AngioJet血栓抽吸装置联合CDT对急性下肢动脉缺血的疗效研究
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摘要
目的对比分析急性下肢动脉缺血中AngioJet血栓抽吸装置联合导管接触性溶栓(CDT与传统CDT的疗效,以期寻求更为适合的治疗方案。方法选取沧州市人民医院普外血管外科2017年1月至2018年1月收治的86例急性下肢动脉缺血的患者为研究对象,采用随机数字表法分为AngioJet血栓抽吸装置联合CDT组(联合组,n=46)与传统CDT组(传统组,n=40)。术后常规检测血红蛋白、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、尿素酶和肌酐等生化指标。记录并对比患者耐受情况以及血栓清除率和通畅率。结果两组患者的年龄、体质指数(BMI)和性别比例比较,差异均无统计学差异(P均>0.05);联合组患者的住院时间比传统组短,差异具有统计学意义(P<0.05)。联合组和传统组的手术情况显示,两组血栓部位及病因和诱因比较,差异均无统计学意义(P均>0.05);两组尿激酶用量的比较,联合组所用的尿激酶明显比传统组要少,差异具有统计学意义(P<0.05)。联合组的血栓清除率要明显优于传统组,差异具有统计学意义(P<0.05);两组患者的耐受情况评分比较,联合组要优于传统组,差异具有统计学意义(P<0.05)。结论 AngioJet血栓抽吸装置联合CDT的方案在急性下肢动脉缺血中可迅速清除血栓、恢复血供,减少截肢率,提高患者生活质量。
Objective To compare the efficacy of AngioJet thrombus aspiration device combined with catheter contact thrombolysis(CDT) with traditional CDT in acute lower extremity arterial ischemia, in order to find a more suitable treatment. Methods 86 patients with acute lower extremity arterial ischemia admitted to the Department of General Surgery(Vascular Surgery), Cangzhou People's Hospital from January 2017 to January 2018 were randomly divided into AngioJet thrombus aspiration device + CDT group(joint group, n=46) and the traditional CDT group(traditional group, n=40). Biochemical indicators such as hemoglobin, alanine aminotransferase, aspartate aminotransferase, urease and creatinine were routinely detected after surgery. Patient tolerance and thrombus clearance and patency rates were recorded and compared. Results There were no significant differences in the age, BMI and sex ratio between the two groups(P>0.05). The hospitalization time of the combined group was shorter than that of the traditional group, and the difference was statistically significant(P<0.05). The operation of the combined group and the conventional group showed that there was no significant difference in the thrombus sites, etiology and incentives between the two groups(P>0.05). The urokinase levels in the combination group were significantly higher than those in the conventional group. There were fewer groups and the difference was statistically significant(P<0.05). The thrombus clearance rate of the combined group was significantly better than that of the traditional group, and the difference was statistically significant(P<0.05). The tolerance scores of the two groups were better than the traditional group, and the difference was statistically significant(P<0.05). Conclusion AngioJet thrombotic suction device combined with appropriate CDT can rapidly remove thrombosis, restore blood supply, reduce amputation rate and improve the quality of life of patients with acute lower extremity arterial ischemia, especially in patients with fresh thrombosis.
Objective To compare the efficacy of AngioJet thrombus aspiration device combined with catheter contact thrombolysis(CDT) with traditional CDT in acute lower extremity arterial ischemia, in order to find a more suitable treatment. Methods 86 patients with acute lower extremity arterial ischemia admitted to the Department of General Surgery(Vascular Surgery), Cangzhou People's Hospital from January 2017 to January 2018 were randomly divided into AngioJet thrombus aspiration device + CDT group(joint group, n=46) and the traditional CDT group(traditional group, n=40). Biochemical indicators such as hemoglobin, alanine aminotransferase, aspartate aminotransferase, urease and creatinine were routinely detected after surgery. Patient tolerance and thrombus clearance and patency rates were recorded and compared. Results There were no significant differences in the age, BMI and sex ratio between the two groups(P>0.05). The hospitalization time of the combined group was shorter than that of the traditional group, and the difference was statistically significant(P<0.05). The operation of the combined group and the conventional group showed that there was no significant difference in the thrombus sites, etiology and incentives between the two groups(P>0.05). The urokinase levels in the combination group were significantly higher than those in the conventional group. There were fewer groups and the difference was statistically significant(P<0.05). The thrombus clearance rate of the combined group was significantly better than that of the traditional group, and the difference was statistically significant(P<0.05). The tolerance scores of the two groups were better than the traditional group, and the difference was statistically significant(P<0.05). Conclusion AngioJet thrombotic suction device combined with appropriate CDT can rapidly remove thrombosis, restore blood supply, reduce amputation rate and improve the quality of life of patients with acute lower extremity arterial ischemia, especially in patients with fresh thrombosis.
