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目的评价采用不同灌注模式导管接触性溶栓(CDT)治疗急性髂股静脉血栓的疗效。方法对65例急性髂股静脉血栓患者进行CDT治疗,术前随机分为3组:A组:21例,采用脉冲注射;B组:22例,采用连续泵入;C组:22例,采用先脉冲注射再连续泵入。24 h内以相同剂量尿激酶连续溶栓72 h,期间采用血管造影监测血栓溶解情况,观察不同溶栓灌注模式对溶栓疗效及并发症发生率的影响。结果 A、B、C组总有效率分别为71.43%、63.64%和77.27%;肢体消肿率分别为(80.00±22.10)%、(67.50±16.40)%和(92.30±15.80)%;静脉通畅度分别为(57.80±18.70)%、(55.60±19.30)%和(70.20±19.80)%。C组溶栓总有效率、肢体消肿率和静脉通畅度均明显高于A、B两组(P均<0.01),3组并发症的发生率差异无统计学意义(P>0.05)。结论采用先脉冲注射再连续泵入的溶栓灌注模式进行CDT可作为治疗急性髂股静脉血栓患者的首选灌注方式。
Objective To evaluate the curative effect of catheterized thrombolysis (CDT) with different perfusion modes in the treatment of acute iliac vein thrombosis. Methods Totally 65 patients with acute iliac vein thrombosis were treated with CDT. The patients were randomly divided into 3 groups: group A: 21 cases received pulse injection; group B: 22 cases received continuous pump; group C: 22 cases. First pulse injection and then pump continuously. Thrombolytic therapy was continued for 24 h with the same dose of urokinase for 72 h. Angiography was used to monitor the thrombolytic effect and the effect of different thrombolytic therapy on thrombolytic efficacy and complication rate was observed. Results The total effective rates in group A, B and C were 71.43%, 63.64% and 77.27%, respectively. The rate of limb swelling was (80.00 ± 22.10)%, (67.50 ± 16.40)% and (92.30 ± 15.80)% respectively. Degrees were (57.80 ± 18.70)%, (55.60 ± 19.30)% and (70.20 ± 19.80)%, respectively. The total effective rate of thrombolysis, limb swelling rate and venous patency in group C were significantly higher than those in group A and B (all P <0.01). The incidence of complications in group C was not significantly different (P> 0.05). Conclusions CDT can be used as the preferred method of perfusion in the treatment of patients with acute iliac vein thrombosis by first pulse injection followed by continuous infusion of thrombolysis perfusion pattern.