机械性血栓抽吸和置管溶栓对87例急性中央型下肢深静脉血栓静脉功能的影响

doi:10.6040/j.issn.1671-7554.0.2019.969

摘要/Abstract

摘要： 目的回顾性分析机械性血栓抽吸与置管溶栓(CDT)对急性中央型下肢深静脉血栓静脉功能的影响。方法选取2015年1月至2017年1月急性中央型深静脉血栓(DVT)患者87例,其中男45例,女42例。血栓抽吸组39例,采用大导管或者鞘管行血栓抽吸,术后辅以小剂量尿激酶溶栓治疗。CDT组48 例,采用溶栓导管行血栓接触式溶栓,比较两组治疗后6个月,1、2年的股浅静脉有效内径、股浅静脉第一对瓣膜血液返流时间、返流距离和出院后血栓后综合征(PTS)的发生概率。结果术后数据分析显示,两组间股浅静脉直径差异有统计学意义(F_处理=10 197.500, P<0.001),治疗后6个月,1、2年间差异有统计学意义(F时间=442.770,P<0.001),同时处理方法与时间因素间存在协同的交互效应(F处理×时间=317.749,P<0.001)。两组间股浅静脉瓣膜返流时间差异有统计学意义(F处理=14 529.193, P<0.001),治疗后6个月,1、2年差异有统计学意义(F时间=670.189,P<0.001),同时处理方法与时间因素间存在协同的交互效应(F_{处理×时间}=501.604,P<0.001)。两组间股浅静脉血液返流距离差异有统计学意义(F处理=4 842.897, P<0.001),治疗后6个月,1、2年间差异有统计学意义(F_时间=413.343,P<0.001),同时处理方法与时间因素间存在协同的交互效应(F_{处理×时间}=313.582,P<0.001)。在随访期内,CDT组PTS发生概率［35.42%(17/48)］与血栓抽吸组［15.40%(6/39)］差异有统计学意义(χ2=106.350,P<0.001)。结论机械性血栓抽吸可以早期扩大股浅静脉有效管腔,减轻瓣膜处血液返流时间和距离,降低远期PTS发生概率,较CDT可以有效保护静脉功能。

关键词: 血栓抽吸, 置管溶栓, 下肢深静脉血栓, 下肢静脉功能

Abstract: Objective To explore the effects of mechanical thrombus aspiration and catheter-directed thrombolysis(CDT)on venous function of acute central deep venous thrombosis(DVT). Methods A total of 87 patients with acute central DVT treated during Jan. 2015 and Jan. 2017 were selected, including 45 males and 42 females. The patients were divided into 2 groups: mechanical group(n=39, thrombus aspiration with big catheter or sheath, supplemented with small dose of urokinase after operation), and CDT group(n=48). The effective internal diameter of superficial femoral vein(SFV), time of blood regurgitation of the first valve in SFV, reflux distance, and incidence of post-discharge postthrombotic syndrome(PTS)were compared 6 months, 1 year and 2 years after treatment. Results There 山东大学学报 (医学版)58卷1期 -孙鑫国,等. 机械性血栓抽吸和置管溶栓对87例急性中央型下肢深静脉血栓静脉功能的影响 \=-was significant difference in the diameter of SFV between the two groups(Ftreatment=10 197.500, P<0.001), the differences 6 months, 1 year and 2 years were statistically significant(F_time=442.770, P<0.001), and there was a synergistic interaction effect between the treatment method and time(F_{treatment×time}=317.749, P<0.001). There was significant difference in valvular regurgitation time between the two groups(F_treatment=14 529.193, P<0.001), the differences 6 months, 1 year and 2 years were significant(F_time=670.189, P<0.001), and there was a synergistic interaction effect between treatment method and time(F_{treatment×time}=501.604, P<0.001). There was significant difference in reflux distance between the two groups(F_treatment=4 842.897, P<0.001), the differences 6 months, 1 year and 2 years were significant(F_time=413.343, P<0.001), and there was a synergistic interaction effect between the treatment method and time(F_{treatment×time}=313.582, P<0.001). The incidence of PTS was ［35.42%(17/48)］ in CDT group, and ［15.40%(6/39)］ in the mechanical group, with statistical difference(χ2=106.350, P<0.001). Conclusion Mechanical thrombus aspiration can expand the cavity of SFV in the early stage, reduce the time and distance of blood reflux at the valve, reduce the incidence of long-term PTS, and better protect the venous function compared with CDT.

Key words: Thrombus aspiration, Catheterization, Deep venous thrombosis of lower extremities, Venous function of lower extremities

中图分类号:

R543.6

孙鑫国,陈堃昊,胡章,邓小军,段诗姣,谢卫华,鄢琼,张宏文. 机械性血栓抽吸和置管溶栓对87例急性中央型下肢深静脉血栓静脉功能的影响[J]. 山东大学学报 (医学版), 2020, 58(1): 26-30.

SUN Xinguo, CHEN Kunhao, HU Zhang, DENG Xiaojun, DUAN Shijiao, XIE Weihua, YAN Qiong, ZHANG Hongwen. Effects of mechanical thrombus aspiration and catheter-directed thrombolysis on venous function in 87 cases of acute central deep venous thrombosis of lower extremity[J]. Journal of Shandong University (Health Sciences), 2020, 58(1): 26-30.

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