D-二聚体与纤维蛋白原联合静脉通畅度评分在下肢深静脉血栓置管溶栓中的应用价值

  目的  分析下肢深静脉血栓行置管溶栓(CDT)过程中监测D-二聚体、纤维蛋白原和静脉通畅度评分的变化，评估其临床应用价值。  方法  选取2019年6月—2021年6月在蚌埠医学院第一附属医院被确诊为急性下肢深静脉血栓的37例患者作为研究对象，患者均进行了下腔静脉滤器置入术、抗凝、置管溶栓等治疗，在治疗过程中测量并记录术前1 d、术后每天监测2次D-二聚体、纤维蛋白原至术后7 d，计算置管溶栓术前1 d、术后3 d、术后7 d的静脉通畅度评分。  结果  37例患者在行置管溶栓过程中均未出现呼吸困难、咯血、胸痛等肺栓塞症状。本治疗组中有2例患者出现腘窝穿刺点出血，1例患者出现牙龈出血，未予特殊处理，均未出现严重出血等并发症。在下肢深静脉血栓行置管溶栓过程中，D-二聚体平均值在DVT溶栓过程中先呈升高趋势，在术后2 d达最高水平，最高值为77.4 mg/L，此后逐渐下降至正常水平，纤维蛋白原平均值在置管溶栓过程中总体呈现下降趋势。术后3 d静脉通畅度评分为(3.7±0.9)分，术后7 d通畅度评分为(2.4±0.7)分，差异有统计学意义(P＜0.05)。  结论  在下肢深静脉血栓置管溶栓过程中，D-二聚体可以作为监测溶栓时间及治疗效果的指标，纤维蛋白原可以作为监测停止溶栓和出血情况的指标，静脉通畅度评分的变化可以作为血栓清除的指标。 

Application value of D-dimer and fibrinogen combined with venous patency score in thrombolysis of deep venous thrombosis of lower extremities

  Objective  To analyze the changes of D-dimer, fibrinogen and venous patency score during catheter-directed thrombolysis (CDT) in deep venous thrombosis of lower limbs, and to evaluate their clinical application value.  Methods  Thirty-seven patients diagnosed with acute lower extremity deep vein thrombosis at the First Affiliated Hospital of Bengbu Medical College from June 2019 to June 2021 were included as the research objects. All patients were treated with inferior vena cava filter surgery, anticoagulation and CDT. During the treatment, D-dimer and fibrinogen were measured and recorded 1 day before operation and twice a day after operation until 7 days after operation, and the venous patency scores were calculated 1 day before operation, 3 days after operation and 7 days after catheter thrombolysis.  Results  None of the 37 patients had pulmonary embolism symptoms such as dyspnoea, haemoptysis and chest pain during CDT. In this treatment group, there were 2 patients with popliteal puncture site bleeding, 1 patient with gingival bleeding, without special treatment, and no serious bleeding and other complications. In the process of CDT for deep vein thrombosis of lower limbs, the average value of D-dimer firstly increased during DVT thrombolytic process, and reached the highest level at 77.4 mg/L two days after the operation, and then gradually decreased to the normal level. The average value of fibrinogen generally showed a downward trend during DVT thrombolytic process. The venous patency score was (3.7±0.9) points 3 days after surgery, and (2.4±0.7) points 7 days after surgery, the difference was statistically significant (P < 0.05).  Conclusion  D-dimer can be used to monitor thrombolysis time and therapeutic effect, fibrinogen can be used to monitor thrombolysis stop and bleeding, and the change of venous patency score can be used as an indicator of thrombus clearance in the process of CDT in deep vein thrombosis of lower limbs.