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腔静脉滤器置入联合导管直接溶栓治疗下肢深静脉血栓形成临床分析(PDF)

《中国普外基础与临床杂志》[ISSN:1007-9424/CN:51-1505/R]

期数:
2010年07期
页码:
679-682
栏目:
专题
出版日期:
2010-07-22

文章信息/Info

Title:
Clinical Analysis of Catheter-Directed Thrombolysis Combined with Vena Cava Filter for Deep Venous Thrombosis of Lower Extremity
稿件编号:
201007011
作者:
郑江华; 武国; 朱彦彬; 陈兴林; 陈开
川北医学院附属医院血管外科（四川南充 637000）
Author(s):
ZHENG Jiang-hua;  WU Guo;  ZHU Yan-bin;  CHEN Xing-lin;  CHEN Kai.
 Department of Vascular Surgery, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province， China
关键词:
下肢深静脉血栓形成; 下腔静脉滤器; 置管溶栓术; 疗效
Keywords:
 ; Lower extremity deep venous thrombosis;  Vena cava filter;  Catheter-directed thrombolysis;  Therapeutic effect
分类号:
R654.4
DOI:
-
文献标识码:
A
摘要:
目的   探讨腔静脉滤器置入联合导管直接溶栓治疗下肢深静脉血栓形成（DVT）的疗效。
方法   回顾性分析2008年1月至2009年8月期间我科收治的65例病程≤7 d的中央型和混合型下肢DVT患者的临床资料，其中32例采用腔静脉滤器置入联合导管直接溶栓，同时行常规抗凝、活血化瘀等治疗，设为研究组; 33例给予常规溶栓、抗凝以及活血化瘀等治疗，设为对照组。比较2组患者的疗效。
结果  研究组患者治疗前双侧肢体周径差为（7.35±1.42） cm，治疗后3、7和14 d双侧肢体周径差分别为（4.21±1.12） cm、（2.87±0.98） cm和（1.22±1.02） cm，治疗前与治疗后不同时间段比较差异有统计学意义（P<0.01）； 对照组治疗前双侧肢体周径差为（6.97±1.27） cm，治疗后3、7和14 d双侧肢体周径差分别为（5.72±1.31） cm、（4.58±0.88） cm和（3.18±1.24） cm，治疗前与治疗后各时间段比较差异也有统计学意义（P<0.05或P<0.01）。2组患者治疗前双侧肢体周径差的差异无统计学意义（P>0.05）。2组患者组内治疗后不同时间段双侧肢体周径差的差异有统计学意义（P<0.01）。研究组治疗后不同时间段双侧肢体周径差均显著低于对照组相应时间段（P<0.01）; 14 d后，研究组髂股静脉完全再通率(71.88%,23/32)和临床治愈率（71.88%,23/32）均显著高于对照组(均为36.36%,12/33),P<0.01; 无一例发生肺栓塞。
结论   从下肢DVT理想治疗目标角度看，腔静脉滤器置入联合导管直接溶栓治疗效果优于传统溶栓治疗。
Abstract:
Objective   To explore the therapeutic effect of catheter-directed thrombolysis combined with vena cava filter on deep venous thrombosis (DVT) of lower extremity.
Methods   The clinical data of 65 patients with DVT of lower extremities from January 2008 to August 2009 were analyzed retrospectively, whose course of diseases were not more than 7 d and clinical type included central type and mixed type. Thirty-two cases were treated with catheter-directed thrombolysis combined with vena cava filter, while administrating treatment of anticoagulation and activating blood circulation to dissipate blood stasis, which were named as study group. Thirty-three cases were treated traditionally with thrombolysis, anticoagulation, and activating blood circulation to dissipate blood stasis, which were named as control group. The course of therapy was continued 10-14 d, then the efficacy in two groups patients was evaluated.
Results  It was (7.35±1.42) cm that circumference difference before treatment between affected extremties and unaffected extremties in study group, which of 3, 7, and 14 d after treatment was (4.21±1.12) cm， (2.87±0.98) cm, and (1.22±1.02) cm, respectively. Circumference difference between before and after treatment had significant difference in study group (P<0.01). It was (6.97±1.27) cm that circumference difference before treatment between affected extremties and unaffected extremties in control group, which of 3, 7, and 14 d after treatment was (5.72±1.31) cm, (4.58±0.88) cm, and (3.18±1.24) cm, respectively. Circumference difference between before treatment and 3, 7, and 14 d after treatment had significant difference in control group (P<0.05 or P<0.01). Circumference difference before treatment in two groups had no significant difference (P>0.05). Circumference difference after treatment at different time points in two groups was significantly different, respectively (P<0.01). Circumference difference after treatment at different time points in study group was significantly less than that in control group, respectively (P<0.01). After 14 d, complete recanalization rate （71.88%, 23/32） and cure rate (71.88%, 23/32) of iliofemoral vein in study group were significant higher than that (36.36%, 12/33) in control group (P<0.01). No pulmonary embolism occurred. Conclusion    In terms of ideal therapy targets of DVT of lower extremity, the catheterdirected thrombolysis combined with vena cava filter is obviously superior to traditional thrombolysis treatment.

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备注/Memo

备注/Memo:
 【通讯作者】陈开，E-mail: chenkai2262418@126.com
【作者简介】郑江华（1975年-），男，四川省广安市人，医学博士，讲师，主要从事血管外科基础与临床研究，Email: zhengjianghua@126.com。
更新日期/Last Update: 2010-07-27