摘要
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Wileoxon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X^2检验进行统计分析。结果治疗前2组膝上20cm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15cm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）×10^6 U和4．100（3．600，5．050）×10^6 U，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（X^2=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（X^2=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元增加。
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 stagewere 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 circumference difference between normal and affected 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 pateney 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） × 10^6U in Group A and 4. 100 （3. 600, 5. 050） ×10^6U 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 （X^2 = 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 （ X^2 = 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.
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2012年第6期561-566,共6页
Chinese Journal of Radiology
