| Objective:Acute lower extremity deep venous thrombosis(LEDVT) refers to the abnormal blood coagulation in deep vein of lower limb, blocking the venous lumen, leading to deep vein circumfluence obstacle, limb swelling and pain, as well as clinical symptoms of different levels of the whole body reaction,onset of less than 2 weeks. And it is threatening people life and health and quality of life of the normal vascular disease, and the main harm to people is pulmonary embolism and thrombosis syndrome.With the research of it’setiology, pathology, physiologyand interventional technology development, the treatment obtains it’s continuous improvement.This study explore the multi-way piercing into the road line of catheter-directed thrombolysis(CDT) to treating lower extremity deep venous thrombosis;Evaluate CDT of different dosing treatment’s the curative effect of deep vein thrombosis of lower limbs.Methods: This study had been used since October 2010 to October 2014, our hospital type treating proximal DVT of lower limb, small saphenous vein thrombolysis in patients with 66 cases.Preoperatively with low molecular heparin calcium standard anticoagulation 85 IU/kg, subcutaneous injection once in 12 hours, before the above cases catheter thrombolysis were confirmed by lower limb venous anterograde imaging, with the exception of thrombolysis taboo, improperness cava filter implantation first, using Seldinger technique under local anesthesia puncture the contralateral femoral vein, in 4F vascular sheath, except taboo, 0.5- 1.0 cm in the renal vein openings under the release of the filter, and then cut the puncture small saphenous vein and successful insertion tube, catheter thrombolysis, choose appropriate length in thrombolysis after catheter, patients were randomly divided into two groups: group A: adopted divide second pulse type dosing way into dissolved suppository specific methods: making simple injection device, with 50 m L saline solution urokinase 0.2 million units in 50 m L syringe, tee end connected to the catheter thrombolysis, the opposite side connecting to 2 m L syringe and the other side connecting to 50 m L syringe, adjusting the three-way switch valve, pumping urokinase into 2 m L syringe, regulating valve, and fierce pushing drugs injection after thrombolysis catheter into the body, continuous operation with drugs, until the 0.2 million units of urokinase injection, once every 4 hours, every time after the end of catheter thrombolysis by heparin saline continue pumping;Group B: the trace continuous dosing pump injection dissolved suppository, with 50 m L syringe will be 0.2 million units of urokinase dissolve in normal saline in the 50 m L, apply trace pump continuous uniform pumping, vascular sheath pathways heparin saline to maintain.Two groups of patients were regularly monitor APTT, makingits be extended to 1.0-1.5 times of the normal value, guarantee the anticoagulation intensity.Two groups of cases in same amount of urokinase thrombolysis treatment for 24 hours, treatment period for 7 days, in the process of thrombolysis timing monitoring angiographic thrombus, monitoring D- dimer, diameter measuring thigh week, curative effect and complications were recorded thrombolysis, including imaging dissolve thrombus or severe complications, stopping thrombolysis, collecting 2 D-dimer monitoring value, venous patency degree and data by the swelling rate and complications such as the number of cases, patients with use of statistical software to compare the two ways each observation indexes, comparing curative effect of thrombolysis drug delivery mode and complications.Results:In this topic all 66 patients were successfully cutted into small saphenous vein and implanted thrombolysis catheter(100% success rate).1 D- dimer concentration changes In the thrombolysisprocess, D- dimer concentrations were lower after rising first, several times pulse group’s average peak of dimer concentration appear earlier than continuous pumping group,the end of thrombolysis pulses group D- dimer mean concentration was6significantly lower than that of continuous pumping group(P < 0.05), After treatment,D- dimer is stable, and a low level,there is no recurrence of thrombosis.2 Thetotal effective rate Group A after thrombolysis, invalid,markedly improved andeffectivecases wererespectively7, 13, 13 cases, the total effective rate was 84.84%;Group Bafter thrombolysis,invalid markedly improvedandeffectivecases were respectively 11, 12, 10 cases, and the total effective rate was 69.69%. After thrombolysis,pulse to total effective rate was significantly higher than continuous drug treatment group(P< 0.05).3 Limb swelling rate and venous patency rate After CDT treatment, all the patients’ s symptoms were significantly improved, group A limb swelling rate was(91.70 + 14.30) %,group B limb swelling rate was(74.49±15.35)%,limb swelling rate of group A is better than that of group B, and there are obvious difference(P< 0.05); Venous patency rate of Group A was(67.97 + 17.89) %;venous patency rate of Group B was(58.46±18.35)%,venous patency rate of Group A is higher than group B’s,and there were significant differences.4 Complications In CDT process,in group A 2 cases with fever,3 cases with small saphenous vein incision bleeding;In Group B 2 cases with fever, 4 cases with small saphenous vein incision bleeding, with symptomatic treatment the symptoms disappear, thrombolytic therapy is not terminated.In the two groups had no serious complications.The incidence of complications in the two groups has no statistical difference(P> 0.05).Conclusions:1 Catheter-directed thrombolysis treatment ofacute deep vein thrombosis(iliac and or femoral popliteal vein) patients,byimplanting tubevia the smallsaphenous vein, is a safe, effective and feasible way of thrombolysis.2 Catheter-directed thrombolysis treatment of acute deep vein thrombosis(iliac and or femoral popliteal vein), several times with pulse type dosing’s the curative effect of thrombolysis is better than that of continuous type dosing. |
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