超声微泡造影剂治疗下肢深静脉血栓的初步临床研究

发布时间：2018-03-18 09:40

  本文选题：下肢深静脉血栓　切入点：血栓抽吸术　出处：《广州中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:比较机械性血栓抽吸术与超声微泡造影剂联合机械性血栓抽吸术治疗急性期中央型下肢深静脉血栓形成(LEDVT)患者的疗效,评估超声微泡造影剂辅助血栓抽吸术治疗下肢深静脉血栓的临床应用价值。方法:收集2015年6月-2016年11月在我院微创介入科就诊的符合纳入标准的下肢深静脉血栓形成患者50例,采取随机数字表法将患者分成实验组(超声微泡+血栓抽吸术治疗组)和对照组(血栓抽吸术治疗组),每组25例。对照组接受血栓抽吸术治疗,包括常规抗凝、溶栓和下腔静脉滤器植入;实验组在血栓抽吸治疗的基础上加超声微泡溶栓治疗。临床疗效的评价包括:(1)比较患者术前、术后3天、术后7天患侧和健侧膝关节上、下15cm处周径差;(2)根据术后静脉造影表现的血栓清除率评价机械性血栓抽吸的效果;(3)采用Villalta评分评价随访患者出院后4周、12周不同程度的PTS的发病情况。结果:治疗前,对2组患者的性别、年龄、病程天数、发病部位等一般资料进行统计学分析,组间差异无统计学意义(P0.05);2组患者患侧和健侧膝关节上、下15cm处周径差在术前、术后3天、术后7天比较,组内比较均具有统计学意义(P0.05),组间比较显示实验组患者术后3天、术后7天患侧和健侧膝关节下15cm处周径差明显低于对照组(P0.05)。两组患者的血栓清除率分级差异有统计学意义(P0.05),实验组血栓清除率较高。采用Villalta评分随访患者出院后4周、12周发生不同程度PTS的人数比较显示实验组和对照无统计学意义(P0.05)。结论:对于急性中央型下肢深静脉血栓患者,与机械性血栓抽吸术的疗效相比,超声微泡造影剂联合机械性血栓抽吸术的近期疗效较显著,血栓清除率较高,能够较早地彻底清除血栓恢复静脉血流,减轻患肢肿胀,但是其远期疗效有待进一步研究。
[Abstract]:Objective: to compare the efficacy of mechanical thrombus aspiration and ultrasound microbubble contrast medium combined with mechanical thromboembolization in the treatment of acute central deep venous thrombosis of lower extremity. To evaluate the clinical value of ultrasound microbubble contrast medium assisted thromboembolization in the treatment of deep venous thrombosis of the lower extremity. Methods: collect the included deep venous blood from June 2015 to November 2016 in the minimally invasive interventional department of our hospital. 50 patients with thrombus formation, The patients were randomly divided into experimental group (ultrasonic microbubble thrombotic aspiration treatment group) and control group (thrombus aspiration treatment group, 25 cases in each group). The control group received thrombus aspiration therapy, including routine anticoagulant therapy. Thrombolytic and inferior vena cava filters were implanted; the experimental group was treated with ultrasound microbubble thrombolytic therapy on the basis of thrombus aspiration. To evaluate the effect of mechanical thrombotic aspiration according to the thrombus clearance rate of postoperative venography, Villalta score was used to evaluate the incidence of PTS in different degrees at 4 weeks and 12 weeks after discharge. The data of sex, age, course of disease and location of disease were analyzed statistically in two groups. There was no significant difference between the two groups. There was no significant difference between the two groups (P 0.05). The difference of circumference between the two groups at the lower 15cm was before operation and 3 days after operation, and there was no significant difference between the two groups. 7 days after operation, the comparison within the group had statistical significance (P 0.05), and the comparison between the groups showed that the patients in the experimental group were 3 days after operation. On the 7th day after operation, the circumference difference between the affected and healthy knee joints was significantly lower than that in the control group (P 0.05). The thrombus clearance rate of the two groups was significantly higher than that of the control group (P 0.05). The thrombus clearance rate in the experimental group was higher than that in the control group. The Villalta score was used to follow up the patients after discharge from hospital. The comparison of the number of patients with different degrees of PTS at the 4th week and 12th week showed that there was no significant difference between the experimental group and the control group. Conclusion: for the patients with acute central deep venous thrombosis of lower extremity, there is no significant difference between the experimental group and the control group. Compared with mechanical thrombotic aspiration, ultrasound microbubble contrast agent combined with mechanical thrombus aspiration has a better short-term curative effect and a higher thrombus clearance rate, which can remove the thrombus completely and restore venous blood flow and reduce the swelling of the affected limb. But its long-term effect needs further study.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R654.4;R445.1
，

本文编号：1629074