本文選題：下肢深靜脈血栓　切入點(diǎn)：血栓抽吸術(shù)　出處：《廣州中醫(yī)藥大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:比較機(jī)械性血栓抽吸術(shù)與超聲微泡造影劑聯(lián)合機(jī)械性血栓抽吸術(shù)治療急性期中央型下肢深靜脈血栓形成(LEDVT)患者的療效,評(píng)估超聲微泡造影劑輔助血栓抽吸術(shù)治療下肢深靜脈血栓的臨床應(yīng)用價(jià)值。方法:收集2015年6月-2016年11月在我院微創(chuàng)介入科就診的符合納入標(biāo)準(zhǔn)的下肢深靜脈血栓形成患者50例,采取隨機(jī)數(shù)字表法將患者分成實(shí)驗(yàn)組(超聲微泡+血栓抽吸術(shù)治療組)和對(duì)照組(血栓抽吸術(shù)治療組),每組25例。對(duì)照組接受血栓抽吸術(shù)治療,包括常規(guī)抗凝、溶栓和下腔靜脈濾器植入;實(shí)驗(yàn)組在血栓抽吸治療的基礎(chǔ)上加超聲微泡溶栓治療。臨床療效的評(píng)價(jià)包括:(1)比較患者術(shù)前、術(shù)后3天、術(shù)后7天患側(cè)和健側(cè)膝關(guān)節(jié)上、下15cm處周徑差;(2)根據(jù)術(shù)后靜脈造影表現(xiàn)的血栓清除率評(píng)價(jià)機(jī)械性血栓抽吸的效果;(3)采用Villalta評(píng)分評(píng)價(jià)隨訪患者出院后4周、12周不同程度的PTS的發(fā)病情況。結(jié)果:治療前,對(duì)2組患者的性別、年齡、病程天數(shù)、發(fā)病部位等一般資料進(jìn)行統(tǒng)計(jì)學(xué)分析,組間差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);2組患者患側(cè)和健側(cè)膝關(guān)節(jié)上、下15cm處周徑差在術(shù)前、術(shù)后3天、術(shù)后7天比較,組內(nèi)比較均具有統(tǒng)計(jì)學(xué)意義(P0.05),組間比較顯示實(shí)驗(yàn)組患者術(shù)后3天、術(shù)后7天患側(cè)和健側(cè)膝關(guān)節(jié)下15cm處周徑差明顯低于對(duì)照組(P0.05)。兩組患者的血栓清除率分級(jí)差異有統(tǒng)計(jì)學(xué)意義(P0.05),實(shí)驗(yàn)組血栓清除率較高。采用Villalta評(píng)分隨訪患者出院后4周、12周發(fā)生不同程度PTS的人數(shù)比較顯示實(shí)驗(yàn)組和對(duì)照無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:對(duì)于急性中央型下肢深靜脈血栓患者,與機(jī)械性血栓抽吸術(shù)的療效相比,超聲微泡造影劑聯(lián)合機(jī)械性血栓抽吸術(shù)的近期療效較顯著,血栓清除率較高,能夠較早地徹底清除血栓恢復(fù)靜脈血流,減輕患肢腫脹,但是其遠(yuǎn)期療效有待進(jìn)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.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R654.4;R445.1
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本文編號(hào)：1629074