DSA引導下置入溶栓導管接觸性溶栓治療下肢深靜脈血栓形成的臨床效果

吳鑒洲 黃金培 吳志林

[摘要]目的 探討數字減影血管造影（DSA）引導下置入溶栓導管接觸性溶栓治療下肢深靜脈血栓形成（LEDVT）的臨床效果。方法 選取2013年5月～2018年12月我院收治的100例LEDVT患者，采用隨機數字表法分為觀察組（n=50）和對照組（n=50）。對照組采用系統性溶栓治療，觀察組接受DSA引導下置入溶栓導管接觸性溶栓。分析比較兩組的溶栓率、靜脈通暢度評分、雙側大腿周徑差、雙側小腿周徑差、治療時間、住院時間、住院費用和尿激酶用量。結果 觀察組的溶栓率高于對照組[周圍型：（70.30±9.51） vs. （32.62±11.62）%; 中央型：（52.84±9.70） vs. （43.95±10.84）%; 混合型：（62.07±12.95） vs. （40.87±10.95）%]（P<0.05）。治療后，兩組的靜脈通暢度評分、雙側大腿周徑差和雙側小腿周徑差均顯著降低，差異均有統計學意義[（0.95±0.53） vs. （1.87±1.01）分; （1.26±0.60） vs. （2.43±0.42）cm; （1.03±0.52）vs.（2.39±0.61）cm]（P<0.05）。觀察組的治療時間短于對照組[（3.62±0.93） vs. （5.29±1.62）d]，住院時間長于對照組[（12.36±2.95） vs. （10.95±2.57）d]，住院費用高于對照組[（3934.94±530.72） vs. （2938.76±486.81）元]，尿激酶用量多于對照組[（532.95±29.47） vs. （301.84±45.95）×104 U/h]（P<0.05）。結論 DSA引導下置入溶栓導管接觸性溶栓治療LEDVT的臨床療效優于系統性溶栓治療，能顯著改善患者臨床癥狀，促進靜脈再通，但同時也會延長患者住院時間和增加治療費用。

[關鍵詞]下肢深靜脈血栓形成;數字減影血管造影引導;置入溶栓導管;接觸性溶栓

[中圖分類號] R543.6? ? ? ? ? [文獻標識碼] A? ? ? ? ? [文章編號] 1674-4721（2019）8（c）-0086-03

[Abstract] Objective To investigate the clinical effect of DSA-guided thrombolysis catheter thrombolysis in the treatment of deep venous thrombosis of lower extremity （LEDVT）. Methods All 100 cases of LED VT patients admitted to our hospital from May 2013 to December 2018 were selected. They were divided into observation group （n=50） and control group （n=50） by random number table method. Patients in the control group were treated with systemic thrombolysis. Patients in the observation group underwent DSA-guided thrombolysis. The thrombolysis rate， venous patency score， bilateral thigh circumferential diameter difference， bilateral calf circumference diameter difference， treatment time， short hospital stay， hospitalization cost and Urokinase dosage were compared between the two groups. Results The thrombolytic rate of the observation group was higher than that of the control group （surrounding type： [70.30±9.51] vs. [32.62±11.62]%; middle type： [52.84±9.70] vs. [43.95±10.84]%; mixed type： [62.07±12.95] vs. [40.87±10.95]%） （P<0.05）. After treatment， the venous patency score， the bilateral thigh circumferential diameter difference and the bilateral calf circumference diameter difference were significantly lower in the two groups， the differences between the two groups were statistically significant （[0.95±0.53] vs. [1.87±1.01] points; [1.26±0.60] vs. [2.43±0.42] cm; [1.03±0.52] vs. [2.39±0.61] cm） （P<0.05）. The treatment time of the observation group was shorter than that of the control group for （3.62±0.93） vs. （5.29±1.62） d，? the hospital stay was longer than the control group for （12.36±2.95） vs. （10.95±2.57） d， and the hospitalization cost was higher than the control group for （3934.94±530.72） vs. （2938.76±486.81）yuan， the amount of Urokinase was more than that of the control group for （532.95±29.47） vs. （301.84±45.95）×104 U/h （P<0.05）. Conclusion DSA-guided thrombolysis catheter thrombolysis for LEDVT is superior to systemic thrombolytic therapy， which can significantly improve clinical symptoms and promote intravenous recanalization， but also prolong patients′ hospitalization time and increase treatment costs.

[Key words] Deep venous thrombosis of the lower extremity; Digital subtraction angiography guidance; Placement of thrombolysis catheter; Contact thrombolysis

下肢深靜脈血栓形成（LEDVT）指下肢深靜脈管腔內血液因各種原因異常凝結，造成靜脈回流障礙而引發的一系列臨床癥狀[1]。LEDVT多表現為患肢突然腫脹、軟組織張力增高、疼痛等，部分患者可能出現淺靜脈曲張及皮溫改變。迅速恢復靜脈血流、預防血栓脫落以及保護靜脈瓣功能是LEDVT治療的關鍵[2-3]。導管接觸性溶栓可通過將導管插入血栓內部，釋放溶栓藥物，從而提高血栓溶解效果，減少各種并發癥的發生[4-5]。本研究旨在探討導管接觸性溶栓治療LEDVT的臨床價值，并將其與系統性溶栓治療進行比較，現報道如下。

1資料與方法

1.1一般資料

選取2013年5月～2018年12月我院收治100例LEDVT患者。納入標準：①確診為LEDVT[6]，單側發病;②自愿簽署知情同意書;③病程≤30 d。排除標準：①雙側下肢受累或下腔靜脈受累者;②產后相關LEDVT患者。……