%(38/41),高于对照组患者的75.61%(31/41),差异有统计学意义(P﹤0.05)。观察组患者尿激酶使用量明显少于对照组患者,静脉通畅率明显高于对照组患者,症状消退时间、溶栓时间、住院时间均明显短于对照组患者,差异均有统计学意义(P﹤0.01)。术后7 d,观察组患者大腿、小腿周径差均低于对照组患者,腘静脉、股静脉血流速度均高于对照组患者,PC、PS水平均高于对照组患者,D-D水平低于对照组患者,差异均有统计学意义(P﹤0.05)。两组患者并发症总发生率、术后6个月PTS发生率比较,差异均无统计学意义(P﹥0.05)。结论机械性血栓抽吸联合CDT治疗急性混合型LEDVT患者效果显著,可有效减少尿激酶用量,缩短溶栓时间及住院时间,促使症状尽快恢复,提高下肢深静脉血流速度,改善凝血功能,安全性较高,值得临床上推广应用。Objective To explore the clinical efficacy of mechanical thrombus aspiration combined with catheter-contact thrombolysis(CDT)in the treatment of acute mixed lower extremity deep vein thrombosis(LEDVT).Method A total of 82 patients with acute mixed LEDVT who were treated in Yueyang Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai University of Traditional Chinese Medicine from August 2019 to January 2022 were selected and divided into the control group(n=41,received CDT)and the observation group(n=41,received mechanical thrombus aspiration+CDT)according to the random number table based on the ratio of 1:1.The clinical efficacy,perioperative indicators,circumference difference of thigh and calf before and after surgery,popliteal vein and femoral vein blood flow velocity,protein C(PC),protein S(PS),D-dimer(D-D)levels,complications and incidence of post-thrombotic syndrome(PTS)6 months after surgery of two groups were compared.Result The total effective rate in the observation group was 92.68%(38/41),higher than that in the control group of 75.61%(31/41),the difference was statistically significant(P<0.05).The dosage of urokinase in the observation group was lower than that in the control group,the venous patency rate higher than that in the control group,symptom resolved time,thrombolytic time and hospitalization time were shorter than those in control group,the differences were statistically significant(P<0.05).7 days after surgery,the circumference difference of thigh and calf of the observation group were lower than those of the control group,the blood flow velocity of the popliteal vein and femoral vein were higher than those of the control group,the levels of PC and PS in the observation group were higher than those in the control group,D-D level was lower than those in the control group,the differences were statistically significant(P<0.05).There were no significant differences in the incidence of complications and 6-month PTS between the two groups(P>0.05).Conclusion Mechanical thrombu

关 键 词：急性混合型下肢深静脉血栓 机械性血栓抽吸 导管接触性溶栓 血流速度 凝血功能 

分 类 号：R543[医药卫生—心血管疾病]