急性髂-股静脉血栓患者行临时下腔静脉放置联合滤器经患肢置管溶栓与经足背溶栓的治疗效果对比观察

doi:10.3969/j.issn.1006-6233.2018.03.017

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摘要 目的: 探讨急性髂-股静脉血栓患者行临时下腔静脉放置联合滤器经患肢置管溶栓与经足背溶栓的治疗效果。方法: 选取2012年3月至2016年3月期间我院收治的急性髂-股静脉血栓患者60例进行回顾性分析,按照治疗方式分为置管溶栓组(n=30)和经足背溶栓组(n=30)。比较患者治疗后的下肢周径变化、肢体消肿率、尿激酶使用量、住院时间、血栓溶解率、溶栓并发症发生情况、远期通畅率及瓣膜功能评估两种治疗方法的临床疗效。结果: 置管溶栓组治疗前、后大腿和小腿的周径差及肢体消肿率均显著高于经足背溶栓组,差异具有统计学意义(P<0.05);置管溶栓组治疗中尿激酶使用量和住院时间明显低于经足背溶栓组,差异具有统计学意义(P<0.05);治疗后2周,置管溶栓组血栓溶解率显著高于经足背溶栓组,而并发症发生率显著低于经足背溶栓组,以上差异均有统计学意义(P<0.05);随访18个月,置管溶栓组静脉通畅率显著高于经足背溶栓组,而血栓后综合征(PTS)发生率和血栓复发率明显低于经足背溶栓组,差异具有统计学意义(P<0.05)。结论: 急性髂-股静脉血栓患者经小隐静脉进行置管溶栓治疗疗效好、治疗时间短、并发症发生率低等优点,值得临床进一步推广应用。

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	黄英杰
	凌永志
	秦梓良

关键词 ：髂-股静脉血栓, 尿激酶, 导管溶栓, 腔静脉滤器, 小隐静脉

Abstract：Objective: To investigate the therapeutic effect of temporary inferior vena cava in the treatment of thrombolytic and transposed thrombolysis in patients with acute iliofemoral vein thrombosis. Methods: From March 2012 to March 2016, 60 patients with acute iliac femoral vein thrombosis in our hospital were retrospectively analyzed. They were divided into catheter thrombolysis group (n=30) and dorsalis pedis thrombolysis group (n=30) according to the treatment. The clinical effects of the two treatment methods were compared after treatment, including the change of the circumference of the lower limbs, the rate of body swelling, the dosage of urokinase, the time of hospitalization, the rate of thrombolysis, the occurrence of thrombolysis, the long-term patency and the valvular function. Results: Catheter circumferential thrombolysis group before and after treatment, thigh and calf circumference difference and limb swelling rate were significantly higher than those in the dorsalis pedis thrombolysis group, the difference was statistically significant (P <0.05). The amount of urokinase and the time of hospitalization in the treatment of thrombolytic therapy were significantly lower than those in the back thrombolytic group (P <0.05). 2 weeks after treatment, the thrombolytic rate in the catheter thrombolysis group was significantly higher than that in the dorsalis pedis thrombolysis group, and the incidence of complications was significantly lower than that in the dorsalis pedis thrombolysis group. The above differences were statistically significant (P <0.05). Follow up for 18 months, venous catheterization rate in catheter thrombolysis group was significantly higher than that in the dorsalis pedis thrombolysis group, while the incidence of thrombotic syndrome (PTS) and thrombosis recurrence rate were significantly lower than those in the dorsalis pedis thrombolysis group, the difference was statistically significant (P <0.05). Conclusion: Thrombolytic therapy via small saphenous vein for patients with acute iliac femoral vein thrombosis has many advantages, such as good curative effect, short treatment time and low incidence of complications. It is worthy of further clinical application.

Key words： Acute iliofemoral deep vein thrombosis Urokinase Catheter-directed thrombolysis Vena cave filters Small saphenous vein

基金资助:广东省惠州市科技计划项目,(编号:20160805)

引用本文:

黄英杰, 凌永志, 秦梓良. 急性髂-股静脉血栓患者行临时下腔静脉放置联合滤器经患肢置管溶栓与经足背溶栓的治疗效果对比观察[J]. 河北医学, 2018, 24(3): 415-419.
HUANG Yingjie, LING Yongzhi, et al. Comparative Analysis of Small Saphenous Vein Thrombolysis by Infusion Catheter and Dorsalis Pedis Vein Directed Thrombolysis in Treatment for Central Venous Thrombosis after Temporary Inferior Vena Cava Filter. HeBei Med, 2018, 24(3): 415-419.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2018.03.017 或 http://www.hbyxzzs.cn/CN/Y2018/V24/I3/415

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