急性下肢深静脉血栓形成局部置管溶栓与外周静脉溶栓的比较

目的 比较急性下肢深静脉血栓形成经局部及外周静脉抗凝溶栓治疗的效果,以指导临床治疗.方法 回顾性分析我院2001年1月至2008年5月期间收治的225例下肢深静脉血栓形成患者的临床资料,按照治疗方法分A、B两组.A组为经股深静脉置管抗凝溶栓治疗患者,共71例,左侧47例,右侧20例,双侧4例;B组为经外周静脉抗凝溶栓治疗的患者,共154例,左侧121例,右侧27例,双侧6例.通过监测患者临床症状、测量下肢周径变化比较两组治疗效果.结果 A组患者治疗3 d后好转率优于B组患者(94.4%比69.5%,P＜0.01).治疗7 d后,A组的治愈率虽然优于B组患者,但差异无统计学意义(85.9%比75.3%,P＞0.05).治疗后平均随访(43±18)个月,两组的并发症及复发率差异无统计学意义(P＞0.05).结论 股静脉置管局部溶栓治疗的早期疗效优于经外周静脉给药,但两种方法的中远期治疗效果相似.

Abstract：

Objective To investigate the efficacy of anticoagulation and thrombolysis for deep venous thrombosis via local vein approach and peripheral vein approach to guide clinical treatment. Methods There were 225 patients with deep venous thrombosis admitted from January 2001 to May 2008. The cases were divided into two groups by therapy procedures. The patients in group A were treated by deep femoral vein catheter-directed anticoagulation and thrombolysis, including a total number of 71 patients, with right lower extremity in 20 patients, left lower extremity in 47 patients and bilateral lower extremities in 4 patients. One hundred and fifty-four patients were included in group B with anticoagulation and thrombolysis through peripheral vein, among them right lower extremity in 27 patients, left lower extremity in 121 patients and bilateral lower extremities in 6 patients. The efficacy was evaluated and compared by observing clinical symptoms and measuring of changes in limb circumference. Results Symptoms were alleviated in all patients in 3 d after the treatment, but the efficacy of group A was better than group B (94. 4% vs. 69. 5% ,P＜0. 01). The efficacy of group A was also better than group B in 7 days after treatment, but with no significant difference (85. 9% vs. 75. 3% , P ＞0. 05). A mean follow-up period was (43 ±18) months.There was no significant difference in incidence of complication and recurrence between two groups.Conclusions The earlier efficacy of anticoagulation and thrombolysis via femoral vein approach is better than via peripheral vein approach in earlier period of deep venous thrombosis. While peripheral intravenous therapy has also good results after long-term treatment.

Evaluation of efficacy of the anticoagulation and thrombolysis for deep venous thrombosis via local vein approach and peripheral vein approach

Objective To investigate the efficacy of anticoagulation and thrombolysis for deep venous thrombosis via local vein approach and peripheral vein approach to guide clinical treatment. Methods There were 225 patients with deep venous thrombosis admitted from January 2001 to May 2008. The cases were divided into two groups by therapy procedures. The patients in group A were treated by deep femoral vein catheter-directed anticoagulation and thrombolysis, including a total number of 71 patients, with right lower extremity in 20 patients, left lower extremity in 47 patients and bilateral lower extremities in 4 patients. One hundred and fifty-four patients were included in group B with anticoagulation and thrombolysis through peripheral vein, among them right lower extremity in 27 patients, left lower extremity in 121 patients and bilateral lower extremities in 6 patients. The efficacy was evaluated and compared by observing clinical symptoms and measuring of changes in limb circumference. Results Symptoms were alleviated in all patients in 3 d after the treatment, but the efficacy of group A was better than group B (94. 4% vs. 69. 5% ,P＜0. 01). The efficacy of group A was also better than group B in 7 days after treatment, but with no significant difference (85. 9% vs. 75. 3% , P ＞0. 05). A mean follow-up period was (43 ±18) months.There was no significant difference in incidence of complication and recurrence between two groups.Conclusions The earlier efficacy of anticoagulation and thrombolysis via femoral vein approach is better than via peripheral vein approach in earlier period of deep venous thrombosis. While peripheral intravenous therapy has also good results after long-term treatment.