留置pigtail导管溶栓治疗急性下腔静脉滤器内血栓的安全性及疗效观察  

Clinical observation of the safety and effects of indwelling pigtail catheter thrombolysis treatment of acute inferior vena cava filter thrombolysis

作　　者：崔志强 段珍珍 李成业 芦军 王思敏 袁会军[1] 支力强 张甜甜 韩鹏[1] CUI Zhiqiang;DUAN Zhenzhen;LI Chengye;LU Jun;WANG Simin;YUAN Huijun;ZHI Liqiang;ZHANG Tiantian;HAN Peng(Department of Peripheral Vascular,Honghui Hospital,School of Medicine,Xi’an Jiaotong University,Xi’an 710054,China;Department of Knee Surgery,Honghui Hospital,School of Medicine,Xi’an Jiaotong University,Xi’an 710054,China)

机构地区：[1]西安交通大学医学院附属红会医院周围血管科,陕西西安710054 [2]西安交通大学医学院附属红会医院膝关节外科,陕西西安710054

出　　处：《实用放射学杂志》2023年第11期1851-1853,1865,共4页Journal of Practical Radiology

基　　金：陕西省2020年重点研发计划项目(2020SF-090)。

摘　　要：目的评价留置pigtail导管溶栓治疗急性下腔静脉滤器内血栓(IVCFT)的安全性及疗效。方法回顾性分析43例骨折术前行下腔静脉滤器(IVCF)置入术患者的临床资料。所有患者均在骨折手术完毕,可足量抗凝后行滤器取出术,术中造影发现IVCFT,如血栓最大直径>1 cm。留置pigtail导管使用尿激酶溶栓,微量泵泵入60万U/d。溶栓过程中,记录溶栓持续时间、尿激酶用量、滤器是否取除、滤器留置时间、出血并发症等指标。结果43例置管溶栓患者,溶栓时间3~9 d,平均(4.34±1.31)d。尿激酶用量180~540万U,平均用量(258.14±79.14)万U。滤器取出率为97.67%(42/43),其中1例未取出者,因溶栓过程中出现骨折手术伤口血肿且滤器内血栓溶解欠佳。滤器在体内留置时间14~25 d,平均(20.33±2.63)d。4例患者发生不同程度的出血事件,出血发生率9.30%(4/43),其中2例皮肤黏膜有瘀斑,予以观察处理。1例骨折手术伤口血肿,停止溶栓后好转。1例股静脉留置血管鞘管处出血,急诊上台造影见滤器内血栓溶解,滤器顺利取出。所有患者溶栓过程中无腹腔内脏、头颅出血等严重并发症发生。结论留置pigtail导管溶栓治疗急性IVCFT安全、有效,可提高IVCF的取出率。Objective To evaluate the safety and effects of indwelling pigtail catheter thrombolysis treatment of acute inferior vena cava filter thrombosis(IVCFT).Methods A retrospective analysis was performed of 43 case data of placement of inferior vena cava filter(IVCF)before facture surgery.All cases were treated by facture surgery and removal of filters after enough anticoagulation.IVCFT was found in the angiography during the surgery.If the thrombus had a maximal diameter larger than 1 cm,in indwelling pigtail catheters urokinase was used for thrombolysis,with 600,000 U micro-pumped per day.In the process of thrombolysis,indicators were recorded,such as thrombolysis duration,the amount of urokinase,filter removal,filter placement duration,and complication of bleeding.Results There were 43 cases of catheter thrombolysis totally,with thrombolysis duration from 3 to 9 days[(4.34±1.31)days on average].The dosage of urokinase was 1,800,000-5,400,000 U,with(2581400±791400)U on average.The filter removal rate was 97.67%(42/43).The only one case,whose filter was not removed,was due to hematoma in the surgical wound in the process of thrombolysis and thrombolysis in the catheter was not good.The duration of filter indwelling in patients’body ranged from 14 to 25 days,with(20.33±2.63)days on average.Four cases experienced bleeding in varying degrees,with a bleeding rate of 9.30%(4/43).Among them,2 cases experienced ecchymosis on skin mucosa and were kept under observation.One case had hematoma in the surgical wound and became better after the pause of thrombolysis.One case bled from femoral veins at the indwelling vascular sheath,filter thrombosis was observed during the emergency angiography,and filter was removed successfully.All patients had no serious complications such as bleeding in abdominal viscerals or head.Conclusion Indwelling pigtail catheter thrombolysis for the treatment of acute IVCFT is safe and effective,and may also improve the removal rate of IVCF.

关 键 词：下腔静脉滤器 置管溶栓 血栓形成 滤器取出 

分 类 号：R643.6[医药卫生—外科学] R816[医药卫生—临床医学]