引文
[1]夏彩凤,顾建平,楼文胜,等.急性下肢动脉栓塞与血栓形成的临床异同分析[J].介入放射学杂志,2012,21(5):369-73.
[2]Patel NH,Krishnamurthy VN,Kim S,et al. Quality improvement guidelines for percutaneous management of acute lower-extremity ischemia[J].J Vasc Interv Radiol,2013,24(1):3-15.
[3]Ballehaninna UK,Hingoral A,Ascher E,et al. Acute superior mesenteric artery embolism:Reperfusion with AngioJet hydrodynamic suction thrombectomy and pharmacologic thrombolysis with the EKOS catheter[J]. Vascular, 2012,20(3):166-9.
[4]张娣,顾建平.急性肢体缺血的介入治疗[J].介入放射学杂志,2011,20(10):832-5.
[5]Weinberg RJ,Okada T,Chen A,et al. Comparison of ASPIRE MechanicalThrombectomyVersusAngioJetThrombectomy System in a Porcine Iliac Vein Thrombosis Model[J]. Ann Vasc Surg,2017,42(4):254-62.
[6]刘凯,段鹏飞,陈珑,等. AngioJet血栓清除装置治疗急性下肢深静脉血栓形成初步临床应用[J].介入放射学杂志,2016,25(6):496-500.
[7]雷小明,刘为民,徐鸿雁,等. Fogarty导管介入动脉取栓30例临床分析[J].河北医科大学学报,2002,23(6):359-60.
[8]王磊,郭松林,阴继凯,等. AngioJet治疗急性髂股静脉血栓形成的早期疗效分析[J].中国血管外科杂志(电子版),2016,8(4):303-5.
[9]Vedantham S,Grassi CJ,Ferral H,et al. Reporting standards for endovascular treatment of lower extremity deep vein thrombosis[J]. J Vasc Interv Radiol,2009,20(7 Suppl):S391-408.
[10] Cynamon J,Stein EG,Dym RJ,et al. A new method for aggressive management of deep vein thrombosis:retrospective study of the power pulse technique[J]. J Vasc Interv Radiol,2006,17(6):1043-9.
[11]KarS,WebelR.Septicthrombophlebitis:percutaneous mechanical thromboctomy and thrombolytie therapies[J]. Am J Ther,2014,21(2):131-6.
[12]Srinivas BC,Patra S,Nagesh CM,et al. Catheter-directed thrombolysis along with mechanical thromboaspiration versus anticoagulation alone in the management of lower limb deep venous thrombosis:a comparative study[J]. Int J Angiol,2014,23(4):247-54.
[13]Garcia MJ,Lookstein R,Malhotra R,et al. Endovascular management ofdeepveinthrombosiswithrheolyticthrombectomy:final repofl of the prospective multicenter PEARL(Peripheral Use of AngioJet Rheolytic Thrombectomy with a Variety of Catheter Lengths)registry[J]. J Vasc Interv Radiol,2015,26(6):777-85.
[14] Alesh I,Kayali F,Stein PD. Catheter-directed thrombolysis(intrathrombus injection)in treatment of deep venous thrombosis:a systematic review[J].Catheter Cardiovasc Interv,2007,70(1):143-8.
[15]段鹏飞,倪才方,刘凯,等.药物一机械偶联式血栓清除术治疗急性下肢深静脉血栓形成[J].中华普通外科杂志,2016,31(4):338-9.
[16]Kearon C,Akl EA,Ornelas J,et al. Antithrombotic therapy forⅧdisease:CHEST guideline and expert panel report[J]. Chest,2016,149(2):315-52.
[17]刘磊,冯家煊,王宏飞,等.下肢深静脉血栓形成的AngioJet机械吸栓与置管溶栓的对比研究[J].中华血管外科杂志,2016,1(1):22-5.
[18]宋进华,何旭,楼文胜,等.急性髂股静脉血栓治疗中AngioJet机械性血栓清除装置初步应用结果[J].中华放射学杂志,2015,49(10):758-62.
[19] Lin PH,Zhou W,Dardik A,et al. Catheter-direct thrombolysis versuspharmacomechanicalthrombeetomyfortreatmentof symptomatic lower extremity deep venous thrombosisy[J]. Am J Surg,2006,192(6):782-8.
