两组不同血栓清除方式结合导管接触性溶栓在急性下肢深静脉高负荷血栓腔内治疗中的对比分析  

Effect of Two Different Thrombectomy Methods Combined with Catheter-Directed Thrombolysis in the Treatment of Acute Lower Extremity Deep Vein Thrombosis of High Clot Burden:A Comparative Analysis

作　　者：周东 何艳平 席宇 李丹 彭莉 ZHOU Dong;HE Yan-ping;XI Yu;LI Dan;PENG Li(Department of Vascular Surgery,Xiangyang No.1 People′s Hospital,Hubei University of Medicine,Xiangyang,Hubei 441000,China)

机构地区：[1]湖北医药学院附属襄阳市第一人民医院血管外科,湖北襄阳441000

出　　处：《湖北医药学院学报》2024年第6期644-649,共6页Journal of Hubei University of Medicine

基　　金：襄阳市院级面上项目(XYY2023MS04)。

摘　　要：目的:对比分析AngioJet机械性血栓清除系统(percutaneous mechanical thrombectomy,PMT)联合人工血栓抽吸术(manual aspiration thrombectomy,MAT)、单用PMT血栓清除系统结合导管接触性溶栓术(catheterdirected thrombolysis,CDT)治疗急性下肢深静脉高负荷血栓的临床疗效。方法:纳入我科2019年10月至2023年3月收治的298例急性下肢深静脉高负荷血栓患者,其中196例采用PMT+MAT方法清除血栓病例设为实验组,102例单用PMT方法清除血栓病例设为对照组。对比两组术后凝血功能、血栓抽吸时间、住院时间、溶栓时间、尿激酶使用量、术后并发症、双下肢周径差、患肢消肿率、血栓清除率、Villalta评分、术后血管通畅程度等指标。结果:所有病例均成功实施血管腔内治疗,住院期间两组无死亡病例。置管溶栓期间,两组APTT监测值对比无统计学差异(P>0.05);实验组D-二聚体下降幅度大于对照组(P<0.05),平均血栓抽吸时间多于对照组(P<0.05),平均住院时间少于对照组(P<0.05);置管溶栓时间、尿激酶使用量上,实验组均少于对照组(P<0.05);实验组术后血红蛋白下降值高于对照组(P<0.05);患者术后双下肢周径差均降低(P<0.05),且实验组优于对照组(P<0.05);实验组患肢消肿率、血栓清除率、Villalta评分、血管再通率均优于对照组(P<0.05);两组术后并发症发生率差异无统计学意义(P>0.05)。结论:AngioJet机械性血栓清除系统联合人工血栓抽吸术提高了血栓清除率,保障了患者患肢长期功效。Objective To compare the clinical effect of AngioJet percutaneous mechanical thrombectomy(PMT)combined with manual aspiration thrombectomy(MAT)and PMT combined with catheter-directed thrombolysis(CDT)in the treat⁃ment of acute lower extremity deep vein thrombosis(LEDVT)of high clot burden.Methods Data of 298 patients diagnosed with acute LEDVT of high clot burden in the Department of Vascular Surgery of Xiangyang No.1 People′s Hospital,Hubei University of Medicine from October 2019 to March 2023 were collected.The patients were assigned into an experimental group(PMT+MAT,n=196)and a control group(PMT alone,n=102).Coagulation function,thrombus aspiration time,hospital stay,thrombolysis time,urokinase usage,postoperative complications,peripheral diameter of both lower extremities,extremity swelling,thrombus clearance rate,Villalta score,and postoperative vascular patency were compared between the two groups.Results All cases were successfully treated with endovascular therapy,and no deaths were reported during hospitalization.There was no significant difference(P>0.05)in the APTT between the two groups.Compared with the control group,the experimental group had greater decrease in D-dimer(P<0.05),longer average thrombus aspiration time(P<0.05),and shorter average hospital stay(P<0.05).In terms of catheter thrombolysis time and urokinase usage,the experimental group was less than the control group(P<0.05),and the hemoglobin in the experimental group after treat⁃ment reduced more than that in the control group(P<0.05).The difference in the peripheral diameter of both lower extremities decreased in both groups of patients after surgery(P<0.05),and the experimental group was better than the control group(P<0.05).In terms of swelling reduction,thrombus clearance rate,Villalta score,and vascular recanalization,the experimental group was superior to the control group(P<0.05).There was no difference in the incidence of postoperative complications between the two groups(P>0.05).Conclusions PMT+MAT improves the effect o

关 键 词：急性下肢深静脉血栓 高负荷血栓 机械性血栓清除术 人工血栓抽吸术 导管接触式溶栓 

分 类 号：R543.6[医药卫生—心血管疾病]