[1]俞靖凡,方昌文,徐国雄.AngioJet机械性血栓抽吸和导管接触性溶栓联合治疗急性混合型下肢深静脉血栓形成疗效观察[J].新乡医学院学报,2023,40(5):421-426.[doi:10.7683/xxyxyxb.2023.05.004]
　YU Jingfan,FANG Changwen,XU Guoxiong.Curative effect of AngioJet mechanical thrombus aspiration combined with catheter-directed thrombolysis in the treatment of acute mixed deep venous thrombosis of lower limbs[J].Journal of Xinxiang Medical University,2023,40(5):421-426.[doi:10.7683/xxyxyxb.2023.05.004]
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AngioJet机械性血栓抽吸和导管接触性溶栓联合治疗急性混合型下肢深静脉血栓形成疗效观察
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
40卷
期数:
2023年5
页码:
421-426
栏目:
临床研究
出版日期:
2023-05-05

文章信息/Info

Title:
Curative effect of AngioJet mechanical thrombus aspiration combined with catheter-directed thrombolysis in the treatment of acute mixed deep venous thrombosis of lower limbs
作者:
俞靖凡; 方昌文; 徐国雄
（苏州市立医院北区血管介入科，江苏　苏州　215000）
Author(s):
YU Jingfan; FANG Changwen; XU Guoxiong
(Department of Vascular Interventional Therapy,North District of Suzhou Municipal Hospital,Suzhou 215000,Jiangsu Province,China)
关键词:
下肢深静脉血栓形成; AngioJet机械性血栓抽吸; 导管接触性溶栓
Keywords:
deep venous thrombosis of lower limbs; AngioJet mechanical thrombus aspiration; catheter-directed thrombolysis
分类号:
R749
DOI:
10.7683/xxyxyxb.2023.05.004
文献标志码:
A
摘要:
目的　探讨AngioJet机械性血栓抽吸和导管接触性溶栓（CDT）联合治疗急性混合型下肢深静脉血栓形成（DVT）的疗效。
方法　选择2019年6月至2022年2月苏州市立医院收治的60例急性混合型下肢DVT患者为研究对象，按照治疗方法将患者分为CDT组（n=32）和联合治疗组（n=28），CDT组患者给予CDT治疗，联合治疗组患者给予AngioJet机械性血栓抽吸和CDT联合治疗。比较2组患者的DVT清除效果、溶栓效果、并发症、血清血管细胞黏附分子-1（VCAM-1）和血小板内皮细胞黏附分子-1（PECAM-1）水平、血浆纤维蛋白原（FIB）及D二聚体（D-D）和血红蛋白（Hb）水平。
结果　联合治疗组和CDT组患者的有效血栓清除率分别为96.73%（27/28）、71.88%（23/32），联合治疗组患者有效血栓清除率显著高于CDT组（χ2=4.835，P<0.05）。术前2组患者的患健侧大腿周径差、患健侧小腿周径差、静脉通畅度评分比较差异无统计学意义（P>0.05），2组患者术后患健侧大腿周径差、患健侧小腿周径差、静脉通畅度评分显著低于术前（P<0.05）；术后，联合治疗组患者患健侧大腿周径差、患健侧小腿周径差、静脉通畅度评分显著低于CDT组（P<0.05）。联合治疗组患者术后静脉通畅率、大腿消肿率和小腿消肿率显著高于CDT组（P<0.05）。联合治疗组患者尿激酶使用量显著少于CDT组，溶栓时间和住院时间显著短于CDT组（P<0.05）。术前2组患者血清VCAM-1、PECAM-1水平比较差异无统计学意义（P>0.05），2组患者术后血清VCAM-1、PECAM-1水平显著低于术前（P<0.05）；术后，联合治疗组患者血清VCAM-1、PECAM-1水平显著低于CDT组（P<0.05）。2组患者术前和术后血浆FIB、D-D及Hb水平比较差异均无统计学意义（P>0.05），2组患者术后血浆FIB、D-D及Hb水平均显著低于术前（P<0.05）。联合治疗组和CDT组患者并发症发生率分别为10.71%（3/28）、9.38%（3/32），2组患者并发症发生率比较差异无统计学意义（χ2=0.067，P>0.05）。
结论　AngioJet机械性血栓抽吸和CDT联合治疗急性混合型下肢DVT可显著提高有效血栓清除率和溶栓效果，减少尿激酶使用量，降低血清细胞黏附分子表达，且未增加并发症。
Abstract:
Objective　To investigate the efficacy of AngioJet mechanical thrombus aspiration combined with catheter-directed thrombolysis (CDT) in the treatment of acute mixed deep venous thrombosis (DVT) of lower limbs.
Methods　A total of 60 patients with acute mixed lower extremity DVT admitted to Suzhou Municipal Hospital from June 2019 to February 2022 were selected as the research subjects,and the patients were divided into CDT group (n=32) and combined treatment group (n=28) according to the treatment method.The patients in the CDT group were treated with CDT,while the patients in the combined treatment group were treated with AngioJet mechanical thrombus aspiration and CDT.The DVT clearance,thrombolytic effect,complications,serum vascular cell adhesion molecule-1 (VCAM-1) and platelet endothelial cell adhesion molecule-1 (PECAM-1) levels,and plasma fibrinogen (FIB),D-dimer (D-D) and hemoglobin (Hb) levels were compared between the two groups.
Results　The effective thrombus removal rate in the combined treatment group and CDT group was 96.73% (27/28) and 71.88% (23/32),respectively.The effective thrombus removal rate in the combined treatment group was significantly higher than that in the CDT group (χ2=4.835,P<0.05).There was no statistically significant difference in the circumference difference between the affected and healthy thighs,the circumference difference between the affected and healthy legs,and the venous patency score of patients between the two groups before operation (P>0.05).The circumference difference between the affected and healthy thighs,the circumference difference between the affected and healthy legs,and the venous patency score of patients after operation were significantly lower than those before operation in both groups (P<0.05).The circumference difference between the affected and healthy thighs,the circumference difference between the affected and healthy legs,and the venous patency score of patients in the combined treatment group were significantly lower than those in the CDT group after operation (P<0.05).The venous patency rate,thigh detumescence rate and leg detumescence rate of patients in the combined treatment group were significantly higher than those in the CDT group after operation (P<0.05).Compared with the CDT group,the urokinase dosage in the combined treatment group was significantly reduced,the thrombolysis time and hospitalization time were significantly shortened (P<0.05).There was no statistically significant difference in serum VCAM-1 and PECAM-1 levels of patients between the two groups before operation (P>0.05).The levels of serum VCAM-1 and PECAM-1 of patients after operation were significantly lower than those before operation in both groups (P<0.05).The levels of serum VCAM-1 and PECAM-1 of patients in the combination treatment group were significantly lower than those in the CDT group after operation (P<0.05).There was no statistically significant difference in the levels of plasma FIB,D-D and Hb of patients between the two groups before and after operation (P>0.05).The levels of plasma FIB,D-D and Hb of patients after operation were significantly lower than those before operation in both groups (P<0.05).The incidence of complications in the combined treatment group and the CDT group was 10.71% (3/28) and 9.38% (3/32),respectively.There was no significant difference in the incidence of complications between the two groups (χ2=0.067,P>0.05).
Conclusion　The combination of AngioJet mechanical thrombus aspiration and CDT in the treatment of acute mixed lower extremity DVT can significantly improve the effective thrombus clearance rate and thrombolytic effect,reduce the dosage of urokinase and the expression of serum cell adhesion molecules,and does not increase the incidence of complications.

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更新日期/Last Update: 2023-05-05