[20]Leung DA,Blitz LR,Nelson T,et al. Rheolytic Pharmacomechanical thrombectomy for the management of acute limb ischemia:results from the PEARL registry[J]. J Endovasc Ther,2015,22(4):546-57.
[2]Patel NH,Krishnamurthy VN,Kim S,et al. Quality improvement guidelines for percutaneous management of acute lower-extremity ischemia[J].J Vasc Interv Radiol,2013,24(1):3-15.
[3]Ballehaninna UK,Hingoral A,Ascher E,et al. Acute superior mesenteric artery embolism:Reperfusion with AngioJet hydrodynamic suction thrombectomy and pharmacologic thrombolysis with the EKOS catheter[J]. Vascular, 2012,20(3):166-9.
[4]张娣,顾建平.急性肢体缺血的介入治疗[J].介入放射学杂志,2011,20(10):832-5.
[5]Weinberg RJ,Okada T,Chen A,et al. Comparison of ASPIRE MechanicalThrombectomyVersusAngioJetThrombectomy System in a Porcine Iliac Vein Thrombosis Model[J]. Ann Vasc Surg,2017,42(4):254-62.
[6]刘凯,段鹏飞,陈珑,等. AngioJet血栓清除装置治疗急性下肢深静脉血栓形成初步临床应用[J].介入放射学杂志,2016,25(6):496-500.
[7]雷小明,刘为民,徐鸿雁,等. Fogarty导管介入动脉取栓30例临床分析[J].河北医科大学学报,2002,23(6):359-60.
[8]王磊,郭松林,阴继凯,等. AngioJet治疗急性髂股静脉血栓形成的早期疗效分析[J].中国血管外科杂志(电子版),2016,8(4):303-5.
[9]Vedantham S,Grassi CJ,Ferral H,et al. Reporting standards for endovascular treatment of lower extremity deep vein thrombosis[J]. J Vasc Interv Radiol,2009,20(7 Suppl):S391-408.
[10] Cynamon J,Stein EG,Dym RJ,et al. A new method for aggressive management of deep vein thrombosis:retrospective study of the power pulse technique[J]. J Vasc Interv Radiol,2006,17(6):1043-9.
[11]KarS,WebelR.Septicthrombophlebitis:percutaneous mechanical thromboctomy and thrombolytie therapies[J]. Am J Ther,2014,21(2):131-6.
[12]Srinivas BC,Patra S,Nagesh CM,et al. Catheter-directed thrombolysis along with mechanical thromboaspiration versus anticoagulation alone in the management of lower limb deep venous thrombosis:a comparative study[J]. Int J Angiol,2014,23(4):247-54.
[13]Garcia MJ,Lookstein R,Malhotra R,et al. Endovascular management ofdeepveinthrombosiswithrheolyticthrombectomy:final repofl of the prospective multicenter PEARL(Peripheral Use of AngioJet Rheolytic Thrombectomy with a Variety of Catheter Lengths)registry[J]. J Vasc Interv Radiol,2015,26(6):777-85.
[14] Alesh I,Kayali F,Stein PD. Catheter-directed thrombolysis(intrathrombus injection)in treatment of deep venous thrombosis:a systematic review[J].Catheter Cardiovasc Interv,2007,70(1):143-8.
[15]段鹏飞,倪才方,刘凯,等.药物一机械偶联式血栓清除术治疗急性下肢深静脉血栓形成[J].中华普通外科杂志,2016,31(4):338-9.
[16]Kearon C,Akl EA,Ornelas J,et al. Antithrombotic therapy forⅧdisease:CHEST guideline and expert panel report[J]. Chest,2016,149(2):315-52.
[17]刘磊,冯家煊,王宏飞,等.下肢深静脉血栓形成的AngioJet机械吸栓与置管溶栓的对比研究[J].中华血管外科杂志,2016,1(1):22-5.
[18]宋进华,何旭,楼文胜,等.急性髂股静脉血栓治疗中AngioJet机械性血栓清除装置初步应用结果[J].中华放射学杂志,2015,49(10):758-62.
[19] Lin PH,Zhou W,Dardik A,et al. Catheter-direct thrombolysis versuspharmacomechanicalthrombeetomyfortreatmentof symptomatic lower extremity deep venous thrombosisy[J]. Am J Surg,2006,192(6):782-8.
[20]Leung DA,Blitz LR,Nelson T,et al. Rheolytic Pharmacomechanical thrombectomy for the management of acute limb ischemia:results from the PEARL registry[J]. J Endovasc Ther,2015,22(4):546-57.