下肢深静脉血栓形成的危险因素及导管接触性溶栓的临床疗效研究

目的:分析下肢深静脉血栓形成(DVT)的危险因素,并探讨导管接触性溶栓治疗下肢DVT的临床疗效。方法:选取2015年12月～2018年12月间在北京积水潭医院治疗的126例下肢DVT患者作为病例组,另外选取同期在我院健康体检的志愿者60例作为对照组,采用多因素Logistic回归分析下肢DVT的危险因素。将病例组按随机数表法分为系统溶栓组(采用系统性溶栓治疗)和导管溶栓组(采用导管接触性溶栓治疗)两个亚组,各63例。评价两组疗效,观察两组患者治疗前及治疗1个月后的双下肢周径差和静脉通畅度评分,记录并比较两组患者治疗时间、住院时间、尿激酶用量以及不良反应发生情况。结果:病例组与对照组年龄、体质量指数(BMI)、红细胞计数(RBC)、手术外伤史比较,差异有统计学意义(P0.05)。多因素Logistic回归分析结果显示,年龄、BMI、RBC、手术外伤史均是下肢DVT的独立危险因素(P0.05)。导管溶栓组痊愈率为57.14%(36/63),高于系统溶栓组的33.33%(21/63)(P0.05);治疗1个月后,两组双侧大腿周径差、双侧小腿周径差以及静脉通畅度评分均明显减小,且导管溶栓组上述指标均明显小于系统溶栓组(P0.05)。导管溶栓组治疗时间和尿激酶用量明显少于系统溶栓组,但住院时间明显长于系统溶栓组(P0.05)。两组患者不良反应发生率比较差异无统计学意义(P0.05)。结论:年龄、BMI、RBC、手术外伤史均是下肢DVT的独立危险因素,导管接触性溶栓治疗下肢DVT的疗效显著,具有较好的安全性。

Risk Factors of Deep Venous Thrombosis in Lower Extremities and Clinical Efficacy of Catheter-directed Thrombolysis

ABSTRACT Objective: To analyze the risk factors of deep venous thrombosis (DVT) in lower extremities, and to explore the clinical efficacy of catheter-contact thrombolysis in the treatment of DVT. Methods: 126 cases of DVT in lower extremities patients who were treated in Beijing Jishuitan Hospital from December 2015 to December 2018 were selected as the case group of this study, and 60 volunteers for physical examination in our hospital during the same period selected as control group . The risk factors of DVT in lower extremities were analyzed by multivariate logistic regression analysis. The case group was randomly divided into two subgroups: systemic thrombolysis group (treated with systemic thrombolysis) and catheter thrombolysis group (treated with catheter-contact thrombolysis), with 63 cases in each group. The curative effect of two groups were evaluated, and the circumference difference of lower limbs and venous patency score of two groups before treatment and 1 month after treatment were observed. The treatment time, hospitalization time, the dosage of urokinase and the occurrence of adverse reactions were recorded and compared between the two groups. Results: There were significant differences in age, body mass index (BMI), red blood cell count (RBC) and surgical trauma history between the case group and the control group (P<0.05). Multivariate logistic regression analysis showed that age, BMI, RBC and surgical trauma history were independent risk factors for DVT in lower extremities(P<0.05). The cure rate of catheter thrombolysis group was 57.14% (36/63), which was higher than that of systemic thrombolysis group 33.33% (21/63) (P<0.05). 1 month after treatment, the bilateral thigh circumference difference, circumference difference of bilateral calf and venous patency scores of the two groups were significantly reduced, and the above indexes of catheter thrombolysis group were significantly lower than those of systemic thrombolysis group. The treatment time and urokinase dosage in catheter thrombolysis group were significantly lower than those of systemic thrombolysis group, but the hospitalization time was significantly longer than that of systemic thrombolysis group (P<0.05). There was no significant difference in incidence of adverse reactions between the two groups (P>0.05). Conclusion: Age, BMI, RBC and history of surgical trauma were independent risk factors for DVT in lower extremities, the efficacy of catheter-contact thrombolysis for DVT in lower extremities is significantly, which has good safety.