CAJ | 학술논문

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≤7 d者45例,8 ～30 d者9例.B超检测为完全性,无漂浮血栓,下腔静脉无血栓.经导管泵入尿激酶30万U/2 h,2次/d；皮下注射低分子肝素4000 U,2次/d；或持续泵入普通肝素18 U· kg-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≤7 d与8 ～30 d患者相比差异无统计学意义(t=1.02,P=0.34).治疗14 d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.
목적 탐토무려기보호도관용전치료조기좌하지심정맥혈전적괄응증、안전성화료효.방법 2008년7월지2010년6월채용무려기보호B초인도치관용전치료조기좌하지심정맥혈전54례.남성25례,녀성29례,평균년령52.8세.중앙형3례,혼합형51례.병정≤7 d자45례,8 ～30 d자9례.B초검측위완전성,무표부혈전,하강정맥무혈전.경도관빙입뇨격매30만U/2 h,2차/d；피하주사저분자간소4000 U,2차/d；혹지속빙입보통간소18 U· kg-1 ·h-1.결과 기술성공솔100％.용전료정6～10d,용전전평분10.8±1.0,용전후평분4.6±2.1；용전솔(58±18)％,병정≤7 d여8 ～30 d환자상비차이무통계학의의(t=1.02,P=0.34).치료14 d후전유20.4％(11/54),현저호전64.8％ (35/54),호전14.8％ (8/54),총유효솔100％.무증상성폐전새발생,용전전혈양포화도(91.0±2.6)％,용전기간위(90.8±2.4)％,차이무통계학의의(t=2.03,P=0.05).무혈뇨급뇌출혈등병발증,도관감염솔7.4％( 4/54),천자부위유소량출혈20.4％(11/54).수방6 ～21개월,수방솔66.7％ (36/54)；31례환자하지종창완전소실혹활동후경도종창,2례환자활동후종창교명현,다보륵초성제시고정맥판막공능불전,3례복발.결론 대우완전성、무표부혈전、하강정맥무혈전적조기좌하지심정맥혈전,무려기보호도관용전안전유효.
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 thrombolysis[(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 expense.