| Objective: To probe the practicability efficacy and safty of catheter thrombolysis therapy in patients with fracture accompanied lower extremity deep venous thromboembolism. And evaluate the incidence of complications after catheter thrombolysis.Methods: Retrospective analysis of 28 patients admitted to our hospital from January 2014 to December 2015, who suffered venous thrombosis in perioperative period of fracture. According to allegations of catheter thrombolysis, these patients accompanied acute venous thrombosis did catheter thrombolysis treatment after fracture operation.All patients with male 22 cases, female 6 cases, the sex ratio of 3.5:1, aged from 20 to 65 years old, average age(42.2±11.6)years. Thrombolysis preparation: all patients with limb venous color doppler examination and deep vein anterograde contrast in order to make clear the diagnosis of lower extremity deep vein thrombosis and thrombosis position and scope. After definite diagnosis we did vena cava filters surgery to prevent pulmonary embolism. Patients eligible for thrombolysis treatment were given catheter thrombolysis after fracture operation. Thrombolysis: 28 patients underwent catheter-directed thrombolysis with discontinuous infusion of urokinase. Push urokinase injection regularly at a speed of 100000u/2h into the catheter. The dose of urokinase was 220~480×10^4 IU, average(368.28±89.34)×10^4 IU, the time of thrombolysis was 48~120h(72.6±17.1)h. During thrombolysis, timing determination of plasma fibrinogen concentration, and according to them adjust thrombolysis drug dose. When FIB between 1~2 g/l, reduce the dose to 50000u/2h; When the FIB< 1 g/L, stop thrombolysis treatment. After continuous thrombolysis 48~72h, observe the thrombolytic effect by catheter angiography. According to imaging results to decide whether to end thrombolysis treatment, if the effect is not ideal we can start secondary thrombolysis by adjusting the position of catheter or replacing catheter. After 24h~48h, thrombolysis effect were confirmed again by angiography. 2 patients were implanted with stents for the residual stenoses after thrombolysis. During catheter thrombolysis, low molecular heparin were given regularly with 4000 u/12 h by subcutaneous injection, continuous 7~10 d.Continue to anticoagulation for at least one year after thrombolysis. The circumferences between normal and affected limbs were measured before and after thrombolysis. The venous patency score, the rate of patency improvement were evaluated by venography. All patients were followed up for 2 to 24 months as outpatient, lower extremity vascular ultrasound, circumference and CT angiography were conventional. Clinical data and follow-up results were analyzed by t-test and Wilcoxon rank-sum test.Results: After catheter thrombolysis treatment, clinical symptoms and signs of 28 patients were obviously improved. Before catheter thrombolysis: Two circumferences between normal and affected limbs were 7.28±1.04 cm and 4.16±0.72cm; After catheter thrombolysis, these data were 2.74±0.8cm and 2.08±0.40 cm. The two limb circumference measurements before and after thrombolytic therapy has significant difference(t=37.65, t=22.59, P<0.05)。The venous patency score of before and after thrombolytic therapy were(9.18±2.02) points and(3.04±0.92) points, the venous patency rate is 68.1%±6.05% after therapy, venous patency have significant difference before and after therapy(Z=-4.650,P<0.05). Compared with pure anticoagulation venous patency rate of thrombosis was significantly higher(Z=-5.697, P<0.05), deep vein valve retention rate is 85.71% after thrombolysis. Of venous thrombosis after thrombolysis dissolved in 3 patients, 2 iliac vein stent angioplasty were carried out, 1 case refused to stent angioplasty. 5 patients was in a small amount of bleeding during the process of thrombolysis, accounted for 17.8% of the total thrombolysis patients, no serious bleeding happens. During the thrombolysis no pulmonary embolism occurs. Carried on analysis to the laboratory test index compared with preoperation after catheter thrombolysis. PT, PLT and HGB had no statistical difference(P>0.05), and TT,APTT, FIB and D-D had significant difference(P<0.05). This group of 23 patients received follow-up, follow-up rate was 82.1%.Follow-up time was 2~24 months, the average(13.5±7.3) months. The two limb circumference measurements in the last follow-up compared with preoperative there are still significant differences(t=35.39, t=17.64, P<0.05). At the time of the last follow-up venous patency score is(3.29±0.94) points, venous patency rate is 64.75%±7.21%, compared with preoperative the difference was statistically significant(Z =-4.648, P < 0.05), deep vein valve retention rate is 78.6%. From the follow-up of 2 patients with stent placement we can see stents were still patent, completely without complications. 1 case of 23 patients recurrent deep vein thrombosis, pulmonary embolism occurs.Conclusion: The study results show that for traumatic fracture patients combined with deep vein thrombosis, the fracture of conventional catheter thrombolytic therapy can effectively alleviate the clinical symptoms of limb, significantly improve the limb venous patency rate, especially for central type and mixed type of blood clots, the treatment effect is obviously better than pure anticoagulant therapy, and the incidence of complications such as venous thrombosis after syndrome is significantly lower than the pure anticoagulation. Most important of all, during catheter thrombolysis and postoperative no severe bleeding and complications occurs. So for fracture patients, as long as grasp the operation indication, control the thrombolytic drug dose in the process of thrombolysis, regular monitoring of blood coagulation index, grasp the thrombolytic time catheter thrombolysis for treatment of fracture patients combined with vein thrombosis remains a safe and effective treatment. |
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