溶栓导管接触性溶栓治疗下肢股青肿体会

对9例股青肿患者行患肢口静脉穿刺,在DSA下将溶栓导管插入到血栓近心端,经导管首次推注尿激酶20万U后,微量泵持续泵入尿激酶20～30万U／8h,同时经血管鞘持续泵入肝素钠7500～100001U／24h。以下肢皮色和皮温变化、消肿情况及深静脉造影评价溶栓效果。经溶栓导管治疗后9例患者皮色皮温改善,无一例发生下肢静脉坏疽,7例完全消肿,完全消肿率77,78％,患肢总消肿率8621％。下肢深静脉血栓部分或完全消融,6例完全溶解,完全溶栓率66．67％,总溶栓率96．97％。未发生严重并发症。溶栓导管接触性溶栓治疗下肢股青肿临床效果满意,是一种安全、有效的临床治疗方法。     

腘静脉置管溶栓联合静脉球囊扩张治疗急性中央型下肢深静脉血栓形成

目的探讨腘静脉置管溶栓联合静脉球囊扩张治疗急性中央型下肢深静脉血栓形成的安全性及疗效。方法 19例急性中央型下肢深静脉血栓形成患者,在下腔静脉滤器保护下行腘静脉置管注入尿激酶溶栓联合静脉球囊扩张治疗。结果本组患者痊愈11例,显效8例,无肺动脉栓塞发生。溶栓后3～6天患肢肿胀开始消退,5～8天患肢肿胀基本消退。静脉造影示下肢深静脉血栓溶解,部分患者血管边缘见少许充盈缺损。尿激酶用量为370万～600万U。随访未再出现血栓复发情况。结论腘静脉置管溶栓联合静脉球囊扩张治疗急性中央型下肢深静脉血栓形成是安全、有效。     

两种入路治疗急性混合型下肢深静脉血栓形成临床疗效分析

目的 比较经小腿深静脉入路与经腘静脉入路行导管抽栓和导管接触性溶栓治疗对急性混合型下肢深静脉血栓形成（DVT）的临床疗效。方法 收集2018年1月至2020年12月武汉市第一医院收治的65例急性混合型下肢DVT患者的临床资料,根据入路方式的不同将患者分为A组（n=39,经腘静脉入路行导管抽栓和导管接触性溶栓治疗）和B组（n=26,经小腿深静脉入路行导管抽栓和导管接触性溶栓治疗）。观察并比较两组患者的治疗相关情况、临床疗效、静脉通畅情况、尿激酶使用量、患肢消肿情况、围手术期2周内血栓相关事件发生率及下肢静脉疾病严重程度。结果 两组患者的技术成功率均为100%,均未出现致命性肺栓塞的症状,无疾病相关死亡病例。两组患者治疗后静脉临床严重程度评分（VCSS）均低于本组治疗前,差异均有统计学意义（P<0.05）;治疗后,两组患者的VCSS比较,差异有统计学意义（P<0.05）。两组患者的有效率均为100%。两组患者的临床疗效、治疗前患肢深静脉通畅度评分、患肢深静脉通畅改善度、治疗前后患肢大腿和小腿周径差、患肢大腿和小腿消肿率、尿激酶用量比较,差异均无统计学意义（P>0.05）。...     

自制多侧孔溶栓导管经腘静脉入路治疗下肢深静脉血栓

目的探讨采用自制多侧孔溶栓导管经腘静脉入路留置溶栓的方法治疗下肢深静脉血栓的可行性及有效性。方法分析96例采用腘静脉顺行法穿刺留置导管溶栓治疗的下肢深静脉血栓患者的临床资料,通过治疗前后健、患肢周径差,静脉通畅率及静脉通畅评分等指标评价临床疗效。结果 96例患者介入手术技术成功率100%,术后经过5~14天留置导管溶栓后血栓大部分溶解,下肢肿胀消退;在手术及治疗过程中无严重并发症发生,溶栓治疗结束后双下肢周径差≤1.5cm,术后静脉通畅评分较术前明显改善[(9.71±2.42)分vs(3.41±1.92)分,Z=1.72,P0.05)],静脉通畅率为(71.42±14.13)%。82例患者通过3~12个月的随访,平均随访(5.11±3.33)个月,通过超声及临床症状体征的评估,介入治疗的有效率为95.12%(78/82)。结论采用经腘静脉入路留置自制溶栓导管是治疗下肢深静脉血栓的有效方法,成功率较高、术后并发症较少,其中远期效果有待进一步随访观察。     

