摘要 目的探讨不同入路溶栓治疗对混合型深静脉血栓形成(DVT)患者细胞黏附分子的影响。方法选取该院2017年1月至2018年2月收治的165例下肢混合型DVT患者,均采取经导管接触溶栓(CDT)治疗,根据患者个体化体征情况选择入路方式,其中经健侧股静脉穿刺置管56例(A组),经患侧小隐静脉穿刺置管59例(B组),患侧经皮穿刺胫前或胫后静脉置管50例(C组)。比较各组手术时间、溶栓导管留置时间、尿激酶用量、血栓清除评分、患肢肿胀程度、深静脉血栓形成后综合征(PTS)发生率和PTS评分、血清血小板内皮细胞黏附分子-1(Pecam-1)、血管细胞黏附分子-1(Vcam-1)水平。Pearson相关系数分析血清Pecam-1、Vcam-1与PTS评分的相关性。结果C组手术时间短于A、B组,A组短于B组,差异有统计学意义(P<0.05)。B、C组的溶栓导管留置时间与尿激酶用量低于A组(P<0.05),B、C组间比较差异无统计学意义(P>0.05)。B、C组的血栓清除评分、患肢消肿率高于A组,PTS发生率、PTS评分低于A组,差异有统计学意义(P<0.05),B、C组间比较差异无统计学意义(P>0.05)。治疗后各组患者的血清Pecam-1、Vcam-1水平均较入院时降低(P<0.05),B、C组低于A组(P<0.05),B、C组间差异无统计学意义(P>0.05)。各组患者血清Pecam-1、Vcam-1水平均与PTS评分呈正相关(P<0.05),血清Pecam-1、Vcam-1水平越高,PTS评分越高。结论经皮穿刺胫前或胫后静脉置管是CDT治疗急性下肢DVT的最佳溶栓路径,可有效降低血清Pecam-1、Vcam-1水平,溶栓效果佳,手术时间短,PTS发生率低。 Objective To explore the effect of different approaches of thrombolytic therapy on the cell adhesion molecules in the patients with mixed deep venous thrombosis(DVT).Methods A total of 165 patients with acute mixed lower extremity DVT admitted to this hospital from January 2017 to February 2018 were selected and treated with catheter-directed thrombolysis(CDT).The approach mode was selected according to the individualized signs of the patients,in which,56 cases(group A)placed the catheter by percutaneous femoral vein puncture in the healthy side,59 cases(group B)placed the catheter by small saphenous vein puncture in the affected side,and 50 cases(group C)placed the catheter by percutaneous anterior or posterior tibial venous catheter.The operative time,thrombolytic catheter indwelling time,urokinase dosage,thrombosis clearance score,swelling degree of the affected limbs,post thrombotic syndrome(PTS)incidence rate and PTS score,serum Pecam-1 and Vcam-1 levels were compared among the groups.The Pearson correlation coefficient was used to analyze the correlation between serum Pecam-1 and Vcam-1 with the PTS scores.Results The operative time in the group C was shorter than that in the group A and B,while which in the group A was shorter than that in the group B(P<0.05).The retention time of thrombolysis catheter and the urokinase dosage in the group B and group C were lower than those in the group A(P<0.05),and there was no statistically significant difference between the group B and C(P>0.05).The thrombus clearance rate and swelling subsidence rate of affected limbs in the group B and group C were higher than those in the group A,and the incidence rate of PTS and PTS scores were lower than those in the group A(P<0.05).There was no statistically significant difference between the group B and C(P>0.05).After treatment,the serum Pecam-1 and Vcam-1 levels in each group were lower than those at admission(P<0.05),and which in the group B and C were lower than those in the group A(P<0.05).The difference between the group
机构地区 河北省邯郸市第一医院血管外科
出处 《重庆医学》 CAS 2021年第7期1136-1140,共5页 Chongqing medicine
基金 邯郸市科学技术研究与发展计划项目(1723208066-7)。
关键词 深静脉血栓形成 混合型 溶栓 手术入路 经导管接触溶栓 细胞黏附分子 deep vein thrombosis mixed type thrombolysis operative approach catheter-directed thrombolysis cell adhesion molecule
