低分子肝素联合普通肝素在下肢深静脉血栓形成导管直接溶栓中的应用

王颖; 王孝高; 官泽宇; Ayoade PhilipAdegoke; 高涌; 余朝文; 陈世远; 卢冉

doi:10.16766/j.cnki.issn.1674-4152.002932

低分子肝素联合普通肝素在下肢深静脉血栓形成导管直接溶栓中的应用

doi: 10.16766/j.cnki.issn.1674-4152.002932

1.
蚌埠医学院检验医学院生化与分子生物学教研室，安徽蚌埠 233000
2.
蚌埠医学院第一附属医院血管外科，安徽蚌埠 233004

基金项目:

安徽省教育厅重点项目 KJ2019A0327

安徽省科技攻关项目 201904a07020020

安徽省卫生健康委科研重点项目 AHWJ2021a016

蚌埠医学院教学研究重点项目 2020fyjyxm14

蚌埠医学院自然科学重点项目 2020byzd67

蚌埠市科技创新指导类项目 20200343

详细信息

通讯作者:
王孝高，E-mail：281421686@qq.com

中图分类号: R543.6
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- 被引次数: 0
出版历程
- 收稿日期: 2022-02-23
- 网络出版日期: 2023-05-31

Application of low molecular weight heparin combined with unfractionated heparin in direct thrombolysis of lower extremity deep vein thrombosis

1.
Department of Biochemistry and Molecular Biology, Laboratory Medical School of Bengbu Medical College, Bengbu, Anhui 233000, China

摘要

摘要: 目的探索不同抗凝方案在下肢深静脉血栓形成(deep venous thrombosis, DVT)导管直接溶栓治疗(catheter-directed thrombectomy, CDT)过程中的溶栓疗效。方法将2021年3月-2022年2月蚌埠医学院医院第一附属医院血管外科收治的35例下肢DVT患者, 采用随机数字表法分为低分子肝素(low molecular weight heparin, LMWH)+小剂量普通肝素(unfractionated heparin, UFH)脉冲应用组(观察组, 18例)及单独低分子肝素组(对照组, 17例), 通过动态监测血浆D-二聚体来评估血栓溶解情况, 治疗完成后通过测量手术前后下肢周径的差值及下肢静脉通畅评分分析疗效。结果观察组与对照组的血浆D-二聚体在溶栓过程中(第3天)升高情况为(78.26±11.57) mg/L、(66.06±12.31) mg/L (t=3.020, P=0.005);溶栓后患肢膝下15 cm周径差值为(1.43±0.34) cm、(2.48±0.63) cm (t=6.185, P < 0.001);患肢下肢静脉通畅评分为(5.34±0.90)分、(7.29±1.19)分(t=5.235, P < 0.001);尿激酶用量为(302.22±20.45)万U、(381.17±27.59)万U (t=9.656, P < 0.001), 上述数据对比差异均有统计学意义。结论低分子肝素+小剂量普通肝素脉冲在DVT的CDT中疗效是确切的、安全的, 可在下肢DVT临床治疗中推广应用。
- 深静脉血栓形成 /
- 溶栓 /
- 肝素抗凝 /
- 导管直接溶栓
Abstract: Objective To explore the clinical efficacy of different anticoagulation regimens during catheter-directed thrombectomy (CDT) in deep venous thrombosis (DVT) of the lower extremities. Methods A total of 35 DVT patients admitted to the Department of Vascular Surgery of the First Affiliated Hospital of Bengbu Medical College Hospital from March 2021 to February 2022 were selected.They were randomly divided into a low molecular weight heparin+small dose unfractionated heparin pulse group (observation group, 18 cases) and a low molecular weight heparin application group merely (control group, 17 cases) by a random number table method.Thrombolysis effect was assessed by dynamic examination of plasma D-dimer.After treatment completed, the curative effect was analyzed by measuring the difference in the circumference of the lower limbs before and after the operation and the venous patency score. Results The plasma D-dimer in the observation group and control group increased during the thrombolysis process (day 3) were (78.26±11.57) and (66.06±12.31) mg/L (t=3.020, P=0.005).The circumference of 15 cm below the knee joint were (1.43±0.34) and (2.48±0.63) cm (t=6.185, P < 0.001);the lower extremity venous patency score was 5.34±0.90 and 7.29±1.19(t=5.235, P < 0.001);the dosage of urokinase were (302.22±20.45)×10⁴ and (381.17±27.59)×10⁴ units (t=9.656, P < 0.001).The comparison of the above two groups of data was statistically significant. Conclusion The efficacy of low molecular weight heparin combined with small dose unfractionated heparin pulse anticoagulation of CDT in DVT is excellent and safe.It should be popularized and applied in clinical treatment of lower extremity DVT.
- Deep venous thrombosis /
- Thrombectomy /
- Heparin anticoagulation /
- Catheter-directed thrombectomy

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图 1 下肢深静脉血栓的导管溶栓

注：A为手术前患肢深静脉造影表现为下肢深静脉充盈缺损及双轨征，髂静脉未见明显显影，提示急性深静脉血栓形成；B为置入Uni Fuse溶栓导管置入病变段深静脉后造影提示髂静脉内部造影剂充盈缺损，提示髂静脉血栓形成；C为CDT溶栓疗程后，再次造影显示髂静脉存在狭窄，腘静脉、股静脉造影剂填充良好，提示血栓溶解良好。

Figure 1. Catheter thrombolysis for deep vein thrombosis of lower extremities

下载: 全尺寸图片幻灯片

图 2 髂静脉残留狭窄的腔内成型治疗

注：A及B示髂静脉狭窄段在球囊扩张成型过程中球囊中间表现为“哑铃样”表现，提示髂静脉狭窄较重；C示扩展成型后，于髂静脉病变段释放支架防止弹性回缩，造影提示左髂静脉血流恢复通畅。

Figure 2. Endoplastic treatment of residual iliac vein stenosis

下载: 全尺寸图片幻灯片

表 1 2组下肢DVT患者的一般资料

Table 1. General information of 2 groups of lower limb DVT patients

组别	例数	年龄 (x±s，岁)	性别 (男/女, 例)	病史 (x±s，d)	患肢 (左/右, 例)
观察组	18	54.44±12.42	7/11	5.56±2.85	16/2
对照组	17	52.35±13.08	7/10	5.71±2.31	15/2
统计量		0.485^a		0.171^a
P值		0.631	0.999^b	0.866	0.999^b
注：^a为t值，^b为采用Fisher精确检验。

下载: 导出CSV

表 2 2组下肢DVT患者的各项统计数据比较

Table 2. Comparison of observed statistical indicators of lower limb DVT patients between the two groups

组别	例数	溶栓3 d后血浆D-二聚体(x±s，mg/L)	疗程总尿激酶量(x±s，万U)	溶栓前后小腿周径差值(x±s，cm)	溶栓后静脉通畅评分(x±s，分)	发生并发症(例)
观察组	18	78.26±11.57	302.22±20.45	1.43±0.34	5.34±0.90	3
对照组	17	66.06±12.31	381.17±27.59	2.48±0.63	7.29±1.19	2
统计量		3.020^a	9.656^a	6.185^a	5.235^a
P值		0.005	< 0.001	< 0.001	< 0.001	0.999^b
注：^a为t值，^b为采用Fisher精确检验。

下载: 导出CSV

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