下腔静脉滤器植入后导管接触性溶栓治疗下肢深静脉血栓形成的临床研究

目的探讨下腔静脉滤器置入后,经皮下肢深静脉置管局部溶栓治疗下肢深静脉血栓形成的可行性及疗效。方法42例下肢深静脉血栓形成患者,分为两组,介入治疗组15例,对照组27例。介入治疗组的15例患者行下腔静脉滤器植入术,经溶栓导管泵入大剂量尿激酶溶栓;对照组30例患者经足背静脉泵入尿激酶。结果介入治疗组血栓完全消失8例（53.33%）,部分消失7例（46.67%）,无明显好转0例（0%）,治疗全过程所有患者均未出现肺动脉栓塞症状及出血现象;对照组血栓完全消失2例（7%）,部分消失25例（83.33%）,无明显好转3例（10%）。结论下腔静脉滤器置入后,患肢深静脉置管大剂量尿激酶溶栓治疗下肢深静脉血栓形成安全、疗效显著。     

下肢骨折术后并发深静脉血栓形成的治疗与护理

目的:探讨下肢骨折术后深静脉血栓形成患者经下腔静脉滤器置入留置导管溶栓的疗效与护理.方法:对31例下肢骨折术后患者采用彩色多普勒超声检查仪检查,在DSA引导下阻断患肢浅静脉经足背静脉留置针注入碘比醇20ml,观察深静脉阻塞的程度及血栓的范围.采用Seldiinger技术,经皮健佣股静脉穿刺置人导管鞘先行下腔静脉造影,经5F猪尾导管以20ml/s速度注入碘比醇30ml,了解双侧肾静脉开口位置,于双侧肾静脉开口下方置入下腔静脉滤器;然后经导管鞘送入溶栓导管,将溶栓导管头端置于血栓内,用肝素冒封好溶栓导管尾瑞,每8小时经溶栓导管推注10万单位尿漱酶溶液50ml(将10万单位尿激酶溶液50ml生理盐水中),常规抗凝并给予真对性护理干预.结果:31例患者治疗3～10天血栓完全溶解,血管通畅,所有患者于滤器置入第10～14天内取出.性别、年龄、骨折部位及有无合并高血压、糖尿病的骨折患者术后下肢深静脉血栓形成有显著性差异(P<0.01).结论:下腔静脉滤器置入留置溶栓导管治疗下肢深静脉血栓形成的患者,做到严密观察、细致护理,对减少并发症的发生具有积极临床意义.     

两种不同途径溶栓治疗下肢深静脉血栓的疗效比较

目的探讨不同途径溶栓治疗下肢深静脉血栓的临床效果。方法将下肢深静脉血栓患者126例,根据前瞻性、随机性采用患肢周围静脉溶栓及腘静脉置管溶栓治疗方法进行治疗,并对比治疗效果。结果经外周静脉溶栓治疗组在小腿消肿率为(0.63±0.11)%,大腿消肿率为(0.57±0.09)%,静脉通畅改善度为(32.34±3.77)%,均低于经腘静脉置管溶栓方组的(0.82±0.14)%,(0.89±0.07)%及(55.41±3.21)%(均P0.05～0.01)。结论经腘静脉顺行置管溶栓治疗下肢深静脉血栓临床治愈率及远期效果明显优于经外周静脉溶栓治疗。     

