下肢深静脉血栓手术取栓及介入溶栓疗效比较

下肢深静脉血栓手术取栓及介入溶栓疗效比较 下肢深静脉血栓手术取栓及介入溶栓疗效 比较 [摘要] 目的,探讨下肢深静脉血栓碎栓溶栓与介入溶栓的临床疗效。方法,回顾性分析我院2006年6月~2010年3月收治的64例下肢深静脉血栓患者临床资料。根据我院采用的治疗方法不同,将其分为对照组和观察组。对照组40例给予碎栓溶栓,观察组24例给予介入溶栓治疗。比较两组的临床疗效、并发症及住院时间。随访1年后,比较两组的复发率和后遗症。结果,与对照组相比,观察组的治愈率和总有效率高于对照组,62.50% vs 37.50%,95.83% vs 82.50%,,差异均有高度统计学意义,χ2=53.94、90.65,均P,0.01,,无效率及并发症发生率低于对照组,4.17% vs 17.50%,9.38% vs 37.50%,,差异均有高度统计学意义,χ2=22.95、37.28,均P,0.01,,观察组的住院时间和复发率低于对照组[,7.9?3.8,d vs ,15.3?5.9,d,0 vs 12.50%],差异均有统计学意义,t=2.854,χ2=12.96,均P,0.05,。结论,介入置管溶栓术治疗下肢深静脉血栓,临床疗效显著,并发症少,复发率低,值得在基层医院推广应用。 [关键词] 下肢深静脉血栓,碎栓溶栓,介入溶栓 1 [中图分类号] R654.4 [文献标识码] , [文章编号] 1673-7210,2011,11,c,-052-02 Curative effect comparison of broken bolt thrombolysis and intervention thrombolysis in lower limb deep vein thrombosis HE Zhijian The First People′s Hospital of Foshan City, Guangdong Province; Foshan 528000, China [Abstract] Objective: To explore curative effect of broken bolt thrombolysis and intervention thrombolysis in lower limb deep vein thrombosis. Methods: The clinical data of 64 cases with lower limb deep vein thrombosis were analyzed from June 2006 to March 2010. According to the different methods of our treatment, they were divided into in the control group and the observation group. 40 patients in the control group were given broken bolt thrombolytic, 24 cases in the observation group were given intervention thrombolytic. The clinical curative effect, complications, and length of hospitalization of the two groups were compared. Follow-up 1 year, the recurrence rate and complications of the two groups were compared. Results: Compared with the control group, the cure rate 2 and effective rate of the observation group were higher (62.50% vs 37.50%, 95.83% vs 82.50%; χ2=53.94, 90.65, all P,0.01), no efficiency and complication was significantly lower (4.17% vs 17.50%, 9.38% vs 37.50%; χ2=22.95, 37.28, all P,0.01), the hospital stays and the recurrence rate of observation group was significantly lower than those of the control group [(7.9?3.8)d vs (15.3?5.9)d, 0 vs 12.50%; t=2.854, χ2=12.96, all P,0.05]. Conclusion: The clinical curative effect of intervention thrombolytic in treating deep vein thrombosis is distinct, less complications, the recurrence rate is lower, so it is worth popularizing widely in basic-level hospitals. [Key words] Lower limb deep vein thrombosis; Broken bolt thrombolysis; Intervention thrombolytic 下肢深静脉血栓形成,deep vein thrombosis,DVT,是 一种周围血管病,为临床上常见和多发病,常发生于长期卧 床的患者[1]。目前国内外尚无满意的治疗方法,而清除静脉 内血栓的有效方法是介入溶栓和手术取栓治疗[2],两种方法 各有其优缺点。目前治疗下肢深静脉血栓多采用介入治疗, 为了更好地治疗下肢深静脉血栓,我院自2006年6月将下 肢深静脉血栓碎栓溶栓与介入溶栓的疗效进行比较,现报道 如下, 3 1 资料与方法 1.1 一般资料 选取我院2006年6月~2010年3月收治的64例下肢深静脉血栓患者,均经临床症状、体征和彩超给予确诊。根据我院采用的治疗方法不同,将其分为对照组和观察组。对照组40例中,男17例,女23例,年龄26~72岁,平均,50.4?6.5,岁,病程2 h~5 d,平均,2.1?0.5,d,诱因包括外伤10例,长期卧床18例,手术12例。观察组24例中,男10例,女14例,年龄25~72岁,平均,50.8?5.9,岁,病程为3 h~5.5 d,平均,2.2?0.8,d,诱因包括外伤5例,长期卧床12例,手术7例。两组患者性别比、年龄、病程及诱因比例比较,差异无统计学意义,P,0.05,,具有可比性。 1.2 方法 对照组给予碎栓溶栓。术前常规放置下腔静脉滤器。局麻后,患者取仰卧位,经同侧大隐静脉穿刺,置入8F短鞘管,内置入6F长鞘管,吸取髂股静脉内血栓,再用球囊捣碎髂股静脉内血栓并扩张成型,远端小腿大腿的血栓经挤压患肢,大部分血栓及部分碎栓子脱落掉落在滤网内后,再经过同侧足背静脉给予尿激酶溶栓总量100万~200万U,分2~3次给药。 4 观察组给予介入溶栓治疗。术前常规放置下腔静脉滤器。经健侧髂静脉穿刺,经鞘管置入5F多侧孔溶栓导管,然后置入患侧髂股静脉管腔内,经溶栓导管和鞘管泵入尿激酶100万~200万U,肝素30~50 mg/d,体重0.5~1.0 mg/kg,,持续静滴,溶栓时间12~15 d,期间每4天经溶栓导管及导管鞘造影,根据血栓溶解的程度适度地调整溶栓导管的位置,并加以固定。 1.3 随访 门诊复查或电话随访。随访间隔为1年,随访项目包括复发及后遗症。 1.4 疗效 根据参照文献[3]制订下肢DVT的疗效评价标准。治愈,症状消失,无水肿,下肢对应部位周径差?0.5 cm,造影或多普勒超声证实静脉通畅。显效,症状明显减轻,水肿减退但周径差为0.5~3.0 cm,造影或多普勒超声显示有血栓残留。无效,症状无明显减轻,水肿明显,下肢对应部位周径差>3.0 cm,造影或多普勒超声证实患肢静脉仍闭塞。总有效=治愈+显效。 5 后遗症,主要包括色素沉着、静脉曲张及间歇性跛行等。 1.5统计学方法 采用SPSS 17.0统计软件处理,计量资料数据以均数?标准差,x?s,示,比较采用t检验,计数资料进行χ2检验,以P 6