置管溶栓术在下肢深静脉血栓治疗中的应用评价

目的探讨置管溶栓术在下肢深静脉血栓治疗中的应用价值,以期为下肢深静脉血栓治疗方法的选择提供参考。方法选取40例急性下肢深静脉血栓患者,均为混合型或中央型,将患者按照随机抽样法分为置管溶栓组与对照组各20例,两组均给予低分子肝素抗凝治疗,置管溶栓组在超声引导下行患侧腘静脉置管溶栓治疗,对照组经患侧足背静脉溶栓治疗,溶栓药物均为尿激酶,观察治疗疗效及并发症发生情况。结果置管溶栓组疼痛消失时间、肿胀消失时间、住院时间及尿激酶使用总量疗效短于(低于)对照组(P<0.05),治疗7 d时置管溶栓组治疗总有效率为100.00%,对照组为65.00%,置管溶栓组治疗有效率高于对照组(P<0.05);置管溶栓组并发症发生率为25.00%,对照组溶并发症发生率为5.00%,两组比较差异有统计学意义(P<0.05);出院后3个月随访,置管溶栓组深静脉通畅率明显高于对照组(P<0.05),但深静脉瓣膜功能保存率低于对照组(P<0.05)。结论置管溶栓术治疗下肢深静脉血栓能在短期内血栓所致的堵塞症状,有利于缩短病程,近期及中期治疗效果明显优于外周静脉溶栓治疗,但置管溶栓术治疗增加了深静脉瓣膜功能受损概率。

Application of catheter thrombolysis in the treatment of lower extremity deep vein thrombosis.

Objective To investigate the value of catheter thrombolysis in the treatment of lower extremity deep vein thrombosis, and to provide reference for the treatment of the disease. Methods Forty patients with acute lower extremity deep vein thrombosis （mixed type or central type） were collected and divided into catheter thrombolysis group （n=20） and the control group （n=20） according to the random sampling method. All the patients were given low mo- lecular heparin anticoagulant treatment. The catheter thrombolysis group was descending with lateral popliteal deep veni- puncture guided by ultrasound thrombolysis treatment, and the control group by parapodum back inlravenous thrombolysis treatment. Urokinase was used as thrombolysis drug. The curative effect and complications were observed. Results The disappear time of pain and swelling, hospitalization time and total efficacy of urokinase in catheter thrombolysis group were significantly shooter or lower than the control group （P〈0.05）. After treatment for 7 d, catheter thrombolysis treat- ment group total effectiveness 100.00%, control group was 65.00%, the total effective rate in catheter thrombolysis group was 100.00%, significantly higher than that in the control group （65.00%）, P〈0.05. The incidence of complications was 25.00% in catheter thrombolysis group and 5.00% in the control group, with no statistically significant difference be- tween the two groups （P〉0.05）. During the three months follow-up after discharge, deep vein patency rate of catheter thrombolysis group was significantly higher than the control group （P〈0.05）, but deep venous valvular function preserva- tion rate was significantly lower （P〈0.05）. Conclusion Catheter thrombolysis treatment of lower extremity deep vein thrombosis can relieve congestion symptoms caused by blood clots in the short term. It is beneficial to shorten the course of disease, and its short and medium treatment effect is superior to peripheral vein thrombolysis treatment, but thromboly- sis tube after treatment increased the chances of impaired deep venous valvular function.