经腘静脉置管溶栓治疗下肢深静脉血栓形成

目的初步探讨经腘静脉置管溶栓治疗下肢深静脉血栓(DVT)的临床应用价值。方法67例下肢深静脉血栓形成患者,在B超引导下行经腘静脉置入溶栓导管,以输液泵经溶栓导管持续泵入溶栓药物10~14d,同时行抗凝治疗。结果所有病人均置管成功,其中3例未能通过髂静脉;治疗后临床表现均有不同程度的好转,出院前均行影像学检查,治愈11例,其中8例病程≤10d,显效42例,有效16例,有效率100%;其中5例接受髂静脉球囊扩张术,3例行髂静脉支架置入术,1例行耻骨上静脉转流术。结论经腘静脉置管溶栓术治疗下肢深静脉血栓可以延长尿激酶溶栓时间窗,减少尿激酶用量,减少出血并发症,并为后续治疗提供机会。     

下肢深静脉溶栓采用血压计止血带浅静脉血流阻断效果比较

目的提高下肢深静脉血栓患者溶栓治疗的有效性及舒适度。方法将80例下肢深静脉血栓患者随机分为止血带组和血压计组各40例,均行足背浅静脉低剂量尿激酶溶栓治疗;对照组采用硅胶止血带扎在患肢踝关节上方15cm处阻断浅静脉血流;血压计组先行下肢静脉造影确定深静脉显影压力值,然后以此压力在同样部位阻断浅静脉血流。均以15min间隔交替。结果血压计组患肢消肿率、静脉通畅度显著优于止血带组,血栓清除率治疗后第4~10天显著高于对照组(P0.05,P0.01);治疗后患肢VAS评分显著低于对照组(均P0.01)。结论与止血带相比,应用血压计袖带阻断下肢浅静脉血流可获得更好的溶栓疗效,患者相对舒适。     

导管溶栓治疗下肢深静脉血栓的临床研究

目的观察经导管直接尿激酶泵入溶栓治疗下肢深静脉血栓形成的疗效。方法 23例下肢深静脉血栓形成患者,在置入腔静脉滤器后,经小隐静脉(或大隐静脉)置入溶栓导管局部直接溶栓,共4～5 d。结果髂股静脉完全再通率21.7%(5/23),临床治愈率78.2%(18/23),总有效率100%;未发生肺栓塞及出血并发症。结论经导管局部直接溶栓治疗下肢深静脉血栓形成,再通率高且安全。     

介入导管溶栓治疗急性下肢深静脉血栓形成32例

目的 探讨经腘静脉置入溶栓导管持续灌注溶栓药物治疗急性下肢深静脉血栓形成(deep venous thrombosis,DVT)的临床应用价值.方法 本组32例急性DVT患者(其中3例合并肺动脉栓塞),男15例,女17例,年龄18 ～71岁,平均(51±17)岁.在超声引导下经患肢腘静脉穿刺置入溶栓导管至髂、股静脉血栓中进行溶栓治疗,并对溶栓效果进行分析.结果 全组患者溶栓后症状明显改善,下肢肿胀消退,肺部症状缓解.溶栓后患、健侧大腿周径差为(1.7±1.3)cm,明显小于溶栓前(5.4±1.4)cm,两者相比差异有统计学意义(t=9.92,P＜0.01).患肢大腿消肿率为91.74％;溶栓后患、健侧小腿周径差为(1.5±0.7)cm,明显小于溶栓前(4.1±1.5)cm(t =7.65,P＜0.01).患肢小腿消肿率为86.02％.溶栓前静脉通畅评分(15±4)分,明显高于溶栓后(4±3)分(t=7.12,P＜0.01),溶栓后静脉平均通畅率为88.21％.3例合并肺动脉栓塞患者1例栓子完全溶解,2例大部分溶解.所有患者均无严重并发症.29例患者获随访,随访3 ～ 12个月,平均(7.8±2.4)个月.无一例出现血栓再发.结论 经腘静脉置管溶栓治疗急性DVT是一种安全、有效的治疗方法.     

