【摘要】 目的探讨下肢深静脉血栓形成药物治疗的时机、使用范围和安全性。方法回顾性分析该科近五年来行非手术治疗的379例单侧LDVT患者的临床资料;根据患者发病至就诊时间将其分为急性期(≤3d)、亚急性期(3～14d)、慢性期(>14d)三组,再根据使用药物的不同将患者分为单独抗凝和溶栓+抗凝治疗两亚组,对各组间的治疗效果、凝血指标改变及相关并发症的发生率进行比较分析。结果在379例单侧LDVT患者中,急性期的治疗效果明显较好,在各组间采取溶栓抗凝组治疗效果均明显好于单独抗凝治疗组,治疗效果有显著差异。在手术后并发LDVT患者中:溶栓抗凝联合治疗组的治疗效果明显好于单独抗凝治疗组,差异显著;两组患者凝血指标改变和相关并发症的发生率无明显差异。结论抗凝溶栓联合用药较单独抗凝治疗效果明显;抗凝溶栓联合治疗对急性期LDVT患者效果最好,但对亚急性期和慢性期患者仍然有效;对手术后LDVT患者在严密监控下使用常规剂量尿激酶进行溶栓治疗是安全、有效。更多还原

【Abstract】 Aim To investigate the indication,application timing and security of thrombolysis therapy in lower extremity deep venous thrombosis(LDVT),and to provide the theoretical basis for clinical treatment for LDVT.Methods The clinic data of 379 patients of unilateral LDVT treated in our departments from 2004 to 2008 were reviewed.All cases were received non-surgical therapy,and were divided into three groups:acute stage(≤3 days),subacute stage(3~14 days) and chronic stage(>14 days) group according to diseased time.Each group was further divided into two sub-groups according to therapeutic protocol:thrombolysis plus anti-coagulation and anticoagulation alone.Changes of the lower extremity circumference and variation of coagulation indexes were recorded in each group to measure the therapeutic effect.All data were treated with SPSS statistical package.Results 379 cases with unilateral LDVT were reviewed,and the patients in acute stage had better outcome.The curative and obvious effective rate with thrombolysis plus anticoagulation treatment in all three groups were 73.6% in acute stage,54.1% in subacute stage and 32.6% in chronic stage,respectively(P<0.01).In summary,the curative and obvious effective rate in thrombolysis plus anti-coagulation subgroup was higher than that in anticoagulation alone subgroup.The data of 158 patients with postoperative thrombosis of deep venous on unilateral lower extremities treated by non-surgical therapy were analyzed retrospectively:the curative and obvious effective rate was 73% in thrombolysis plus anticoagulation group,and 42% in the anticoagulation alone group was.There were significant differences between two groups(P<0.01),but no significant difference(P>0.05)in variation of coagulation indexes and complication rate among the two groups.Conclusion The outcome of protocol with anticoagulant plus thrombolytic therapy is better than that with anticoagulation alone in LDVT,and that in acute stage has better outcome than that in non-acute phase.For patients in non-acute stage phase,thrombolysis plus anticoagulation treatment is still effective.Thrombolysis plus anticoagulation is an effictive and safe method for postoperative LDVT,under the tight monitoring of clot relative parameters.更多还原