| Purpose: To study the use of a new thrombolytic drug Reteplase(r-PA)under CDT(Catheter directed thrombolysis,CDT)and PMT(Percutaneous mechanical thrombectomy,PMT)in the treatment of patients with deep vein thrombosis of the lower extremities in the clinical efficacy and adverse reactions of the disease;and when the same thrombolytic drug urokinase is used,the clinical observation of mechanical thrombectomy compared with deep venous catheter thrombolysis,in order to explore a more superior medication plan and intracavitary treatment method.Provide more reference guidance for clinical diagnosis and treatment of similar diseases in the future.Methods: We retrospectively analyzed the clinical data of patients with acute deep vein thrombosis in the First Affiliated Hospital of Guangxi Medical University from January 2017 to December 2020.After screening the patients according to the selection criteria and exclusion criteria,they were divided into three different groups according to the treatment plan.Including 2 medication regimen groups and 1 surgical treatment group,the efficacy and adverse reaction results between each group were compared.Medication regimen group: Under the same surgical method,CDT+percutaneous transluminal angioplasty(PTA),urokinase(UK)thrombolysis,urokinase combined with reteplasty thrombolysis were used;Under the same surgical method,PMT+PTA,UK and r-PA were used alone for thrombolysis.Operation group: Under the same drug UK thrombolytic therapy,two operation methods,CDT+PTA and PMT+PTA were used respectively.Results: A total of 197 patients with DVT in the acute phase were included in this study,180 cases were followed up,and the loss to follow-up rate was 9.4%.Under the same operation method CDT+PTA,the average increase of D dimer in the UK group and UK+r-PA group was 4753.00 ng/ml and 22577.00ng/ml,respectively,and the average decrease in fibrinogen was 1.90± 1.40 g/L and 2.61±1.45 g/L,the difference was statistically significant(P<0.05).The two groups were similar in hospitalization days,hospitalization expenses,patency rates before and after surgery,lower extremity swelling rate,villalta score,PTS incidence,and mid-term(1-3 months)patency rate,but there was no statistically significant difference(P>0.05).There was no statistically significant difference in the frequency of adverse reactions between the groups(P>0.05).Under the same operation method PMT+PTA,the average decrease of fibrinogen in the UK group and r-PA group was 1.34±0.83 and 3.34±1.08(g/L),respectively.The deep vein patency rates before and after the operation were respectively It was 60.00% and 80.00%,the difference was statistically significant(P<0.05).The hospitalization days,hospitalization expenses,lower limb swelling rate,PTS score,recent(1-3 months)patency rate,and frequency of adverse reactions between the two groups were similar,and the difference was not statistically significant(P>0.05).Under the same UK regimen of thrombolytic drugs,the average hospital stay of the CDT+PTA group and PMT+PTA group was 7 days and 5 days,respectively.The total hospitalization expenses were 58934.54±12906.73 yuan and 83299.14±13559.97 yuan,respectively.D-dimer increased The high was4753.00 ng/ml and 37247.00 ng/ml,the swelling rates of the thigh were 50.00%and 65.00%,the patency rates before and after the operation were 60.00% and77.78%,and the villalta score was 5.00 and 3.00 respectively.PTS between groups The frequency was 91 cases(81%)and 7 cases(47%).The frequency of adverse reactions between the groups was 43 cases(38%)and 10 cases(66.67%).The difference was statistically significant(P< 0.05).There was no significant difference in the degree of fibrinogen reduction,calf swelling rate and mid-term(1-3 months)patency rate(P>0.05).Conclusion:1.In the use of catheter thrombolysis + balloon dilatation and angioplasty,urokinase combined with reteplase compared with urokinase alone can significantly increase D dimer and decrease fibrinogen,but the short-term and long-term is the same and does not increase the risk of adverse reactions in patients.2.In the case of mechanical thrombectomy + balloon dilatation angioplasty,intraoperative use of reteplase alone brings better postoperative patency than urokinase,and there are no obvious mid-term and long-term effects and adverse reactions statistical difference.3.Under the same thrombolytic drug urokinase regimen,the use of mechanical thrombus removal + balloon dilatation and angioplasty brings better short-term and long-term curative effects than intubation thrombolysis + balloon dilatation and angioplasty.There are also hospitalization days.However,the risk of adverse reactions such as hematuria after surgery increases. |
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