本文選題：深靜脈血栓形成　切入點(diǎn)：導(dǎo)管溶栓　出處：《南昌大學(xué)》2016年碩士論文

【摘要】：目的:回顧分析混合型急性下肢深靜脈血栓形成經(jīng)不同入路置管溶栓的療效。方法:收集2012年1月-2015年12月118例混合型急性下肢深靜脈血栓形成患者的住院及隨訪資料,將其分為A、B、C三組,A組含經(jīng)健側(cè)股靜脈穿刺置管23例、B組含切開(kāi)或經(jīng)皮小隱靜脈穿刺置管30例、C組含經(jīng)皮穿刺脛前或脛后靜脈置管65例,分別比較三組病人溶栓手術(shù)前后療效差異、三組間術(shù)后療效差異、手術(shù)并發(fā)癥、遠(yuǎn)期隨訪PTS發(fā)生率差異。評(píng)價(jià)指標(biāo)包括手術(shù)前后大腿、小腿周徑差,患肢消腫率,手術(shù)前后深靜脈通暢度評(píng)分,血栓清除率、手術(shù)完成時(shí)間,手術(shù)并發(fā)癥及術(shù)后2年隨訪PTS發(fā)生率等。結(jié)果:1、A組:手術(shù)前后患、健側(cè)大腿周徑差分別為(5.53±0.42)cm及(1.78±0.53)cm,差異有統(tǒng)計(jì)學(xué)意義(t=4.63,P0.05);手術(shù)前后患、健側(cè)小腿周徑差分別為(4.96±0.54)cm及(2.13±0.65)cm,差異有統(tǒng)計(jì)學(xué)意義(t=3.32,P0.05);手術(shù)前后靜脈通暢度評(píng)分分別為(8.95±1.63)分及(4.26±1.26)分,差異有統(tǒng)計(jì)學(xué)意義(t=6.37,P0.05);B組:手術(shù)前后患、健側(cè)大腿周徑差分別為(5.46±0.38)cm及(1.85±0.68)cm,差異有統(tǒng)計(jì)學(xué)意義(t=4.68,P0.05);手術(shù)前后患、健側(cè)小腿周徑差分別為(4.81±0.45)cm及(1.75±0.59)cm,差異有統(tǒng)計(jì)學(xué)意義(t=3.16,P0.05);手術(shù)前后靜脈通暢度評(píng)分分別為(8.77±1.43)分及(3.27±1.59)分,差異有統(tǒng)計(jì)學(xué)意義(t=6.43,P0.05);C組:手術(shù)前后患、健側(cè)大腿周徑差分別為(5.67±0.46)cm及(1.72±0.56)cm,差異有統(tǒng)計(jì)學(xué)意義(t=4.63,P0.05);手術(shù)前后患、健側(cè)小腿周徑差分別為(5.03±0.64)cm及(1.72±0.62)cm,差異有統(tǒng)計(jì)學(xué)意義(t=3.32,P0.05);手術(shù)前后靜脈通暢度評(píng)分分別為(8.35±1.78)分及(3.35±1.38)分,差異有統(tǒng)計(jì)學(xué)意義(t=6.28,P0.05)。溶栓術(shù)后,三組患者肢體腫脹程度及靜脈通暢評(píng)分較溶栓術(shù)前明顯改善。2、A、B、C三組溶栓術(shù)后患、健側(cè)大腿周徑差分別為(1.78±0.53)cm、(1.85±0.68)cm、(1.72±0.56)cm,差異無(wú)統(tǒng)計(jì)學(xué)意義(F=0.51,P0.05);患肢大腿消腫率(70.72±15.67)%、(68.39±17.25)%、(73.95±17.33)%,差異無(wú)統(tǒng)計(jì)學(xué)意義(F=1.17,P0.05)。三組溶栓術(shù)后患、健側(cè)小腿周徑差分別為(2.13±0.65)cm、(1.75±0.59)cm、(1.72±0.62)cm,差異顯著(F=3.91,P0.05);患肢小腿消腫率(55.82±17.63)%、(66.28±18.26)%、(67.95±17.32)%,差異顯著(F=4.11,P0.05);組間比較B組、C組小腿療效優(yōu)于A組,B組、C組療效相似。三組血栓清除率評(píng)分分別為(2.55±0.16)分、(2.68±0.19)分、(2.65±0.20)分,差異有統(tǒng)計(jì)學(xué)意義(F=3.31,P0.05);術(shù)后靜脈通暢度評(píng)分分別為(4.26±1.26)分、(3.27±1.59)分、(3.35±1.38)分,差異有統(tǒng)計(jì)學(xué)意義(F=3.59,P0.05);手術(shù)時(shí)間分別為(65.27±5.42)min、(69.36±4.19)min、(52.33±4.25)min,差異顯著(F=174.43,P0.05);組間比較B組、C組血栓清除率及靜脈通暢評(píng)分高于A組,B組、C組無(wú)差別,手術(shù)時(shí)間C組A組B組。留置溶栓導(dǎo)管天數(shù)分別為(7.37±1.35)d、(6.25±1.48)d、(6.42±1.39)d,差異顯著(F=4.87,P0.05);尿激酶總量統(tǒng)計(jì)結(jié)果分別為(435.30±56.45)萬(wàn)IU、(383.59±52.39)萬(wàn)IU、(375.35±58.20)萬(wàn)IU,差異顯著(F=9.77,P0.05);組間比較B組、C組留置溶栓導(dǎo)管天數(shù)及尿激酶總用量少于A組,B組、C組無(wú)明顯差別。