目的 研究球囊扩张辅助经导管直接溶栓(CDT)治疗急性下肢深静脉血栓形成(DVT)的疗效及安全性.方法 回顾性分析连续收治的94例急性下肢DVT患者的临床资料.A组为2008年9月至2009年8月收治的病例,共50例,行单纯CDT；B组为2009年9月至2011年5月收治的病例,共44例,行球囊扩张辅助CDT.以治疗前后健侧和患侧下肢周径差、静脉通畅度评分、静脉通畅率评价治疗效果.比较2组尿激酶用量及溶栓导管留置时间.以肺栓塞、出血并发症的发生率评价治疗的安全性.用超声和(或)血管造影随访静脉通畅率.正态分布的计量资料用(x)±s表示,采用成组设计t检验和配对t检验进行统计分析；非正态分布的计量资料用四分位数法表示[中位数(25％位数,75％位数)],采用配对样本比较的Wilcoxon符号秩检验和两个独立样本比较的Wilcoxon 秩和检验；计数资料用率表示,采用x2检验进行统计分析.结果 治疗前2组膝上20 cm处健侧和患侧周径差分别为(5.37±1.97)cm和(5.41±2.22) cm,差异无统计学意义(t=-0.113,P=0.910)；治疗后分别为(2.96±1.10)cm和(1.78±1.40)cm,差异有统计学意义(t=4.66,P＜0.01).治疗前2组膝下15 cm处健侧和患侧周径差分别为(4.14±1.57)cm和(4.05±1.61)cm,差异无统计学意义(t =0.288,P =0.774)；治疗后分别为(1.93±0.84) cm和(1.41±1.17)cm,差异有统计学意义(t=2.548,P=0.012).治疗前2组静脉通畅度评分分别为9.0(8.0,10.0)分和8.3(7.0,10.0)分,差异无统计学意义(Z=-1.5172,P=0.1292)；治疗后分别为3.5(2.0,5.0)分和0(0,1.0)分,差异有统计学意义(Z=- 5.7702,P＜0.01).治疗结束时2组平均静脉通畅率分别为55.0％ (42.3％,72.4％)和100％ (88.5％,100％),差异有统计学意义(Z=4.9148,P＜0.01).2组尿激酶用量分别为5.950(5.525,7.225)×106 U和4.100(3.600,5.050) ×106U,差异有统计学意义(Z=-6.0133,P＜0.01).2组溶栓导管留置时间分别为10(9,12)d和6(5,7)d,差异有统计学意义(Z=-8.0358,P＜0.01).2组皆无症状性肺栓塞发生.2组出血并发症发生率分别为38.0％ (19/50)和22.3％( 10/44),差异无统计学意义(x2=2.5590,P=0.1097).2组临时滤器取出率分别为88.37％(38/43)和100％ (39/39),差异有统计学意义(x2 =4.829,P =0.028).末次随访时平均静脉通畅率分别为50.0％(44.4％,59.2％)和95.4％ (83.6％,100％),差异有统计学意义(Z=- 3.2721,P=0.0011).结论 在下腔静脉滤器保护下,球囊扩张辅助的CDT治疗急性下肢DVT较单纯CDT,溶栓效果好、尿激酶用量少、肺栓塞并发症发生率并无增加.
