【摘要】：目的:評(píng)價(jià)采用不同灌注模式導(dǎo)管接觸性溶栓(CDT)治療急性髂股靜脈血栓的療效。 方法:先行動(dòng)物實(shí)驗(yàn)。破壞17只犬后肢髂-股靜脈血管內(nèi)膜后注入凝血酶制作血栓模型,造模成功后行實(shí)驗(yàn)側(cè)髂股靜脈順行造影、CT靜脈造影。其中1只處死取造模側(cè)髂股靜脈血管行病理檢查證實(shí)血栓形成。一周后實(shí)驗(yàn)犬隨機(jī)分為2個(gè)實(shí)驗(yàn)組,分別行脈沖注射溶栓及連續(xù)滴注溶栓,并于1 h末、2 h末、3 h末經(jīng)溶栓導(dǎo)管造影觀察血管再通情況。對(duì)65例急性髂股靜脈血栓患者進(jìn)行CDT治療,術(shù)前隨機(jī)分為3組:A組:21例,采用脈沖注射;B組:22例,采用連續(xù)泵入;C組:22例,采用先脈沖注射再連續(xù)泵入。24 h內(nèi)以相同劑量尿激酶連續(xù)溶栓72 h,期間采用血管造影監(jiān)測(cè)血栓溶解情況,觀察不同溶栓灌注模式對(duì)溶栓療效及并發(fā)癥發(fā)生率的影響。 結(jié)果:17只犬全部成功建立髂股靜脈血栓。實(shí)驗(yàn)側(cè)髂股靜脈順行造影、CTV檢查證實(shí)靜脈內(nèi)可見充盈缺損影,病理檢查也證實(shí)髂股靜脈血管內(nèi)血栓形成。動(dòng)物溶栓實(shí)驗(yàn)顯示,脈沖注射組溶栓療效明顯優(yōu)于連續(xù)滴注組。臨床研究顯示,A、B、C組總有效率分別為71.43%、63.64%和77.27%;肢體消腫率分別為(80.00±22.10)%、(67.50±16.40)%和(92.30±15.80)%;靜脈通暢度分別為(57.80±18.70)%、(55.60±19.30)%和(70.20±19.80)%。C組溶栓總有效率、肢體消腫率和靜脈通暢度均明顯高于A、B兩組(P均0.01),3組并發(fā)癥的發(fā)生率差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。 結(jié)論:采用先脈沖注射再連續(xù)泵入的溶栓灌注模式進(jìn)行CDT可作為治療急性髂股靜脈血栓患者的首選灌注方式。
[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 鹵22.10), (67.50 鹵16.40)% and (92.30 鹵15.80), the patency of vein was (57.80 鹵18.70), (55.60 鹵19.30)% and (70.20 鹵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.
【學(xué)位授予單位】：南京醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2011
【分類號(hào)】：R-332

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 陳漢威,劉海英;經(jīng)乆靜脈順行穿刺治療下肢靜脈血栓的探討[J];放射學(xué)實(shí)踐;2002年06期

2 何旭,顧建平,范春瑛,陳亮,樓文勝,蘇浩波;經(jīng)乆靜脈介入治療下肢深靜脈血栓形成[J];放射學(xué)實(shí)踐;2003年02期

3 顧建平,范春瑛,何旭,陳亮,蘇浩波;下肢深靜脈血栓形成的綜合性介入治療[J];介入放射學(xué)雜志;2000年04期

4 黃曉鐘;張紀(jì)蔚;梁衛(wèi);池家昌;;介入腔內(nèi)溶栓治療急性下肢深靜脈血栓形成[J];介入放射學(xué)雜志;2006年10期

5 顧建平;;加強(qiáng)下肢靜脈病變的影像診斷和介入治療研究[J];介入放射學(xué)雜志;2008年01期

6 錢結(jié)勝;李征然;姜在波;朱康順;關(guān)首海;周斌;許長(zhǎng)謀;何可可;單鴻;;經(jīng)頸靜脈導(dǎo)管血管內(nèi)溶栓聯(lián)合足背靜脈溶栓治療下肢深靜脈血栓[J];介入放射學(xué)雜志;2009年04期

7 顧建平;何旭;樓文勝;陳亮;蘇浩波;陳國(guó)平;宋進(jìn)華;;介入治療576例下肢深靜脈血栓形成[J];南京醫(yī)科大學(xué)學(xué)報(bào)(自然科學(xué)版);2006年12期

8 田卓平,張培華;導(dǎo)管溶栓術(shù)治療下肢深靜脈血栓[J];中國(guó)現(xiàn)代普通外科進(jìn)展;2004年06期

9 徐琳;吳性江;范欣馨;潘爭(zhēng)妍;;導(dǎo)管介入溶栓治療下肢深靜脈血栓形成不同給藥方式的療效分析[J];外科理論與實(shí)踐;2009年05期

10 蘇浩波;顧建平;樓文勝;何旭;陳亮;陳國(guó)平;宋進(jìn)華;;經(jīng)大隱靜脈穿刺置管溶栓治療急性期髂股靜脈血栓形成[J];醫(yī)學(xué)影像學(xué)雜志;2006年11期

，

本文編號(hào)：2207347