探讨经导管高压团注尿激酶治疗急性下肢深静脉栓塞疗效观察

目的比较高压团注尿激酶和常规压力置管溶栓治疗急性下肢深静脉血栓的临床疗效。方法回顾性分析2017年5月~2018年12月我院收治的37例急性下肢深静脉血栓形成患者的临床资料,依据治疗方式不同分为观察组(n=20)和对照组(n=17),在每天使用同等剂量尿激酶的情况下,观察组给予经导管用高压注射器团注尿激酶溶栓治疗,对照组给予常规微量泵经导管接触溶栓治疗。2组均按体重给予基础抗凝治疗,术后常规抗凝6个月。比较2组患者的溶栓治疗效果,治疗前后患肢大腿、小腿的周径差值,溶栓并发症的发生率,3、6个月后深静脉通畅状况、复发率。结果在使用相同剂量尿激酶情况下,2组患者经治疗后,临床症状均明显改善,观察组部分通畅14例,完全通畅5例;对照组部分通畅9例,完全通畅3例。与对照组比较,观察组患者的溶栓时间短、并发症的发生率低,差异有统计学意义(P<0.05)。随访发现深静脉瓣膜功能保存率无差异。结论对于下肢深静脉血栓形成的治疗,经导管高压团注溶栓比常规导管接触溶栓的效果好,可以缩短治疗时间,减少溶栓并发症的发生率,瓣膜功能保存率无差异,总的治疗费用较低。

Observation of curative effect on acute deep venous thrombosis of lower extremities by the high-pressure mass of urokinase via the catheter

Objective To compare the clinical efficacy of high-pressure mass and routine pressure catheter thrombolysis in the treatment of acute deep venous thrombosis.Methods The clinical data of 37 patients with acute deep venous thrombosis admitted to Qidong people's Hospital from May 2017 to December 2018 were retrospectively analyzed.According to the different treatment methods,they were divided into observation group(n=20)and control group(n=17).Under the condition of using the same dose of urokinase every day,the observation group was given thrombolytic therapy with high pressure mass of urokinase via catheter.The control group was treated with routine micropump contact thrombolysis via catheter.Both groups were given basic anticoagulation according to body weight,and routine anticoagulation was given 6 months after operation.We compared two groups of patients with the efficacy of thrombolytic therapy,the perimeter difference in the affected thigh and shank before and after treatment,incidence of thrombolytic complications,deep vein patency and recurrence rate after 3 and 6 months.Results Under the same dosage of urokinase,the clinical symptoms of the two groups were obviously improved after treatment,including 14 cases of partial patency and 5 cases of complete patency in the observation group,and 9 cases of partial patency and 3 cases of complete patency in the control group.Compared with the control group,the patients in the observation group had shorter thrombolysis time and lower incidence of complications(P<0.05).After follow-up,there was no difference in the preservation rate of deep venous valve function.Conclusion For the treatment of deep venous thrombosis,thrombolysis by catheter high pressure mass injection is better than that by catheter contact.It can shorten the treatment time,reduce the incidence of thrombolytic complications,valvular function preservation rate has no difference,and the total cost of treatment is lower.