| Objective:Lower extremity deep venous thrombosis(LEDVT)is a common peripheral vascular disease admitted to vascular surgery,which has a serious impact on the quality of life of patients.According to incomplete statistics,the incidence of LEDVT is increasing year by year,and it is more common in patients with chronic diseases such as cerebrovascular disease,recovery after myocardial infarction,post-fracture,post-operative,etc.,and the occurrence of comorbidity not only brings economic benefits to patients.Burden and increase the difficulty of treatment also seriously affect the quality of life of patients,which is one of the difficult problems to be solved in clinical practice.At present,patients with LEDVT often use simple anticoagulation,surgical thrombectomy and systemic thrombolysis,which are prone to faecal detachment leading to fatal pulmonary embolism.How to maximize thrombolysis and remove blood clots as soon as possible,improve the patency rate of deep veins of lower extremities,in order to preserve the function of venous valve of lower extremity as much as possible,reduce the incidence of postoperative PTS,to improve the quality of life of patients is the clinical aspect of LEDVT.Urokinase thrombolysis is the first-generation thrombolytic drug,which is inexpensive and has a positive thrombolytic effect.It is the drug of choice for thrombolysis of LEDVT.This study compared urokinase lumen thrombolysis with peripheral venous thrombolysis.The clinical efficacy of the mode of administration was evaluated to evaluate the efficacy and safety of endovascular thrombolysis in the treatment.Methods:A random sampling method was used to select 249 patients with vascular surgery from the Third Hospital of Hebei Medical University and the First Hospital of Baoding City from March 2016 to July 2018.The patients were diagnosed with LEDVT.The patients finally met the inclusion criteria and exclusion criteria.128 cases.They were randomly divided into group A and group B.There were 62 patients in group A.Group A was treated with posterior iliac vein or small saphenous vein to place thrombolysis catheter,and thrombolysis catheter was injected into urokinase and heparin.Group B had 66 patients.In group B,urokinase and heparin were pumped from the peripheral limbs of the affected limb.There were no significant differences in gender,age,disease duration,limb distribution,thigh circumference difference,and calf circumference difference between group A and group B(P>0.05).All patients were given standard anticoagulant therapy according to kilograms of body weight.All patients were treated with venous angiography of the lower extremities.The circumference of the thigh and the circumference of the calf were calculated by measuring the day before thrombolysis and 7 am on the 7th day after treatment.Diameter;calculated the rate of swelling of the affected limb 7 days after surgery.According to the clinical manifestations before and after treatment,limb mobility,vascular Doppler ultrasound or deep vein angiography and other imaging data.Evaluate the efficacy of thrombolysis,the efficacy scores:class 0,class 1,class 2,and calculate the efficiency and improvement rate.The venous patency of the lower extremities was evaluated primarily with reference to the Porter criteria.Observed indicators of complications:close observation of bleeding at the puncture site,subcutaneous ecchymosis,subcutaneous hematoma,gastrointestinal bleeding,scleral bleeding and other signs of bleeding,chest pain,hemoptysis,dyspnea and other symptoms and signs,symptoms of pulmonary embolism.The data of this study were analyzed by SPSS20.0 statistical analysis software.The test level was set toα=0.05,and P<0.05 was considered statistically significant.Results:1.Comparative analysis of basic data of two groups of patients at admissionThe comparative analysis of the basic data of the two groups of patients at admission showed that there was no difference in the basic data of admission between the two groups in group A and group B,such as age,gender,thrombosis site,disease duration,thigh circumferential diameter difference and calf circumference diameter difference.The data were comparable,P>0.05.2.Results of comparative analysis of limb circumference difference before and after treatment in 2 groups of patientsThe comparative analysis of the circumferential diameter difference between the two groups before and after treatment showed that the difference in the circumference of the thigh was 4.02±1.34 cm before the operation in group A and 4.11±1.39 cm in group B.The t-test was used to compare the thigh week before surgery.There was no difference in the diameter difference,t=0.394,P=0.694;the difference in thigh circum-ference in the A group was 1.16±0.19 cm on the 7th day after operation,and 2.16±0.21cm in the B group.The t-test was used to compare the thigh circumference difference between the two groups.There was a statistical difference,t=28.080,P<0.001.There was a statistically significant difference between the preoperative and postoperative patients in the group A,t=16.185,P<0.001.The preoperative and postoperative analysisin the circumferential diameter of the thighwasstatistically significant differencein the B group,t=11.326,P<0.001.The