Pulse-spray pharmacomechanical thrombolysis for proximal deep vein thrombosis.

OBJECTIVE: The aim of this study was to evaluate the efficacy, safety, and feasibility of pulse-spray pharmacomechanical thrombolysis to treat proximal deep vein thrombosis (DVT) in conjunction with the placement of a non-permanent IVC filter. METHODS: We studied 31 consecutive patients with acute proximal DVT defined as the inferior vena cava (IVC), iliac vein and/or femoral vein, who were diagnosed using duplex ultrasonography and/or contrast venography. All were treated with pulse-spray urokinase. Early success was assessed by comparing the pre- and post-treatment venographic severity score. Non-permanent IVC filters were used to reduce the risk of pulmonary thromboembolism. RESULTS: The average total urokinase dose was 1.71 million IU (range: 0.72-3.6 million IU) and the average duration of therapy was 2.4 days. The average percentage of thrombus lysed was 85% (range: 22-100%). A large thrombus trapped by the filter was detected using cavography before extraction of the filter in one patient. There was no major treatment-related adverse event. CONCLUSION: The combination of pulse-spray pharmacomechanical thrombolysis and the prophylactic use of a non-permanent IVC filter was a safe and effective approach for treating acute proximal DVT.     

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??Catheter-directed thrombolysis for acute lower limb deep venous thrombosis HUANG Xiao-zhong, LIANG Wei??XUE Guan-hua, et al. Department of Vascular Surgery, Renji Hospital, Affiliated Shanghai Jiaotong University School of Medical??Shanghai200001??China
Corresponding author?? ZANG Ji-wei??E-mail??zhangjiwei001@sina.com
Abstract Objective To evaluate the efficacy of catheter-directed thrombolysis in treatment of acute lower limb deep venous thrombosis(DVT). Method 217 patients with lower limb acute DVT underwent treatment by cathter-directed thrombolysis with urokinase (261.26±95.35)×104IU continues infusion immediately. The venous patency score and the rate of patency were measured before and after lysis, improvement were observed by venograms. some patients were followed. Results After lysis, the venous patency score was significant difference (P<0.01). The mean rate of venous patency improvent was ??62.24±15.47??%. 153 patients were followed 6~28 monthes, average ??13.75±7.63 ??monthes. The mean score of venous patency was also significant difference (P<0.01), the mean rate of venous patency improve to ??68.37±17.54??%. The valve function preserved in 126 patients(82.35%). Conclusion This initial experience suggest that catheter -directed thrombolysis with urokinase for treatment of acute lower limb DVT is safe and effective.     

高频超声引导下经腘静脉穿刺置管溶栓治疗下肢深静脉血栓

目的探讨经腘静脉穿刺置管直接溶栓治疗下肢深静脉血栓(DVT)的应用价值。方法收集经CDFI或下肢深静脉造影确诊为DVT的36例患者。对观察组患者行超声引导下患侧腘静脉穿刺,置入溶栓导管,经导管持续灌注尿激酶溶栓;对照组采用经外周静脉滴注尿激酶,比较两组的治疗效果。结果观察组(16例)患者自治疗后第2天患肢肿胀开始减退,第4～6天时肿胀明显减退,治愈3例,显效11例,有效2例,总体有效率为100%(16/16);对照组(20例)自第2～4天起患肢肿胀开始减退,第7～9天明显减退,显效8例,有效6例,无效6例,总体有效率为70.00%(14/20);两组治疗效果的差异有统计学意义(Z=3.270,P=0.002)。溶栓治疗前后观察组肢体肿胀缓解程度较对照组明显,患肢大腿及小腿周径的差异均有统计学意义(P均<0.01)。结论于高频超声引导下经腘静脉穿刺置管直接溶栓治疗DVT安全、微创、疗效确切,且并发症少。     

