标题：不同途径置管溶栓治疗急性下肢深静脉血栓临床对照研究

      作者：吴强，覃海航    (河池市第三人民医院颈胸血管外科，广西 河池 547000)

      卷次： 2018年29卷4期

      【摘要】 目的 探究不同途径置管溶栓治疗急性下肢深静脉血栓的临床效果。方法 选取河池市第三人民医院颈胸血管外科2015年3月至2017年3月收治的急性下肢深静脉血栓80例，采取随机数表法分为对照组与观察组，每组40例，对照组给予周围静脉置管，观察组给予深静脉置管，连续治疗1周，比较两组患者治疗后的血管开通人数，治疗前后Porter评分、大腿及小腿患侧、健侧的周径差值以及并发症发生率。结果 观察组患者的血管开通率为87.5%，明显高于对照组的65.0%，并发症发生率为7.5%，明显低于对照组的25.0%，差异均有统计学意义(P<0.05)；对照组患者治疗前的Porter评分为(9.3±2.2)分，治疗后Porter评分为(5.9±2.1)分，观察组治疗前Porter评分为(9.2±2.5)分，治疗后Porter评分为(3.5±1.2)分，两组患者治疗后与治疗前相比Porter评分均降低，观察组治疗后与对照组治疗后相比Porter评分降低更加显著，差异有统计学意义(P<0.05)；对照组患者大腿患侧-健侧周径差治疗前为(5.6±2.1) cm、治疗后为(2.2±0.7) cm，小腿患侧-健侧周径差治疗前为(4.3±1.7) cm、治疗后为(1.4±1.6) cm，观察组大腿患侧-健侧周径差治疗前为(5.7±1.9) cm、治疗后为(2.1±0.8) cm，小腿患侧-健侧周径差治疗前为(4.4±1.8) cm、治疗后为(1.5±1.7) cm，两组治疗后与治疗前相比大腿及小腿患侧、健侧的周径差值均缩小，差异均有统计学意义(P<0.05)；两组治疗后大腿及小腿患侧、健侧的周径差值比较差异均无统计学意义(P>0.05)。结论 周围静脉置管及深静脉置管治疗急性下肢静脉深静脉血栓均可取得显著的疗效，但深静脉置管相比于周围静脉置管能够获得更好的静脉通畅率，并发症发生率较低，且安全性较高。
      【关键词】 周围静脉置管；深静脉置管；急性下肢深静脉血栓；疗效
      【中图分类号】 R658.3 【文献标识码】 A 【文章编号】 1003—6350（2018）04—0477—03

Clinical study of different approaches for catheter-directed thrombolysis in treatment of acute lower extremitydeep vein thrombosis.
WU Qiang, QIN Hai-hang. Department of Cervical Thoracic Vascular Surgery, the Third People'sHospital of Hechi City, Hechi 547000, Guangxi, CHINA
【Abstract】 Objective To study the clinical effect of different approaches for catheter-directed thrombolysis intreatment of acute lower extremity deep vein thrombosis. Methods From March 2015 to March 2017, 80 patients withacute lower extremity deep vein thrombosis treated in Department of Cervical Thoracic Vascular Surgery, the Third Peo-ple's Hospital of Hechi City were selected and divided into control group and observation group by random number ta-ble, with 40 cases in each group. The control group was given peripheral venipuncture, and the observation group wasgiven deep venipuncture, continuously for 1 week. The number of patients with vascular patency after treatment, Porterscore before and after the treatment, circumference difference between affected side and healthy side of thigh and shin,and the incidence of complications were compared between the two groups. Results The vascular patency rate was87.5% in the observation group, significantly higher than 65.0% in the control group (P<0.05), and the incidence of com-plications was 7.5% in the observation group, significantly lower than 25.0% in the control group (P<0.05). The Porterscores before and after treatment were (9.3±2.2) and (5.9±2.1) in the control group, (9.2±2.5) and (3.5±1.2) in the obser-vation group. The scores after treatment in the two groups were significantly lower compared with those before treat-ment, and the decrease in the observation group was more significant (P<0.05). In the control group, the circumference dif-ference between affected side and healthy side of thigh was (5.6±2.1) cm before treatment versus (2.2±0.7) cm after treat-ment (P<0.05), and that of shin was (4.3±1.7) cm versus (1.4±1.6) cm (P<0.05), with (5.7±1.9) cm versus (2.1±0.8) cm(P<0.05), (4.4±1.8) cm versus (1.5±1.7) cm (P<0.05) in the observation group, respectively. The circumference differencesafter treatment showed no significant difference between the two groups (P>0.05). Conclusion Peripheral venipunctureand deep venipuncture in treatment of acute lower extremity deep vein thrombosis can obtain significant curative effect,but deep venipuncture can achieve higher vascular patency rate, lower incidence of complications, and higher safety.
      【Key words】 Peripheral venipuncture; Deep venipuncture; Acute lower extremity deep vein thrombosis; Clinicaleffect·论 著·doi:10.3969/j.issn.1003-6350.2018.04.010