3、三組手術(shù)并發(fā)癥比較:A組出現(xiàn)4例,發(fā)生率17.4%;B組出現(xiàn)6例,發(fā)生率20%;C組出現(xiàn)10例,發(fā)生率為15.4%,差異無(wú)統(tǒng)計(jì)學(xué)意義(x~2=0.32,P0.05)。4、118例患者術(shù)后完成隨訪101例,失仿17例,隨訪率85.59%,隨訪時(shí)間3—24個(gè)月(中位時(shí)間20.4個(gè)月)。83例髂靜脈受壓綜合征患者,植入支架83枚,失仿10例。73例植入支架患者,2年通暢率為89.04%。其中發(fā)生支架再狹窄5例,3例出現(xiàn)支架狹窄合并血栓形成。PTS發(fā)生率分別為:A組隨訪20例發(fā)生8例,發(fā)生率40%;B組隨訪24例發(fā)生3例,發(fā)生率12.50%;C組隨訪57例發(fā)生8例,發(fā)生率14.04%,差異有統(tǒng)計(jì)學(xué)意義(x~2=7.36,P0.05),其中B、C組PTS發(fā)生率無(wú)明顯差異且低于A組。A、B、C三組PTS評(píng)分分別為(6.36±1.35)分、(4.53±1.56)分、(4.28±1.23)分,差異有統(tǒng)計(jì)學(xué)意義(F=20.90,P0.00),其中B、C無(wú)明顯差異且低于A組。血栓復(fù)發(fā)率A組隨訪20例發(fā)生2例,發(fā)生率10.00%;B組隨訪24例發(fā)生2例,發(fā)生率8.33%;C組隨訪57例發(fā)生4例,發(fā)生率7.02%,差異有統(tǒng)計(jì)學(xué)意義(x~2=0.19,P0.05),總的血栓復(fù)發(fā)率為7.92%。結(jié)論:1、經(jīng)皮穿刺脛前或脛后靜脈置管溶栓效果好、手術(shù)時(shí)間短、操作簡(jiǎn)便,其他手術(shù)入路可做為備選方案。2、三組不同入路置管溶栓治療急性下肢DVT療效顯著、手術(shù)并發(fā)癥少,2年隨訪血栓復(fù)發(fā)率、PTS發(fā)生率低。順行置管溶栓治療下肢DVT療效優(yōu)于逆行置管溶栓,PTS發(fā)生率更低。3、PTA聯(lián)合支架植入術(shù)治療IVCS療效確切,2年通暢率高。
[Abstract]:Objective: To review the mixed type of acute lower extremity deep vein thrombosis by different approaches of the efficacy of thrombolysis. Method: patients in hospitalization and follow-up data were collected in January 2012 -2015 year in December 118 cases of mixed type of acute lower extremity deep venous thrombosis, which can be divided into A, B, C three group, A group with 23 cases of tube the contralateral femoral vein puncture, group B with open or percutaneous small saphenous vein catheterization in 30 cases, C group with percutaneous anterior or posterior tibial vein catheterization in 65 cases, were compared between three groups before and after surgery in patients receiving thrombolytic efficacy, complications difference, postoperative curative effect between the three groups, long-term the follow-up of PTS incidence were compared. Evaluation indexes include before and after surgery, thigh, calf circumference difference, limb swelling rate, before and after the surgery of deep venous patency score, thrombus removal rate, operation time, postoperative complications and postoperative follow-up of 2 years. Results: the incidence rate of PTS 1, A group: patients before and after surgery, rehabilitation lateral thigh 鍛ㄥ緞宸垎鍒負(fù)(5.53鹵0.42)cm鍙，

本文編號(hào)：1722443