CAJ | 학술논문

目的探讨抗凝、系统溶栓与导管溶栓治疗下肢急性深静脉血栓形成(DVT)的远期疗效及对深静脉血栓后综合征(PTS)的影响.方法随访2005年1月至2009年12月在中山大学附属第一医院及广州医学院第二附属医院血管外科收治的下肢急性DVT患者(152例)的临床资料,根据治疗方法分为单纯抗凝组(A组)、系统溶栓联合抗凝组(B组)和导管溶栓联合抗凝组(C组).随访时行静脉彩超或下肢顺行静脉造影了解患肢静脉通畅情况,用Villalta评分法调查各组患者PTS的发生率,用CIVIQ-2调查表研究各组患者的生活质量,分析各组患者出院后抗凝时间及弹力袜使用情况.结果 (1)A、B、C3组患者静脉通畅率分别为69.1％、70.8％、85.1％,C组与A组差异有统计学意义(P＜0.05),C组虽然高于B组,但差异尚无统计学意义(P＞0.05),A、B两组间差异无统计学意义(P＞0.05).(2)A、B、C3组PTS的发生率分别为56.8％、54.2％、38.3％,C组与A、B两组间差异有统计学意义(P＜0.05),A、B两组间的差异无统计学意义(P＞0.05).(3)A、B、C3组CIVIQ-2评分为20±14、20±12、17±11,C组较A、B两组分数低,但差异尚无统计学意义(P＞0.05).(4)A、B、C3组出院后平均抗凝及弹力袜时间差异无统计学意义(P＞0.05).结论与单纯抗凝及系统溶栓相比较,导管溶栓联合抗凝能降低急性下肢DVT转归为PTS的发生率,改善临床症状,提高生活质量.
목적 탐토항응、계통용전여도관용전치료하지급성심정맥혈전형성(DVT)적원기료효급대심정맥혈전후종합정(PTS)적영향.방법 수방2005년1월지2009년12월재중산대학부속제일의원급엄주의학원제이부속의원혈관외과수치적하지급성DVT환자(152례)적림상자료,근거치료방법분위단순항응조(A조)、계통용전연합항응조(B조)화도관용전연합항응조(C조).수방시행정맥채초혹하지순행정맥조영료해환지정맥통창정황,용Villalta평분법조사각조환자PTS적발생솔,용CIVIQ-2조사표연구각조환자적생활질량,분석각조환자출원후항응시간급탄력말사용정황.결과 (1)A、B、C3조환자정맥통창솔분별위69.1％、70.8％、85.1％,C조여A조차이유통계학의의(P＜0.05),C조수연고우B조,단차이상무통계학의의(P＞0.05),A、B량조간차이무통계학의의(P＞0.05).(2)A、B、C3조PTS적발생솔분별위56.8％、54.2％、38.3％,C조여A、B량조간차이유통계학의의(P＜0.05),A、B량조간적차이무통계학의의(P＞0.05).(3)A、B、C3조CIVIQ-2평분위20±14、20±12、17±11,C조교A、B량조분수저,단차이상무통계학의의(P＞0.05).(4)A、B、C3조출원후평균항응급탄력말시간차이무통계학의의(P＞0.05).결론 여단순항응급계통용전상비교,도관용전연합항응능강저급성하지DVT전귀위PTS적발생솔,개선림상증상,제고생활질량.
Objective To explore the outcomes of anticoagulation,systematic thrombolysis and catheter-directed thrombolysis (CDT) in the treatment of lower extremity acute deep venous thrombosis (DVT).Methods The clinical data of 152 patients with lower extremity acute DVT from January 2005 to December 2009 were analyzed retrospectively.They were divided into single anticoagulation group (A),systematic thrombolysis plus anticoagulation group (B) and CDT plus anticoagulation group (C).Follow-up studies were performed to inquire about patient symptoms,check the status of affected extremities and examine venous patency with venous ultrasonography or anterograde venous radiography.The incidence rate of post-thrombotic syndrome (PTS) was evaluated with the Villalta score while the quality of life with CIVIQ-2 questionnaire.And the post-discharge anticoagulation time and use of compression stockings were analyzed in each group.Results (1) The venous patency rate was 69.1％,70.8％,85.1％ in groups A,B and C respectively.The differences was significant between groups A and C (P ＜ 0.05).The differences was insignificant between groups C and B (P ＞ 0.05).And the venous patency rate of group C was higher than that of group B.The difference was insignificant between groups A and B (P ＞ 0.05).Such remodeling effects as venous valvular destruction and intravenous wall thickening were observed in PTS patients with venous ultrasonography and anterograde venous radiography.(2) The incidence of PTS was 56.8％,54.2％,38.3％ in groups A,B and C.Compared with groups A and B,the difference was significant in group C (P ＜ 0.05).The difference was insignificant between groups A and B (P ＞ 0.05).(3) CIVIQ-2 score was 20.2 ± 14.4,20.1 ± 12.5,16.6 ± 11.0 in groups A,B and C.Compared with groups A and B,the difference was insignificant in group C (P ＞ 0.05).And it was lower in group C than groups A and B.(4) The differences of average anticoagulant time and compression stocking use were insignificant in 3 groups (P ＞ 0.05).Conclusion Compared with anticoagulant and systematic thrombolysis,a combination of CDT and anticoagulation may reduce the risk for PTS,alleviate clinical symptoms and improve quality of life.