摘要
目的探讨无滤器保护导管溶栓治疗早期左下肢深静脉血栓的适应证、安全性和疗效。方法2008年7月至2010年6月采用无滤器保护B超引导置管溶栓治疗早期左下肢深静脉血栓54例。男性25例，女性29例，平均年龄52．8岁。中央型3例，混合型51例。病程47d者45例，8～30d者9例。B超检测为完全性，无漂浮血栓，下腔静脉无血栓。经导管泵人尿激酶30万U／2h，2次／d；皮下注射低分子肝素4000U，2次／d；或持续泵入普通肝素18U·k^-1·h^-1。结果技术成功率100％。溶栓疗程6～10d，溶栓前评分10．8±1．0，溶栓后评分4．6±2．1；溶栓率（58±18）％，病程47d与8～30d患者相比差异无统计学意义（t=1．02，P=0．34）。治疗14d后痊愈20．4％（11／54），显著好转64．8％（35／54），好转14．8％（8／54），总有效率100％。无症状性肺栓塞发生，溶栓前血氧饱和度（91．0±2．6）％，溶栓期间为（90．8±2．4）％，差异无统计学意义（t=2．03，P=0．05）。无血尿及脑出血等并发症，导管感染率7．4％（4／54），穿刺部位有少量出血20．4％（11／54）。随访6～21个月，随访率66．7％（36／54）；31例患者下肢肿胀完全消失或活动后轻度肿胀，2例患者活动后肿胀较明显，多普勒超声提示股静脉瓣膜功能不全，3例复发。结论对于完全性、无漂浮血栓、下腔静脉无血栓的早期左下肢深静脉血栓，无滤器保护导管溶栓安全有效。
Objective To investigate the indications, safety and efficacy of catheter directed thrombolysis for early left lower extremity deep venous thrombosis （DVT） without vena cava filters protection. Methods Clinical data of 54 cases of early left lower extremity DVT received catheter directed thrombobysis without vena cava filters from July 2008 to June 2010 were retrospectively analyzed. The thrombosis was entire without free floating clots and no thrombosis in vena cava detected with ultrasound scan. Twenty-five patients were male and 29 were female with the average age of 52.8 years. Fifty-one of which were iliofemoral and popliteal, the other 3 were iliofemoral. The course were ≤ 7 d in 45 cases and these were 8 to 30 d in 9 cases. Urokinase of 300 000 U was infused through catheters per 2 h twice a day. Meanwhile 4000 U of low weight heparin was administered subcutaneously per 12 h, or heparin infusion at dosage of 18 U · kg^-1 · h^-1. Results The procedure technically succeeded in all patients. In total cases venous score decreased to 4. 6 ± 2. 1 post 6 to 10 d of thrombolysis from 10. 8 ± 1.0 with thrombolysis rate of 58% ± 18% which was not significantly different between groups of ≤7 d and 8 to 30 d （t = 1.02,P = 0. 34）. On 14th day, 11 patients （20.4%） completely recovered, 35 cases （64. 8% ） experienced large improvement, 8 patients （14. 8% ） had mild improvement and nobody was failed, resulting in total efficacy of 100%. No patient developed clinical symptomatic pulmonary embolism. SpO2 did not alter markedly post thrombolysisE（91.0±2.6）% vs. （90.8 ±2.4）%, t =2.03,P =0.05]. No patients suffered from cerebral hemorrhage and haemoturia, and catheter induced inflammation occurred in 4 cases （7.41%）. There was mild bleeding in puncture sites in 11 patients （20. 4% ） during the course. There were 36 patients （66. 7% ） had been followed up with the time of 6 to 21 months. In which 31 cases had no lower extremity edema or had mild edema after activities. Two patients developed serious edema after activities for deep venous insufficiency. Three cases combined with malignant tumor or renal failure recurred. Conclusions For early left extremity DVT which is entire without free floating clots and no thrombosis in vena cava, catheter directed thrombolysis without filter protection maybe administered with safety, efficiency and lower exoense.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2012年第1期15-18,共4页
Chinese Journal of Surgery
基金
国家自然科学基金资助项目（30860276）