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目的探讨应用导管接触溶栓治疗急性动脉闭塞性疾病的临床效果。方法回顾性分析2004年8月至2006年4月间中国人民解放军总医院应用导管接触溶栓治疗急性动脉闭塞性疾病8例临床资料。持续导管接触溶栓治疗后均行腔内球囊扩张成型或支架置入治疗。结果8例8条肢体均在局部麻醉经皮穿刺下完成,导丝均能通过闭塞段,并通过脉冲喷射技术给予50万单位尿激酶,使闭塞段通溶开一条缝隙。后续治疗中持续泵入尿激酶(50万~100万单位)18~40h后,造影复查有7例获得较满意的溶栓效果,并对考虑为引起闭塞的中重度狭窄病变处给予相应的处理(单纯球囊扩张3例次,合并支架治疗4例)。2例发生血栓移位堵塞远处血管,1例腔内治疗好转,另1例行胫后动脉切开取栓合并自体大隐静脉补片手术。8条肢体造影均可见病变血管恢复通畅,术后原症状均有不同程度的改善。无截肢(趾),无穿刺部位假性动脉瘤及血肿,无死亡、无溶栓相关的严重出血并发症等。结论溶栓治疗可以恢复缺血肢体的血流,与传统外科手术相比,溶栓治疗可有效恢复侧支循环的血流。在有必要进行外科手术重建血运时,溶栓治疗通常可以缩小手术的范围;并将急诊手术转化为择期手术。但是要注意溶栓治疗时血栓移位形成远端动脉栓塞的发生及处理。     

DSA引导下胫后/胫前静脉穿刺置管碎栓/溶栓治疗急性下肢深静脉血栓形成

目的:初步探讨DSA引导下行胫后/胫前静脉穿刺置管碎栓/溶栓治疗急性下肢深静脉血栓形成(DVT)的疗效。方法:对2012年8月—2016年11月收治的87例混合型及中央型DVT患者行DSA引导下经胫后/胫前静脉穿刺置管碎栓/溶栓治疗,以术前、术后肢体的周径差以及溶栓后造影深静脉通畅情况评估疗效。结果:87例患者80例穿刺成功(91.9%),其中胫后静脉穿刺成功68例,胫前静脉穿刺成功12例,未穿刺成功7例行胫后静脉切开置管。置管成功后均行碎栓术,并行留置导管溶栓。与溶栓前比较,溶栓后患者小腿周径差明显减小[(4.28±1.02)cmvs.(1.06±0.42cm)],静脉通畅度评分明显降低[(10.25±1.84)vs.1.92±0.5)],差异均有统计学意义(均P0.05)。结论:DSA引导下经胫后/胫前静脉穿刺置管碎栓/溶栓治疗下肢DVT是一种简便、有效、疗效确切的方法。     

Evaluation of thrombolysis in a porcine model of chronic deep venous thrombosis: an endovascular model

PURPOSE: The advancement of catheter-based interventions for vascular recanalization has underscored the need for an experimental animal model of vascular thrombosis that can be used for the evaluation of interventional therapies. In this model, a porcine model of deep venous thrombosis with a novel endovascular technique was described, and the efficacy of thrombolytic therapy with urokinase was evaluated. METHODS: An endovascular device that consisted of a tapered polytetrafluoroethylene graft attached within a self-expanding nitinol stent was delivered to bilateral common iliac veins in 20 pigs. Venous thrombosis occurred as a result of flow stasis created by the intrastent stenosis. Catheter-directed pulse-spray thrombolysis with urokinase (250,000 units) and heparin (5000 IU) was performed on one limb while the contralateral limb received control saline solution. Thrombolysis was performed in 1 hour (n = 4), 8 hours (n = 4), 3 days (n = 4), 7 days (n = 4), and 14 days (n = 4) after the stent-graft deployment. Venography and intravascular ultrasound were used to evaluate the efficacy of thrombolysis. Light microscopy was used for histologic analysis of the thrombus. RESULTS: Complete thrombolysis was achieved in groups with deep vein thrombosis that were younger than 1 day. Angioplasty of the tapered stent-grafts in the completely thrombolysed iliac vein was successful in restoring venous flow. The efficacy of thrombolysis in 3-day, 7-day, and 14-day groups was 86% +/- 7%, 73% +/- 13%, and 42% +/- 23%, respectively. The thrombolytic efficacy was enhanced to 92% +/- 16% and 86% +/- 18% (P <.05) in 3-day and 7-day groups, respectively, when doses of the pulse-spray thrombolysis were doubled. Increased dosages of the thrombolytic agent, however, did not significantly enhance the thrombus dissolution in the 14-day group. CONCLUSION: The thrombolytic efficacy of urokinase correlated with the chronicity of deep venous thrombosis in our model. An increased dose of urokinase may be used to enhance the efficacy of thrombolysis in a 1-week-old thrombus.     

