摘要
目的观察重组人尿激酶原(rhPro-UK)置管溶栓治疗急性下肢深静脉血栓(DVT)对患者血流动力学水平和下肢静脉功能的影响。方法前瞻性选取2019年9月至2023年5月天津市第四中心医院收治的DVT患者100例,采用随机数字表法分为观察组与对照组,每组各50例。两组均给予低分子肝素钠注射液进行抗凝治疗,对照组给予尿激酶置管溶栓治疗,观察组给予rhPro-UK置管溶栓治疗。检测两组治疗前和治疗5 d后的血流动力学(静脉容积、静脉最大流出量及静脉压恢复时间)、血液流变学指标[全血低、中、高切黏度及血浆黏度、纤维蛋白原(FIB)、D-二聚体]变化,评估两组治疗前和治疗5 d后的深静脉通畅评分,计算两组深静脉通畅率,测定两组患肢与健侧不同部位周径差,对比两组并发症发生率。结果治疗5 d后,两组静脉容积、静脉最大流出量、静脉回流速率及静脉压恢复时间均较治疗前升高,观察组静脉容积、静脉压恢复时间分别为(7.58±1.33)mL、(12.87±2.61)s,均高于对照组[(7.01±1.24)mL、(11.14±2.87)s],差异均有统计学意义(P<0.05),两组静脉最大流出量、静脉回流速率比较,差异均无统计学意义(P>0.05)。治疗5 d后,两组全血黏度(涵盖低、中、高切)、血浆黏度、FIB、D-二聚体均较治疗前降低,观察组FIB、D-二聚体分别为(2.71±0.85)g/L、(1.32±0.36)mg/L,均低于对照组[(3.22±1.02)g/L、(1.74±0.41)mg/L],差异均有统计学意义(P<0.05)。两组全血低、中、高切黏度、血浆黏度与对照组比较,差异均无统计学意义(P>0.05);治疗5 d后,两组深静脉通畅评分均较治疗前降低,观察组为(1.47±0.43)分,低于对照组[(2.19±0.67)分],观察组深静脉通畅率为(83.32±7.69)%,高于对照组[(75.85±8.41)%],差异均有统计学意义(P<0.05)。治疗5 d后,两组患肢与健侧股部、膝上15 cm、膝下15 cm周径差均较治疗前降低,观察组治疗后患肢与健侧股部、膝上15 cm周径差分别为(1.06±0.61)、(1.04±0.51)cm,均低于对照组[(1.48±0.89)、(1.32±0.68)cm],差异均有统计学意义(P<0.05);两组膝下15 cm周径差比较,差异无统计学意义(P>0.05)。观察组与对照组的总并发症发生率比较,差异无统计学意义(P>0.05)。结论rhPro-UK置管溶栓治疗急性DVT可改善患者血流动力学和血液流变学,促进患肢消肿,增加深静脉通畅率,有助于保护静脉功能。
Objective To observe the effect of recombinant human urokinase(rhPro-UK)on hemodynamic level and venous function of lower extremity in patients with acute deep vein thrombosis(DVT).Methods A total of 100 patients with acute deep vein thrombosis of the lower limbs who were admitted to the Tianjin Fourth Central Hospital from September 2019 to May 2023 were prospectively selected and divided into the observation group and the control group according to the random number table method,with 50 cases in each group.Both groups were given low molecular weight heparin sodium injection for anticoagulation therapy,the control group was given urokinase catheter thrombolysis therapy,and the observation group was given rhPro-UK catheter thrombolysis therapy.The changes in hemodynamics(venous volume,maximum venous outflow and venous pressure recovery time)and hemorheology indicators[whole blood low,medium and high shear viscosity and plasma viscosity,fibrinogen(FIB),D-Dimer]of the two groups before treatment and after 5 days of treatment were detected,the deep vein patency scores of the two groups before treatment and after 5 days of treatment were evaluated,the deep vein patency rates of the two groups were calculated,the circumference differences between the affected limbs and the healthy side of the two groups were measured,and the incidence of complications between the two groups was compared.Results After 5 days of treatment,the venous volume,maximum venous outflow,venous return rate and venous pressure recovery time of the two groups were higher than those before treatment,the venous volume and venous pressure recovery time of the observation group were(7.58±1.33)mL and(12.87±2.61)s,which were higher than those of the control group[(7.01±1.24)mL and(11.14±2.87)s],the differences were statistically significant(P<0.05).There were no statistically significant differences in the maximum venous outflow and venous return rate between the two groups(P>0.05).After 5 days of treatment,the whole blood viscosity(covering low,medium and high shear),plasma viscosity,FIB and D-Dimer of the two groups were lower than those before treatment,the FIB and D-Dimer of the observation group were(2.71±0.85)g/L and(1.32±0.36)mg/L,which were lower than those of the control group[(3.22±1.02)g/L and(1.74±0.41)mg/L],the differences were statistically significant(P<0.05).There were no statistically significant differences in the low,medium and high shear viscosity of whole blood and plasma viscosity between the two groups and the control group(P>0.05).After 5 days of treatment,the deep vein patency scores of the two groups were lower than those before treatment,and the score of the observation group was(1.47±0.43)points,which was lower than that of the control group[(2.19±0.67)points],the deep vein patency rate of the observation group was(83.32±7.69)%,which was higher than that of the control group[(75.85±8.41)%],and the differences were statistically significant(P<0.05).After 5 days of treatment,the circumference difference between the affected limb and the healthy side thigh,15 cm above the knee,and 15 cm below the knee in both groups were lower than those before treatment,and the circumference difference between the affected limb and the healthy side thigh,15 cm above the knee,and 15 cm below the knee in the observation group were(1.06±0.61)and(1.04±0.51)cm,which were lower than those in the control group[(1.48±0.89)and(1.32±0.68)cm],and the differences were statistically significant(P<0.05).There was no statistically significant difference in the 15 cm circumference below the knee between the two groups(P>0.05).There was no statistically significant difference in the total incidence of complications between the observation group and the control group(P>0.05).Conclusion rhPro-UK catheterization therapy for acute DVT can improve the hemodynamics and hemorheology of patients,promote the reduction of swelling of the affected limb,increase the patency rate of deep veins,and help to protect venous function.
作者
李雪松
刘一东
肖永生
刘喆
张芊慧
LI Xue-song;LIU Yi-dong;XIAO Yong-sheng(Department of Vascular Surgery,Tianjin Fourth Central Hospital,Tianjin 300140,China)
出处
《临床和实验医学杂志》
2024年第14期1513-1518,共6页
Journal of Clinical and Experimental Medicine
基金
天津市科技支撑重点项目(编号:19YFZCSY00620)。
关键词
急性下肢深静脉血栓
重组人尿激酶原
置管溶栓
尿激酶
血流动力学
Acute deep venous thrombosis of lower extremity
Recombinant human urokinase
Catheter thrombolysis
Urokinase
Hemodynamics
