导管接触性溶栓治疗急性下肢深静脉血栓形成并发肺栓塞的临床研究

发布时间：2018-03-17 22:40

本文选题：下肢深静脉血栓形成　切入点：肺栓塞　出处：《安徽医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的评价导管接触性溶栓在下肢深静脉血栓形成并发肺动脉栓塞的临床应用价值方法选取我院血管外科在2014.09~2016.09收治的189例下肢深静脉血栓形成(DVT)患者,其中80例并发肺栓塞(PE)患者作为研究对象。全组病例均由下肢深静脉彩色多普勒超声和/或深静脉造影明确下肢DVT诊断,经肺动脉CTA血管造影明确PE诊断。在80例PE患者中,采用单纯抗凝治疗32例(A组),采用抗凝+IVCF+导管溶栓(CDT)治疗(B组)48例,并对18例髂静脉受压综合征患者进行介入治疗,对以上患者进行跟踪性随访3~12个月。结果DVT住院患者合并发生肺栓塞的发生率为42.3%(80/189),年龄在45岁以上占91.25%,其中平均年龄为63.75±12.36岁。96.25%(77/80)患者存在致病的危险因素,其中以心血管系统疾病(48.9%)、吸烟(33.8%)、感染(32.4%)、卧床制动(30.6%)、手术创伤(16.4%)、肿瘤(13.2%)为主要致病因素。右下肢DVT患者并发PE的发生率为82.3%,高于左下肢的31.2%。在中央型(髂-股、股-乆静脉)DVT患者中,并发肺栓塞的人数为77例,明显高于小腿静脉(周围型)并发肺栓塞的人数。在治疗方面,单纯抗凝组再发肺动脉栓塞5例,抗凝+IVCF+导管溶栓(CDT)治疗组再发肺动脉栓塞1例;经导管接触性溶栓治疗DVT,在患肢消肿率、静脉平均通畅率方面,近期疗效较好,溶栓治疗前患、健侧大、小腿周径差分别为为(4.26±2.75)cm、(3.22±1.63)cm,导管溶栓治疗后患、健侧大小腿周径差分别为(1.0±0.90)cm、(0.90±0.80)cm。结论(1)导管接触性溶栓对治疗DVT患者安全可靠、简便易行,能迅速降低患肢水肿。(2)CDT结合下腔静脉滤器可以有效防治DVT高危人群并发PE的风险。(3)CTPA能降低肺栓塞的漏诊,是诊断肺栓塞的主要方法。
[Abstract]:Objective to evaluate the clinical value of catheter contact thrombolysis in the treatment of deep venous thrombosis complicated with pulmonary embolism. Methods 189 patients with DVT were selected from our hospital from April 09 to June 2009. Among them, 80 patients with pulmonary embolism (PE) were studied. The diagnosis of lower extremity DVT was confirmed by deep vein color Doppler ultrasound and / or deep vein angiography, and the diagnosis of PE was confirmed by pulmonary CTA angiography. 32 cases of group A were treated with anticoagulant therapy, 48 cases of group B were treated with anticoagulant IVCF catheter thrombolytic therapy, and 18 cases of iliac vein compression syndrome were treated with interventional therapy. Results the incidence of pulmonary embolism in DVT inpatients was 42.3%, and the age over 45 years was 91.25%. The mean age was 63.75 卤12.36 years old. 96.25% of the patients had risk factors of pulmonary embolism. Among them, 48.9% of cardiovascular diseases, 33.8% of smoking, 32.4% of infection, 30.6% of bed rest, 16.442% of surgical trauma, 13.2% of tumor. The incidence of PE in patients with DVT of right lower extremity was 82.3, higher than that of 31.2in left lower extremity. Among the patients with DVT, 77 cases were complicated with pulmonary embolism, which was significantly higher than that of the shank vein (peripheral type) complicated with pulmonary embolism. In the treatment, 5 cases had recurrent pulmonary embolism in the anticoagulant group. In the anticoagulant IVCF catheter thrombolytic therapy group, there was 1 case of recurrent pulmonary embolism and 1 case was treated with transcatheter contact thrombolytic therapy, the short-term curative effect was better in terms of deswelling rate of affected limb and average patency rate of vein, and before thrombolytic therapy, the healthy side was large. The difference of leg circumference was 4.26 卤2.75 cm ~ (-1) and 3.22 卤1.63 cm respectively. After thrombolytic therapy with catheter, the circumference difference of normal leg was 1.0 卤0.90 cm ~ (-1) 0.90 卤0.80 cm 路cm ~ (-1) respectively. Conclusion the catheter contact thrombolytic thrombolysis is safe, reliable and easy to treat DVT patients. CDT combined with inferior vena cava filter can effectively prevent and treat PE in high risk population of DVT. It can reduce the missed diagnosis of pulmonary embolism and is the main method in the diagnosis of pulmonary embolism.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R543.6;R563.5

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