不同灌注模式治疗急性髂股静脉血栓的疗效评价

发布时间：2018-08-27 12:53

【摘要】：目的:评价采用不同灌注模式导管接触性溶栓(CDT)治疗急性髂股静脉血栓的疗效。方法:先行动物实验。破坏17只犬后肢髂-股静脉血管内膜后注入凝血酶制作血栓模型,造模成功后行实验侧髂股静脉顺行造影、CT静脉造影。其中1只处死取造模侧髂股静脉血管行病理检查证实血栓形成。一周后实验犬随机分为2个实验组,分别行脉冲注射溶栓及连续滴注溶栓,并于1 h末、2 h末、3 h末经溶栓导管造影观察血管再通情况。对65例急性髂股静脉血栓患者进行CDT治疗,术前随机分为3组:A组:21例,采用脉冲注射;B组:22例,采用连续泵入;C组:22例,采用先脉冲注射再连续泵入。24 h内以相同剂量尿激酶连续溶栓72 h,期间采用血管造影监测血栓溶解情况,观察不同溶栓灌注模式对溶栓疗效及并发症发生率的影响。结果:17只犬全部成功建立髂股静脉血栓。实验侧髂股静脉顺行造影、CTV检查证实静脉内可见充盈缺损影,病理检查也证实髂股静脉血管内血栓形成。动物溶栓实验显示,脉冲注射组溶栓疗效明显优于连续滴注组。临床研究显示,A、B、C组总有效率分别为71.43%、63.64%和77.27%;肢体消肿率分别为(80.00±22.10)%、(67.50±16.40)%和(92.30±15.80)%;静脉通畅度分别为(57.80±18.70)%、(55.60±19.30)%和(70.20±19.80)%。C组溶栓总有效率、肢体消肿率和静脉通畅度均明显高于A、B两组(P均0.01),3组并发症的发生率差异无统计学意义(P0.05)。结论:采用先脉冲注射再连续泵入的溶栓灌注模式进行CDT可作为治疗急性髂股静脉血栓患者的首选灌注方式。
[Abstract]:Objective: to evaluate the efficacy of catheter contact thrombolysis (CDT) in the treatment of acute iliofemoral venous thrombosis. Methods: animal experiment was carried out first. Thrombus model was made by injecting thrombin into the iliofemoral vein intima of hind limb of 17 dogs. The experimental iliofemoral vein angiography and CT venography were performed after the successful establishment of the model. One of them was killed and the thrombosis was confirmed by pathological examination of iliofemoral vein. One week later, the dogs were randomly divided into two experimental groups. The dogs were given pulse thrombolytic therapy and continuous drip thrombolysis respectively. The recanalization of blood vessels was observed by thrombolytic catheter angiography at the end of 1 h and 2 h and 3 h respectively. 65 patients with acute iliac femoral vein thrombosis were treated with CDT. Before operation, they were randomly divided into 3 groups: group A: 21 cases, group B: 22 cases, group C: 22 cases. The thrombolytic effects of different thrombolytic models were observed by continuous infusion of urokinase at the same dose for 72 h after pulse injection and continuous infusion for 72 h, and the effects of different thrombolytic perfusion modes on thrombolytic efficacy and incidence of complications were observed. Results all 17 dogs successfully established iliofemoral venous thrombosis. CTV examination of iliofemoral vein showed filling defect in vein and thrombosis of iliofemoral vein was also confirmed by pathological examination. Animal thrombolytic experiment showed that the thrombolytic effect of pulse injection group was better than that of continuous infusion group. The clinical study showed that the total effective rate of group C was 71.433.64% and 77.27%, the swelling rate of limbs was (80.00 卤22.10), (67.50 卤16.40)% and (92.30 卤15.80), the patency of vein was (57.80 卤18.70), (55.60 卤19.30)% and (70.20 卤19.80). The rate of limb detumescence and the patency of vein were significantly higher than those of group A B (P 0.01). There was no significant difference in the incidence of complications among the three groups (P0.05). Conclusion: thrombolytic perfusion with pulse injection and continuous infusion is the first choice for the treatment of acute iliofemoral venous thrombosis.
【学位授予单位】：南京医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R-332

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