Cockett綜合征合并急性期血栓的治療療效臨床分析
發(fā)布時間：2018-08-28 07:31
【摘要】：目的:探討Cockett綜合征合并急性下肢深靜脈血栓形成(DVT)的不同治療方法的療效以及進(jìn)行CDT治療時濾器置入是否常規(guī),為臨床對Cockett綜合征合并急性DVT的治療尋找更加合理治療方法。方法:回顧性分析鄭州大學(xué)第一附屬醫(yī)院2014年8月至2016年4月期間就診89例Cockett綜合征合并急性下肢DVT患者,按治療方式分為實驗組(A組和B組)和對照組(C組),A組36例均行下腔濾器置入+置管溶栓,均進(jìn)行首次球擴(kuò);B組22例均行置管溶栓,不進(jìn)行首次球擴(kuò);C組31例采用行患肢足背靜脈泵入溶栓藥物進(jìn)行治療;三組均輔助抗凝、活血、消腫藥物以及穿彈力襪等治療,比較A、B兩組患者血栓溶解程度,肺栓塞發(fā)生率評估治療效果,院外均規(guī)律口服華法林至少6個月,遠(yuǎn)期通過電話、復(fù)查彩超或者深靜脈順行造影隨訪,以靜脈嚴(yán)重程度評分以及療效分級評估觀察各組治療療效及血栓相關(guān)事件發(fā)生率。結(jié)果:治療期間,A和B組技術(shù)成功率均為100%,均未出現(xiàn)肺栓塞,差異無統(tǒng)計學(xué)意義(P0.05),無疾病相關(guān)死亡病例,3例出現(xiàn)牙齦出血,鼻出血,血尿調(diào)整方案后癥狀消失;A、B組第3d溶栓療效比較(Hc=6.646,P=0.01),差異具有統(tǒng)計學(xué)意義(P0.05),第7d溶栓療效比較(Hc=2.186,P=0.139),差異無統(tǒng)計學(xué)無意義(P0.05);A組11例行球擴(kuò),16例支架置入;B組7例行球擴(kuò),11例行支架置入。87例獲得隨訪,隨訪時間為3-20個月,平均8.9月,支架內(nèi)2例血栓復(fù)發(fā),A、B組有效率均為100%,組間治療療效比較(Hc=0.079,P=0.778),差異無統(tǒng)計學(xué)意義(P0.05);C組有效率80%;實驗組和對照組治療療效比較(Hc=13.026,P=0.000),差異具有統(tǒng)計學(xué)意義(P0.05);血栓后遺癥發(fā)生率,實驗組明顯低于對照組,差異有統(tǒng)計學(xué)意義(P0.05);三組治療方式的VCSS評分比較(χ2=50.226,P=0.000),差異具有統(tǒng)計學(xué)意義(P0.05);組間進(jìn)行兩兩比較,A組與C組(Z=6.572,P=0.000)、B組與C組(Z=5.311,P=0.000),差異具有統(tǒng)計學(xué)意義(P0.05),而A組與B組(Z=0.541,P=0.295),差異無統(tǒng)計學(xué)意義(P0.05)。結(jié)論:1.對于Cockett綜合征合并急性期血栓治療,腔內(nèi)治療較藥物系統(tǒng)溶栓效果好,并且具有起效快,創(chuàng)傷小,恢復(fù)快,通暢率高,發(fā)生血栓后綜合征率低;2.對于Cockett綜合征合并急性期血栓進(jìn)行CDT治療,本實驗結(jié)果顯示濾器組和非濾器組肺栓塞發(fā)生無差異,我們中心認(rèn)為可以不常規(guī)置入下腔靜脈濾器;3.進(jìn)行CDT治療同時,首次給予球囊擴(kuò)張與不給予球囊擴(kuò)張比較,溶栓后療效短第3d有差異,第7d差異不明顯,說明首次球擴(kuò)后能夠減少溶栓藥物用量,減少出血并發(fā)癥發(fā)生,但遠(yuǎn)期治療效果無明顯差異。
[Abstract]:Objective: to investigate the curative effect of different treatment methods of Cockett syndrome with acute deep venous thrombosis of lower extremity (DVT) and to find a more reasonable treatment for Cockett syndrome with acute DVT. Methods: a retrospective analysis was made on 89 patients with Cockett syndrome complicated with acute lower limb DVT from August 2014 to April 2016 in the first affiliated Hospital of Zhengzhou University. According to the treatment method, 36 cases of group A were divided into experimental group (group A and group B) and control group (group C). All 36 cases of group A were treated with inferior chamber filter, 22 cases of group B were treated with thrombolytic therapy in group B for the first time. In group C, 31 patients were treated with thrombolytic drugs by injecting thrombolytic drugs into the dorsal vein of affected limbs, and all three groups were treated with anticoagulant, activating blood circulation, anti-swelling drugs and wearing elastic socks, to compare the thrombolysis degree of patients in group A and B, The incidence rate of pulmonary embolism was evaluated. Regular oral warfarin was taken out of hospital for at least 6 months. The patients were followed up by color Doppler ultrasound or deep vein anterograde angiography by telephone in the long term. The therapeutic efficacy and the incidence of thrombus-related events were evaluated by venous severity score and efficacy classification. Results: the technical success rate of group A and B was 100, and there was no significant difference in pulmonary embolism (P0.05). There were 3 cases of gingival bleeding and epistaxis in no disease related death cases. Comparison of thrombolytic efficacy (Hc=6.646,P=0.01) on the 3rd day (P0.05) and 7 days after thrombolytic therapy (Hc=2.186,P=0.139) in group A (P05), there was no significant difference between group A and group A (P0.05). 11 cases underwent stent implantation. 87 cases were followed up. The follow-up period was 3 to 20 months, with an average of 8.9 months. The effective rate of two patients with thrombus recurrence in stent group B was 100. There was no significant difference (P 0.05) between the two groups (P 0.05). The effective rate of group C was 80%, while that of experimental group and control group (Hc=13.026,P=0.000) was statistically significant (P0.05), the incidence of thrombotic sequelae was significantly higher than that of control group (P 0.05), while that of control group was significantly higher than that of control group (P 0.05). The experimental group was significantly lower than the control group. The difference was statistically significant (P0.05); the VCSS score of the three groups was significantly different (蠂 2: 50.226P 0.000), the difference was statistically significant (P0.05); the difference between group A and group C was statistically significant (P0.05); the difference between group B and group C was statistically significant (P0.05), but the difference between group A and group B (0.295) was not significant (P0.05). Conclusion 1. For Cockett syndrome combined with acute thrombus therapy, endovascular therapy is better than drug system thrombolytic effect, and has quick effect, little trauma, quick recovery, high patency rate and low rate of post-thrombotic syndrome. For the treatment of Cockett syndrome with acute thrombus, the results show that there is no difference between the filter group and the non-filter group. We believe that the inferior vena cava filter can be placed unroutinely. At the same time, compared with non-balloon dilatation and the first balloon dilatation, the effect of thrombolytic therapy was shorter in the third day than that in the seventh day, which indicated that the dosage of thrombolytic drugs could be reduced and the complications of bleeding could be reduced after the first balloon expansion. But there was no significant difference in long-term therapeutic effect.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R543.6
