Acostream机械性血栓抽吸序贯低剂量阿替普酶在下肢深静脉血栓治疗中的初步应用  

Preliminary application of Acostream percutaneous aspiration thromboembolectomy sequential low-dose alteplase in the treatment of lower extremity deep vein thrombosis

作　　者：姜锐 公茂峰 刘正立 赵伯翔[1] 孔杰 顾建平[1] 何旭[1] JIANG Rui;GONG Maofeng;LIU Zhengli;ZHAO Boxiang;KONG Jie;GU Jianping;HE Xu(Department of Interventional and Vascular Radiology,Nanjing First Hospital,Nanjing First Hospital Affiliated to Nanjing Medical University,Nanjing,Jiangsu 210006,China)

机构地区：[1]南京医科大学附属南京医院南京市第一医院介入血管科,江苏南京210006

出　　处：《中国临床研究》2025年第2期186-190,共5页Chinese Journal of Clinical Research

基　　金：江苏省医学会介入医学第三期科研专项资金项目[SYH-3201140-0088(2023035)]。

摘　　要：目的探讨Acostream机械性血栓抽吸术(PAT)序贯低剂量阿替普酶(rt-PA)治疗下肢深静脉血栓(LEDVT)的有效性和安全性。方法回顾性分析南京市第一医院2022年6月至2024年3月收治的22例LEDVT患者的临床资料,记录手术相关参数、联合低剂量rt-PA使用参数、住院时间、血栓清除率、患肢消肿率、术后48 h血红蛋白变化、并发症等资料。结果血栓抽吸时间为1.7(1.4,2.7)min,PAT术后即刻Ⅲ级血栓清除率13.6%(3例),Ⅱ级血栓清除率81.8%(18例),Ⅰ级血栓清除率4.5%(1例);序贯rt-PA溶栓,溶栓时间为(51.1±14.6)h,溶栓剂量21.0(20.0,36.5)mg,Ⅲ级血栓清除率63.6%(14例),Ⅱ级血栓清除率31.8%(7例),Ⅰ级血栓清除率4.5%(1例)。住院时间为(10.4±3.2)d。溶栓治疗结束后,患者大腿周径减少(1.7±0.8)cm,小腿周径减少0.8(0.5,1.3)cm。住院期间7例患者出现小出血事件。无新增肾功能损伤、过敏事件和严重并发症发生。随访6个月,1例患者在初次治疗后血栓复发,1例患者术后6个月发生轻度血栓后综合症;22例患者Villalta评分为2(1,2)分。结论Acostream机械性血栓抽吸术序贯低剂量rt-PA可快速降低血栓负荷,恢复患肢血流,初步评估可安全有效地应用于LEDVT患者的治疗。Objective To investigate the efficacy and safety of Acostream percutaneous aspiration thromboembolectomy(PAT)sequential low-dose alteplase(rt-PA)in the treatment of lower extremity deep vein thrombosis(LEDVT).Methods The clinical data of 22 patients with LEDVT admitted to Nanjing First Hospital from June 2022 to March 2024 were retrospectively analyzed.Data on procedure-related parameters,parameters of combined low-dose rt-PA use,hospital stay,thrombus clearance rate,swelling rate of the affected limb,hemoglobin changes at 48 h after operation,and complications were recorded.Results The thrombus aspiration time was 1.7(1.4,2.7)min.Immediate post-PAT gradeⅢthrombus clearance was achieved in 3 cases(13.6%),gradeⅡclearance in 18 cases(81.8%),and gradeⅠclearance in 1 case(4.5%).Sequential rt-PA thrombolysis had a thrombolytic time of(51.1±14.6)h and a dose of 21.0(20.0,36.5)mg,with gradeⅢclearance in 14 cases(63.6%),gradeⅡclearance in 7 cases(31.8%),and gradeⅠclearance in 1 case(4.5%).The hospital stay was(10.4±3.2)d.After thrombolytic therapy,the reduction in thigh circumference was(1.7±0.8)cm,and the reduction in calf circumference was 0.8(0.5,1.3)cm.Small bleeding events occurred in 7 patients during hospitalization.No new renal function impairment,allergic reactions,or severe complications were observed.After 6 months of follow-up,thrombosis recurred in 1 patient after the initial treatment,and 1 patient developed mild post-thrombotic syndrome 6 months post-procedure;the mean Villalta score was 2(1,2)for the 22 patients.Conclusion Acostream mechanical thrombectomy followed by low-dose rt-PA can rapidly reduce thrombus burden and restore limb blood flow,and it is preliminarily assessed as a safe and effective treatment for LEDVT patients.

关 键 词：Acostream 机械性血栓抽吸术 阿替普酶 下肢深静脉血栓 溶栓 

分 类 号：R364.15[医药卫生—病理学]