不同溶栓技术治疗急性下肢深静脉血栓形成患者的疗效及对大小腿患健肢周径差血浆D-二聚体 蛋白C 蛋白S水平的影响

doi:10.3969/j.issn.1006-6233.2021.04.015

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摘要 目的: 探讨不同溶栓技术治疗急性下肢深静脉血栓形成(DVT)患者的疗效及对大小腿患健肢周径差、血浆D-二聚体(D-D)、蛋白C(PC)、蛋白S(PS)水平的影响。方法: 按照1:1配对原则回顾性收集2017年6月至2020年6月我院收治的128例采用不同手术方案治疗的急性DVT患者的临床资料,分别设为A组(n=32,行腘静脉顺行溶栓)、B组(n=32,行经大隐静脉顺行溶栓)、C组(n=32,行逆行溶栓)、D组(n=32,行全身溶栓)。统计四组围手术期情况、并发症发生率、血栓形成后综合征(PTS)发生率及术前、术后7d大小腿患健侧周径差、血浆D-D、PC、PS水平、下肢深静脉血流动力学。结果: A组溶栓时间、症状消退时间短于B组、C组、D组,且B组、C组短于D组,静脉通畅率高于B组、C组、D组,且B组、C组高于D组(P<0.05);术后7d A组大小腿患健侧周径差小于B组、C组、D组,且B组、C组小于D组(P<0.05);术后7d A组血浆D-D水平低于B组、C组、D组,PC、PS高于B组、C组、D组,B组、C组血浆D-D水平低于D组,PC、PS高于D组(P<0.05);术后7d A组股静脉、腘静脉血流速度大于B组、C组、D组,B组、C组股静脉、腘静脉血流速度大于D组(P<0.05);四组并发症发生率及术后1个月PTS发生率比较,无显著差异(P＞0.05)。结论: 导管接触溶栓(CDT)治疗急性DVT,在症状消退时间、溶栓时间、静脉通畅率、小腿患健肢周径差、下肢深静脉血流动力学、血浆D-D、PC、PS水平等方面较全身溶栓更具优势,其中又以腘静脉顺行溶栓效果最好。

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关键词 ：溶栓, 急性下肢深静脉血栓形成, 患健肢周径差, D-二聚体, 蛋白C, 蛋白S

Abstract：Objective: To investigate the efficacy of different thrombolytic techniques in the treatment of patients with acute deep venous thrombosis (DVT) of lower extremity and the effects on the circumference difference of the affected and healthy the legs and the plasma D-dimer (D-D), protein C (PC) and protein S (PS) levels.Methods: According to the 1:1 matching principle, the clinical data of 128 patients with acute DVT treated in our hospital from June 2017 to June 2020 who were treated with different surgical plans were collected retrospectively. They were divided into group A (n=32, anterograde popliteal vein thrombolysis), group B (n=32, anterograde saphenous vein thrombolysis), group C (n=32, retrograde thrombolysis), and group D (n=32, systemic thrombolysis). The perioperative conditions, the incidence of complications, and the incidence of post-thrombotic syndrome (PTS), the circumference difference of the affected and healthy the legs, the plasma D-D, PC, PS levels, and the hemodynamics of the deep veins of the lower limbs before and 7 days after the operation in the four groups were counted. Results: The thrombolytic time and symptom resolution time of group A were shorter than those of group B, C, and D, and group B and C were shorter than group D. The patency rate of vein was higher than that of group B, C, and D, and group B and C were higher than group D (P<0.05). At 7 days after operation, the circumference difference of the affected and healthy the legs in group A was smaller than that of group B, C, and D, and group B and C were smaller than that of group D (P<0.05). Plasma DD levels in group A were lower than groups B, C, and D at 7 days postoperatively, PC and PS were higher than groups B, C, and D. The plasma D-D levels in groups B and C were lower than those in group D, and PC and PS were higher than those in group D (P<0.05). At 7 days after operation, the blood flow velocity of femoral vein and popliteal vein in group A was greater than that of group B, C, and D, and the blood flow velocity of femoral vein and popliteal vein of group B and C was greater than that of group D (P<0.05). There was no significant difference in the incidence of complications in the four groups and the incidence of PTS at 1 month after operation (P＞0.05). Conclusion: Catheter-directed thrombolysis (CDT) in the treatment of acute DVT is more advantageous than systemic thrombolysis in terms of symptom resolution time, thrombolysis time, venous patency rate, circumference difference of the affected and healthy the legs, hemodynamics of the deep veins of the lower limbs, plasma D-D, PC, and PS levels, among which anterograde thrombolysis of popliteal vein has the best effect.

Key words： Thrombolysis Acute deep vein thrombosis of the lower extremities Circumference difference of the affected and healthy the legs D-dimer Protein C Protein S

基金资助:2018年河北省承德市科学技术研究与发展计划项目,(编号:201801A034)

引用本文:

张青云, 丁萌, 景阳, 高建国, 杨植. 不同溶栓技术治疗急性下肢深静脉血栓形成患者的疗效及对大小腿患健肢周径差血浆D-二聚体蛋白C 蛋白S水平的影响[J]. 河北医学, 2021, 27(4): 592-598.
ZHANG Qingyun, DING Meng, JING Yang, et al. The Efficacy of Different Thrombolytic Techniques in Treating Acute Deep Vein Thrombosis of Lower Lime and the Effects on Circumference Difference of the Affected and Normal Limbs and Plasma D-D PC PC and PS Levels. HeBei Med, 2021, 27(4): 592-598.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2021.04.015 或 http://www.hbyxzzs.cn/CN/Y2021/V27/I4/592

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