difference in the calf circumference of the group A was 4.15±1.09 cm one day before operation and 3.92±1.20 cm in the B group.There was no difference in the calf circumference difference between the two groups on the day before operation,t=1.117,P=0.266;group A The difference of the calf circumference was 1.29±0.22 cm in the 7 days after operation and2.09±0.32 cm in the B group.The difference in the calf circumference between the two groups was statistically different by t test.t=16.201,P<0.001;Group A There was a statistically significant difference in the circumferential diameter difference between the patients before and after surgery,t=20.905,P<0.001.There was a statistical difference between the B group and the postoperative analysis of the calf circumference difference,t=12.204,P<0.001.3.Comparison results of thrombolytic efficacy evaluation in two groups of patientsThe comparison of thrombolytic efficacy evaluation between the two groups showed that 37 cases were effective in group A,20 cases were effective,and 5 cases were ineffective.In group B,27 cases were markedly effective,23 cases were effective,and 16 cases were ineffective.After rank sum test,the effect of suppository was statistically different.The effect of group A was significantly higher than that of group B,Z=2.542,P=0.011.There were 57 cases in group A and 5 cases ineffective.In group B,there were 50 cases and 16 cases were ineffective.After chi-square test,the thrombolytic effect of the two groups was statistically different.The effect of group A was significantly higher than that of group B,?χ~2=6.101.,P=0.014.4.Comparison results of Porter scores before and after treatment in two groups of patientsThe results of Porter scores before and after treatment showed that the Porter score of the patients in group A was 8.21±1.24 on the day before surgery and 8.59±1.49 in group B.There was no statistical difference between the two groups by t test.t=1.568,P=0.119.The Porter score was 1.23±0.42 in the seventh group and 3.21±1.32 in the B group.The t-test was used to compare the scores.The scores of the two groups were statistically different.The patients in group A were significantly lower than the group B,t=11.327,P<0.001.5.Comparative analysis of the incidence of adverse events in the two groupsThe comparative analysis of the incidence of adverse events in the two groups showed that there were 4 patients with signs of bleeding in group A and 12 patients with signs of bleeding in group B.There was a statistically significant difference in the incidence of bleeding between the two groups.The incidence of bleeding in the group was higher than that in the A group,χ~2=4.022,P=0.045.There were 3 patients with embolization symptoms in group A and 6 patients with embolization symptoms in group B.There was no significant difference in the incid-ence of embolization symptoms between the two groups by chi-square test,χ~2=0.884,P=0.347.6.Comparative analysis of patency rate and swelling rate in the two groupsThe patency rate and detumes cence rate of the two groups showed that the patency rate of group A was 84.59±6.20%,and the patency rate of group B was 62.09±15.73%.The patency rate of the two groups was statistically analyzed by t test.Learning differences,group A patency rate was significantly higher than group B,t=10.519,P<0.001;group A patients with thigh swelling rate of 67.29±13.93%,group B patients with thigh swelling rate of 44.60±18.73%,by t test Comparative analysis showed that the thigh swelling rate of the two groups was statistically different.The swelling rate of thighs in group A was significantly higher than that in group B,t=7.736,P<0.001.The swelling rate of leg in group A was 66.46±11.30%,group B.The patient’s calf swelling rate was 44.33±17.20%.After t-test,the two groups of patients had statistically significant differences in the rate of swelling of the legs.The swelling rate of the calf in group A was significantly higher than that in group B,t=8.547,P<0.001.Conclusion:1.Intracavitary tube thrombolysis for LEDVT,in reducing the circumference of the thigh and calf,improve the rate of limb swelling,significantly better than the common intravenous thrombolytic therapy,cavity thrombolysis treatment of limb swelling is more effective than ordinary intravenous thrombolytic therapy More significant,intracavitary tube thrombolysis can achieve better clinical outcomes of LEDVT.2.The clinical efficacy and clinical improvement rate of intraca-vitary tube thrombolysis are significantly better than that of common intravenous thrombolysis.The clinical efficacy of intracavitary thromb-olysis for LEDVT is significantly better than that of common intravenous infusion thrombolysis.The effect is satisfactory.3.Cavity thrombolysis and common intravenous thrombolysis have certain clinical effects on patients with LEDVT,but the venous vascular patency of patients with LEDVT in patients with LEDVT is significantly better than that of common intravenous thrombolysis.4.The incidence of adverse events in thrombolysis of the lumen is significantly lower than that of common intravenous thrombolysis,which can effectively reduce the risk of bleeding and is worthy of clinical promotion. |
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