| Objective:Comparison of intravenous catheter thrombolysis combined with inferior vena cava filter and pure anticoagulation thrombolytic therapy of deep venous thrombosis of short-term effect, the number of cases of pulmonary embolism occur, the incidence of bleeding, the time of hospitalization of the two methods of treatment duration, the amount of urokinase, and after 12 months of treatment in the evaluation of the effect of thrombolysis.To provide accurate clinical evidence for the efficacy and safety of CDT thrombolysis and monoclonal antibody thrombolysis in the treatment of lower extremity deep venous thrombosis.Methods:Choosing the 103 DVT patients of invasive technology department for subjects from2011.1 to 2015.2 in Jin Cheng General Hospital. These patients are single deep venous thrombosis and without anticoagulant thrombolytic taboo. All patients are paroxysm at the first time, clinical examination of body indicate the side of disease have varing degrees manifestation of swelling, pain, skin temperature, gastrocnemius extrusion experiments etc.After the venography and confirmed diagnosis, introduce the therapeutic regimen and fee of the treatment of intravenous catheter thrombolysis(CDT) combined with ivc filter and the method of simple anticoagulant thrombolytic in detail to the patients and their relation.Because the high cost of CDT, the period of thrombolysis need to brake, accept radiograghic exposure during intraoperative and cathetering, patients can incorporate many factors and choose intravenous catheter thrombolysis(CDT) or simple anticoagulant thrombolytic. There are 65 cases of patients accept CDT and 38 cases accept simple anticoagulant thrombolytic. Among the patients accept CDT, there are 31 males and female patients with DVT in 34 cases, the age distribution in 14-74 years, mean age of 56.0 years.Among the simple anticoagulant thrombolytic, there are 16 males and 22 females patients with DVT, age, from 30 to 81 and has an average of 61. Among 103 cases of patients, CDT treat 42 cases of DVT on left lower limb, 22 cases of DVT on the right, simple anticoagulant thrombolytic treat 25 cases of DVT on left lower limb and 16 cases on the right. All patients with thrombosis enrolled in intravascular are located proximal femoral、iliac vein.The average time of attack is 2.5 days among 103 cases of patients. Evaluating curative effect according to the efficiency of treatment and the change of weak limbs and trunk difference of cross-section diameter when patients leave hospital and follow up visit in 12 months. Evaluating the treatment of security between two groups according to the occurrence rate of pulmonary embolism, complications such as hemorrhage and comparing the average stay and the total dosage of urokinase between two groups. The all data use the SPSS 13.0 analysis.Results:1. Generally: 65 cases of patients in CDT and 38 patients in single anticoagulant thrombolytic, there are no statistically significance in sexual, distribution of affect limb,age, course of disease and cross-section diameter of two therapies and has comparability.2. Curative effect analysis2.1 Comparsion of effective rate: The efficient of thrombolytic therapy reached 75.4%during hosipital discharge and the single anticoagulant thrombolytic only 55.3%.(2c=4.459,P=0.035). During the 12-month-follow-up visit, the efficient of CDT was78.5%, the efficient of single anticoagulant thrombolytic dropped to 47.4%,(2c=10.484,P=0.001). CDT is obviously superior to single anticoagulant thrombolytic.2.2 Comparison of difference of cross-section diameter2.2.1 Difference of cross-section diameter of normal and affected side test points of crus and ham: by repeated measures ANOVA we know that it has statistically significance that the average difference of cross-section diameter at pre therapy and post-treatment(F=91.68、P<0.001)、(F=233.02、P<0.001), difference of cross-section diameter when patients leave the hospital and follow-up visit in 12 months has no statistically significance,but pre therapy. Reduction of difference of cross-section diameter at post therapy indicated that two therapies are effective and stabilize. Average difference of cross-section diameter of crus and ham by two terapies has statistically significance(F=11.74、P=0.001)、(F=7.82、P=0.006), the average difference of cross-section diameter of CDT is less than the single anticoagulant thrombolytic manifests that CDT is superior to single anticoagulant thrombolytic.According to the Two independent sample t-test:CDT hasa smaller average difference and less rate of descent than single anticoagulant thrombolytic at hospital discharge and it becmes more obviously at the 12-month-follow-up visit. We can know from the marginal mean interaction diagrams that the d-ifference of two terapies are both descent at hospital discharge.Ham is more steady and declines further after 12 months, but difference is higher than leaving the hospital by single anticoagulant thrombolytic. Crus has a trend of decline both of two terapies.2.3 Average length of stay and dosage of urokinaseThe length of stay of CDT is(14.0±3.00), single anticoagulant thrombolytic is(20.50±4.50), CDT is shorter than the other one(Z=7.595,P<0.001).The amount of urokinase of CDT is(260.0±35.00)×104U per day, the average length of stay of CDT is less than single anticoagulant thrombolytic(Z=6.319,P<0.001).2.4 Incidence rate of pulmonary embolism(PE)Incidence rate of CDT is 0(0/65), the single anticoagulant thrombolytic is23.7%(9/38). CDT is superior to single anticoagulant thrombolytic on prevention of PE.2.5 ComplicationsIncidence rate of complications during thrombolysis of CDT is 13.8%, complications related to hemorrhage is 4.6% of CDT, 21.1% of single anticoagulant thrombolytic.CDT is below single anticoagulant thrombolytic on hemorrhage complications(2c=6.792,P=0.009).Conclusions:(1) Treatment of deep venous thrombosis of lower extremity with intravenous catheter thrombolysis combined with vena cava filter implantation. has the characteristic of safe, better efficacy, short hospitalization stay, reduce the complications effectively etc.(2) During the treatment of anticoagulation and thrombolysis, inferior vena cava filter implantation can prevent the pulmonary thromboembolism.(3) Intravenous catheter thrombolysis combined with inferior vena cava filter placement has a good prospect in clinical applicaton to treat low limbs DVT... |
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