本文編號：2208711
[Abstract]:Objective: to investigate the curative effect of different treatment methods of Cockett syndrome with acute deep venous thrombosis of lower extremity (DVT) and to find a more reasonable treatment for Cockett syndrome with acute DVT. Methods: a retrospective analysis was made on 89 patients with Cockett syndrome complicated with acute lower limb DVT from August 2014 to April 2016 in the first affiliated Hospital of Zhengzhou University. According to the treatment method, 36 cases of group A were divided into experimental group (group A and group B) and control group (group C). All 36 cases of group A were treated with inferior chamber filter, 22 cases of group B were treated with thrombolytic therapy in group B for the first time. In group C, 31 patients were treated with thrombolytic drugs by injecting thrombolytic drugs into the dorsal vein of affected limbs, and all three groups were treated with anticoagulant, activating blood circulation, anti-swelling drugs and wearing elastic socks, to compare the thrombolysis degree of patients in group A and B, The incidence rate of pulmonary embolism was evaluated. Regular oral warfarin was taken out of hospital for at least 6 months. The patients were followed up by color Doppler ultrasound or deep vein anterograde angiography by telephone in the long term. The therapeutic efficacy and the incidence of thrombus-related events were evaluated by venous severity score and efficacy classification. Results: the technical success rate of group A and B was 100, and there was no significant difference in pulmonary embolism (P0.05). There were 3 cases of gingival bleeding and epistaxis in no disease related death cases. Comparison of thrombolytic efficacy (Hc=6.646,P=0.01) on the 3rd day (P0.05) and 7 days after thrombolytic therapy (Hc=2.186,P=0.139) in group A (P05), there was no significant difference between group A and group A (P0.05). 11 cases underwent stent implantation. 87 cases were followed up. The follow-up period was 3 to 20 months, with an average of 8.9 months. The effective rate of two patients with thrombus recurrence in stent group B was 100. There was no significant difference (P 0.05) between the two groups (P 0.05). The effective rate of group C was 80%, while that of experimental group and control group (Hc=13.026,P=0.000) was statistically significant (P0.05), the incidence of thrombotic sequelae was significantly higher than that of control group (P 0.05), while that of control group was significantly higher than that of control group (P 0.05). The experimental group was significantly lower than the control group. The difference was statistically significant (P0.05); the VCSS score of the three groups was significantly different (蠂 2: 50.226P 0.000), the difference was statistically significant (P0.05); the difference between group A and group C was statistically significant (P0.05); the difference between group B and group C was statistically significant (P0.05), but the difference between group A and group B (0.295) was not significant (P0.05). Conclusion 1. For Cockett syndrome combined with acute thrombus therapy, endovascular therapy is better than drug system thrombolytic effect, and has quick effect, little trauma, quick recovery, high patency rate and low rate of post-thrombotic syndrome. For the treatment of Cockett syndrome with acute thrombus, the results show that there is no difference between the filter group and the non-filter group. We believe that the inferior vena cava filter can be placed unroutinely. At the same time, compared with non-balloon dilatation and the first balloon dilatation, the effect of thrombolytic therapy was shorter in the third day than that in the seventh day, which indicated that the dosage of thrombolytic drugs could be reduced and the complications of bleeding could be reduced after the first balloon expansion. But there was no significant difference in long-term therapeutic effect.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R543.6
【參考文獻(xiàn)】
相關(guān)期刊論文 前1條
1 張福先;楊子明;;關(guān)于腔靜脈濾器臨床應(yīng)用的若干問題——專家觀點(diǎn)與基本共識[J];中華外科雜志;2010年24期
，本文編號：2208711
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