目的 研究毬囊擴張輔助經導管直接溶栓(CDT)治療急性下肢深靜脈血栓形成(DVT)的療效及安全性.方法 迴顧性分析連續收治的94例急性下肢DVT患者的臨床資料.A組為2008年9月至2009年8月收治的病例,共50例,行單純CDT；B組為2009年9月至2011年5月收治的病例,共44例,行毬囊擴張輔助CDT.以治療前後健側和患側下肢週徑差、靜脈通暢度評分、靜脈通暢率評價治療效果.比較2組尿激酶用量及溶栓導管留置時間.以肺栓塞、齣血併髮癥的髮生率評價治療的安全性.用超聲和(或)血管造影隨訪靜脈通暢率.正態分佈的計量資料用(x)±s錶示,採用成組設計t檢驗和配對t檢驗進行統計分析；非正態分佈的計量資料用四分位數法錶示[中位數(25％位數,75％位數)],採用配對樣本比較的Wilcoxon符號秩檢驗和兩箇獨立樣本比較的Wilcoxon 秩和檢驗；計數資料用率錶示,採用x2檢驗進行統計分析.結果 治療前2組膝上20 cm處健側和患側週徑差分彆為(5.37±1.97)cm和(5.41±2.22) cm,差異無統計學意義(t=-0.113,P=0.910)；治療後分彆為(2.96±1.10)cm和(1.78±1.40)cm,差異有統計學意義(t=4.66,P＜0.01).治療前2組膝下15 cm處健側和患側週徑差分彆為(4.14±1.57)cm和(4.05±1.61)cm,差異無統計學意義(t =0.288,P =0.774)；治療後分彆為(1.93±0.84) cm和(1.41±1.17)cm,差異有統計學意義(t=2.548,P=0.012).治療前2組靜脈通暢度評分分彆為9.0(8.0,10.0)分和8.3(7.0,10.0)分,差異無統計學意義(Z=-1.5172,P=0.1292)；治療後分彆為3.5(2.0,5.0)分和0(0,1.0)分,差異有統計學意義(Z=- 5.7702,P＜0.01).治療結束時2組平均靜脈通暢率分彆為55.0％ (42.3％,72.4％)和100％ (88.5％,100％),差異有統計學意義(Z=4.9148,P＜0.01).2組尿激酶用量分彆為5.950(5.525,7.225)×106 U和4.100(3.600,5.050) ×106U,差異有統計學意義(Z=-6.0133,P＜0.01).2組溶栓導管留置時間分彆為10(9,12)d和6(5,7)d,差異有統計學意義(Z=-8.0358,P＜0.01).2組皆無癥狀性肺栓塞髮生.2組齣血併髮癥髮生率分彆為38.0％ (19/50)和22.3％( 10/44),差異無統計學意義(x2=2.5590,P=0.1097).2組臨時濾器取齣率分彆為88.37％(38/43)和100％ (39/39),差異有統計學意義(x2 =4.829,P =0.028).末次隨訪時平均靜脈通暢率分彆為50.0％(44.4％,59.2％)和95.4％ (83.6％,100％),差異有統計學意義(Z=- 3.2721,P=0.0011).結論 在下腔靜脈濾器保護下,毬囊擴張輔助的CDT治療急性下肢DVT較單純CDT,溶栓效果好、尿激酶用量少、肺栓塞併髮癥髮生率併無增加.
목적 연구구낭확장보조경도관직접용전(CDT)치료급성하지심정맥혈전형성(DVT)적료효급안전성.방법 회고성분석련속수치적94례급성하지DVT환자적림상자료.A조위2008년9월지2009년8월수치적병례,공50례,행단순CDT；B조위2009년9월지2011년5월수치적병례,공44례,행구낭확장보조CDT.이치료전후건측화환측하지주경차、정맥통창도평분、정맥통창솔평개치료효과.비교2조뇨격매용량급용전도관류치시간.이폐전새、출혈병발증적발생솔평개치료적안전성.용초성화(혹)혈관조영수방정맥통창솔.정태분포적계량자료용(x)±s표시,채용성조설계t검험화배대t검험진행통계분석；비정태분포적계량자료용사분위수법표시[중위수(25％위수,75％위수)],채용배대양본비교적Wilcoxon부호질검험화량개독립양본비교적Wilcoxon 질화검험；계수자료용솔표시,채용x2검험진행통계분석.결과 치료전2조슬상20 cm처건측화환측주경차분별위(5.37±1.97)cm화(5.41±2.22) cm,차이무통계학의의(t=-0.113,P=0.910)；치료후분별위(2.96±1.10)cm화(1.78±1.40)cm,차이유통계학의의(t=4.66,P＜0.01).치료전2조슬하15 cm처건측화환측주경차분별위(4.14±1.57)cm화(4.05±1.61)cm,차이무통계학의의(t =0.288,P =0.774)；치료후분별위(1.93±0.84) cm화(1.41±1.17)cm,차이유통계학의의(t=2.548,P=0.012).치료전2조정맥통창도평분분별위9.0(8.0,10.0)분화8.3(7.0,10.0)분,차이무통계학의의(Z=-1.5172,P=0.1292)；치료후분별위3.5(2.0,5.0)분화0(0,1.0)분,차이유통계학의의(Z=- 5.7702,P＜0.01).치료결속시2조평균정맥통창솔분별위55.0％ (42.3％,72.4％)화100％ (88.5％,100％),차이유통계학의의(Z=4.9148,P＜0.01).2조뇨격매용량분별위5.950(5.525,7.225)×106 U화4.100(3.600,5.050) ×106U,차이유통계학의의(Z=-6.0133,P＜0.01).2조용전도관류치시간분별위10(9,12)d화6(5,7)d,차이유통계학의의(Z=-8.0358,P＜0.01).2조개무증상성폐전새발생.2조출혈병발증발생솔분별위38.0％ (19/50)화22.3％( 10/44),차이무통계학의의(x2=2.5590,P=0.1097).2조림시려기취출솔분별위88.37％(38/43)화100％ (39/39),차이유통계학의의(x2 =4.829,P =0.028).말차수방시평균정맥통창솔분별위50.0％(44.4％,59.2％)화95.4％ (83.6％,100％),차이유통계학의의(Z=- 3.2721,P=0.0011).결론 재하강정맥려기보호하,구낭확장보조적CDT치료급성하지DVT교단순CDT,용전효과호、뇨격매용량소、폐전새병발증발생솔병무증가.