经导管直接溶栓治疗下肢深静脉血栓形成的尿激酶量效分析

目的探讨经导管直接溶栓（CDT）治疗下肢深静脉血栓中尿激酶的合理用量。方法将拟接受CDT的90例DVT患者随机分为3组：A组用小剂量尿激酶溶栓（每日用量〈40万U）,B组用中等剂量（每日用量40万～80万U）,C组用大剂量（每日用量〉80万U）进行溶栓治疗。比较3组的溶栓效果、溶栓时间及出血情况。结果3组溶栓疗效差异有统计学意义（Hc=15．09,P〈O．05）,A组与B组疗效差异有统计学意义（t=1．99,P〈0．05）。3组溶栓时间差异有统计学意义（F=4．92,P〈0．05）。各组出血发生率差异无统计学意义（x^2=2．96,P〉0．05）,C组出血程度最重。结论CDT治疗DVT安全有效,每日尿激酶用量在40万U～80万U时溶栓疗效好,且出血发生率低。     

Intermittent pneumatic compression of the foot and calf improves the outcome of catheter-directed thrombolysis using low-dose urokinase in patients with acute proximal venous thrombosis of the leg

OBJECTIVE: Catheter-directed thrombolysis (CDT) is a promising treatment of acute proximal deep vein thrombosis (DVT) to prevent the postthrombotic syndrome by early removal of thrombus. During CDT for DVT patients, the calf muscle pump is compromised because of immobility. Intermittent pneumatic compression (IPC) can be used to increase venous flow during bed rest. The CDT with IPC may lyse venous thrombus better than CDT alone. The purpose of this study was to evaluate the efficiency and safety of IPC during CDT for DVT using low-dose urokinase. METHODS: Twenty-four patients with proximal DVT confirmed by duplex ultrasonography underwent CDT alone (10 cases) and CDT with IPC and a temporary inferior vena cava filter (14 cases) for 3 to 6 days. Pulmonary emboli (PEs) were assessed by pretreatment and posttreatment pulmonary angiogram or spiral computed tomography of the chest, and in the CDT/IPC patients, a posttreatment inferior vena cavogram was performed. The initial results were evaluated by venogram immediately after CDT, and the late results were evaluated by venous disability score and duplex ultrasonography 6 to 36 months after treatment. RESULTS: There was no symptomatic PE in either group. In CDT with IPC, one new asymptomatic PE was found, but there was no large thrombus in the inferior vena cava. The initial thrombolytic results of CDT with IPC were better than those of CDT alone (five cases of complete lysis in the CDT/IPC group and none in the CDT alone group). In the follow-up, the deep veins were patent and competent in 43% (6/14) in the CDT/IPC group, compared with 17% (1/6) in the CDT-alone group. The venous disability score showed that the CDT/IPC group had less disability than the CDT-alone group. CONCLUSIONS: This pilot study showed that adding IPC to CDT using low-dose urokinase for DVT treatment of the leg resulted in better early and late outcomes compared with CDT alone and was not associated with an increased risk of symptomatic PEs.