下肢深静脉血栓形成的溶栓抗凝治疗:附139 例报告
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王湘英, Email: wangxyrmyy@yahoo.com.cn

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Anticoagulant and thrombolytic treatment for deep venous thrombosis of lower extremity: a report of 139 cases
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    目的:探讨下肢深静脉血栓形成(DVT)的溶栓抗凝治疗的有效性和安全性。 方法:回顾性分析139例下肢DVT患者的临床资料,其中左下肢106例,右下肢28例,双下肢5例,均通过下肢静脉彩超检查确诊。患者均予以低分子肝素钙4 100 U/12 h皮下注射,根据患者起病时间长短及有无禁忌,57例患者予以尿激酶10万U/12 h溶栓治疗,所有患者均同时给予低分子右旋糖酐250~500 mL/d静脉滴注祛聚治疗。若患肢红肿明显,血象增高,辅以头孢类抗生素治疗。出院后服用华法林继续抗凝治疗至少半年。 结果:所有患者肢体肿胀、疼痛症状均缓解出院,其中1例合并晚期肿瘤患者为签字要求出院。 1例患者入院时即有肺栓塞症状,由于经济原因未安装下腔静脉滤器,经溶栓及抗凝治疗后好转出院。所有患者治疗过程中未发生明显出血等并发症。121例患者获得随访,随访时间1个月至 3年,平均14个月。患者症状均明显缓解,恢复正常生活。 结论:低分子肝素钙抗凝,尿激酶溶栓治疗在下肢DVT中的应用是安全有效的。

    Abstract:

    Objective: To investigate the efficacy and safety of anticoagulant and thrombolytic treatment for deep venous thrombosis (DVT) of lower extremity. Methods: The clinical data of 139 patients with lower limb DVT were retrospectively analyzed. Of the patients, 106 cases had DVT in the left leg, 28 cases in the right leg and 5 cases in both legs, and all of them were diagnosed by lower extremity venous Doppler examination. All patients underwent anticoagulant treatment with subcutaneous injection of low molecular weight heparin calcium (4 100 U/12 h), 57 cases of whom received thrombolytic therapy with urokinase (100 000 U/12 h) based on the length of onset to admission interval and the absence of contraindications to the medication, and all patients had antiaggregant therapy with intravenous infusion of low molecular dextran (250–500 mL/d). Cephalosporin antibiotics were used for patients with evident redness and swelling of the affected leg or an increased white blood cell count. Warfarin anticoagulant therapy was continued for at least 6 months after discharge. Results: Except for one patient with an advanced malignant tumor who was discharged from hospital on request, all the other patients were discharged from the hospital after their swelling and pain in the affected legs were relieved. One patient complicated by pulmonary embolism at admission refused the inferior vena cava filter placement due to economic reasons, and recovered after anticoagulant and thrombolytic treatment. No complications such as evident bleeding were noted in any of the patients during therapy. Follow-up for one month to three years (average of 14 months) was obtained in 121 patients, and all of them had recovered and returned to normal life. Conclusion: Anticoagulant and thrombolytic treatment with low molecular weight heparin and urokinase is safe and effective for lower limb DVT.

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欧阳尚|王湘英|黄忠诚.下肢深静脉血栓形成的溶栓抗凝治疗:附139 例报告[J].中国普通外科杂志,2013,22(6):697-700.
DOI:10.7659/j. issn.1005-6947.2013.06.007

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  • 收稿日期:2012-12-10
  • 最后修改日期:2013-03-29
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  • 在线发布日期: 2013-06-15