Objective To investigate the efficacy and safety of balloon-assisted catheter directed thrombolysis (CDT) for acute lower extremity deep vein thrombosis (DVT).Methods From September 2008 to February 2011,94 patients with acute lower extremity DVT were admitted.The cases in early stage were treated by CDT (Group A,n =50),and the cases in late stage were treated by balloon-assisted CDT ( Group B,n =44).The clinical data of these patients were retrospectively analyzed.The circumference difference between normal and affected limbs,scores of venous patency,and rates of venous patency were recorded for judging the efficacy.The total dose of urokinase and retention time of infusion catheter was compared between the two groups.The incidence of pulmonary embolism and bleeding were used to judge the safety of treatment.The venous patency was followed up by ultrasound or/and venography.Measurement data with normal distribution was described by mean + standard,and was analyzed using T test.Measurement data with non-normal distribution was described by M ( QL,QU ),QL =P25,QU =P75,and was analyzed using Wilcoxon' s test.Categorical variable data was analyzed using Chi-Square test Results The prior treatment circunfference difference between normal and affectéd limbs were (5.37 ±1.97) cm (thigh) & (4.14 ± 1.57) cm (calf) in Group A and (5.41±2.22) cm (thigh) & (4.05 ±1.61) cm (calf) in Group B ; and the difference between the groups was insignificant ( thigh:t =- 0.113,P=0.910; calf:t =0.288,P =0.774).The post treatment correspondences were:(2.96 ± 1.10) cm (thigh) & ( 1.93 ± 0.84 ) cm (calf) in Group A and ( 1.78 ± 1.40) cm ( thigh ) & ( 1.41± 1.17 ) cm (calf) in Group B; the difference between the groups was significant (thigh:t =4.66,P ＜0.0001; calf:t =2.548,P =0.012 ).The prior treatment score of venous patency was 9 (8,10) in Group A and 8.3(7,10) in Group B without significant difference (Z =- 1.5172,P =0.1292).The post treatment score of venous patency was 3.5 ( 2,5 ) in Group A and 0 ( 0,1) in Group B with significant difference ( Z =-5.7702,P ＜0.01).The rate of venous patency after the treatment was 55.0％ (42.3％,72.4％ ) in Group A and 100％ (88.5％,100％ ) in Group B,with significant difference ( Z =4.9148,P ＜ 0.01).The total dose of urokinase used in the treatment was 5.950 ( 5.525,7.225 ) × 106U in Group A and 4.100 (3.600,5.050) × 106U in Group B with significant difference (Z =-6.0133,P ＜ 0.01).The retention time of perfusion catheter was 10 (9,12) d in Group A and 6 (5,7) d in Group B with significant difference ( Z =- 8.0358,P ＜ 0.01).No symptomatic pulmonary embolism occurred in both groups during the treatment and follow-up period.The rate of bleeding complication was 38.0％ (19/50) in Group A and 22.3％ (10/44) in Group B,without significant difference (x2 =2.5590,P =0.1097 ).The removal rate of optional filter was 88.37％ (38/43) in Group A and 100％ (39/39) in Group B,with significant difference ( x2 =4.829,P =0.028 ).The rate of venous patency at the last follow-up point was 50.0％ (44.4％,59.2％ ) in Group A,and 95.4％ (83.6％,100％ ) in Group B,with significant difference (Z =- 3.2721,P =0.0011).Conclusions Balloon-assisted CDT was a promising treatment for acute lower-extremity DVT.It improved the effect of thrombolysis and reduced the dosage of urokinase,and did not increase the risk of pulmonary embolism.
