不同溶栓方式治疗下肢深静脉血栓过程中血浆D-二聚体的变化及意义

[目的]通过观察不同溶栓方式对下肢深静脉血栓形成患者血浆D-二聚体(DD)影响及其动态变化,并结合临床症状、影像检查静脉通畅率的情况,评价其作为判断溶栓疗效指标的价值。[方法]按治疗方法不同分为介入组和传统治疗组,两组病人均口服祛湿化瘀1号,前者采用Seldinger技术,在X线透视引导下,经腘静脉穿刺,将溶栓导管置于血栓部位,经微量输液泵持续泵入尿激酶20万u及活血化瘀类药,同时给予低分子肝素6150u,皮下注射,q12h,并于患肢踝关节上方扎止血带,给予尿激酶20万u静脉注射;后者经患足背静脉给予溶栓、活血化瘀类药物,用量同前,同时抗凝治疗,用法同前。[结果]前者治疗开始后d1DD水平明显升高,平均2.5d后达高峰,随后呈下降趋势,随着溶栓导管后撤,DD水平明显升高,平均12.9d恢复至正常水平;后者治疗后d2DD水平开始上升,平均4.5d后达高峰,平均6.2d降到正常水平,两组DD水平在治疗前对比,经统计学分析差异无统计学意义(P﹥0.05),治疗开始后在各时间点对比,差异有统计学意义(P﹤0.05);前者临床显效率为80%,后者为23%,二者对比差异有统计学意义(P﹤0.05);两者治疗后复查静脉造影或彩超提示两组在静脉通畅率方面对比差异有统计学意义(P﹤0.05)。[结论]介入溶栓治疗对于急性下肢深静脉血栓形成治疗效果优于经外周静脉系统溶栓治疗,同时动态观察DD变化可以作为溶栓、抗凝的给药指导及治疗效果的评价指标,但应结合治疗过程中临床症状变化及影像复查情况。

THROMBOLYTIC THERAPY IN DIFFERENT WAYS THE PROCESS OF DEEP VENOUS THROMBOSIS OF PLASMA D-DIMER AND ITS SIGNIFICANCE

[Objective]To observe the different ways of thrombolysis of lower extremity deep vein thrombosis in patients with plasma D-dimer(DD)and its dynamic changes and clinical symptoms,imaging venous patency,evaluate it as a solution to determine efficacy endpoint of the value of the bolt.[Methods]The intervention groups were divided into treatment and traditional treatment group,patients in both groups oral QHD 1,the former using Seldinger technique,under the guidance of the X-ray,the popliteal vein,the thromboly...