| Objective: To observe the deep venous thrombosis(DVT)in patients with thrombosis site of Fibrinogen(FIB),D-dimer(DD),C-reactive protein(CRP)and peripheral venous blood values level whether there is a difference,and to explore thrombus site FIB,DD and CRP values clinical guiding significance for the treatment of patients with DVT.Methods:The clinical data of 70 DVT patients treated in the interventional department of the affiliated hospital of Zunyi medical university from June 2019 to September 2021 were collected and the patients data,including general data,the clinical course of deep vein thrombosis and thrombosis induced factors,study of patients,discharge standard.All patients by doppler ultrasound and angiography clear diagnosis of blood,and the implementation of treatment to avoid heavier or pulmonary embolism,both the vena cava filter placement,first time after limb popliteal vein puncture into the road,for the treatment of deep vein thrombosis in cavity,at the same time on thrombosis in blood samples,send the FIB,DD and CRP,measurements and arm basilic vein(hereinafter referred to as the upper extremity peripheral vein)acquisition of peripheral venous blood corresponding detection index comparison,and installment and thrombosis induced factors of thrombosis related analysis.Vein thrombosis cavity treatment finished,back to the ward for patients with deep venous blood tube residual thrombus to continue the limb dorsalis pedis intravenous drip to anterograde urokinase thrombolysis treatment,according to adjust the dose of urokinase treatment,initialphase,the June 2019-June 2020(group A),dosage of urokinase with reference to systemic venous dosage,which is 300000 units/time,2 times daily,total 3million units to 4 million units.Subsequent phase,the July 2020-September 2021(group B),according to A group of patients with curative effect and complications of adjust dosage of urokinase is 200000 units/time,2 times daily,total 3 million units to 4million units.Curative effect observation: In thrombolysis treatment of 3 days,5 days and 7 days review of lower extremity venous imaging,according to the imaging conditions for venous patency rating,thrombosis,residual volume and thrombus clearance measurement;And statistical complications appeared in the process of thrombolysis therapy.Compare two groupsof patients with clinical treatment effect and thrombosis in patients with site the level of FIB,DD and CRP values the relationship with the clinical curative effect.Results: Discharge standard of 70 cases of patients,including 28 cases in group A,B group of 42 cases.Group A: male 16 cases,12 cases,women aged 35 to 83 years old,the average(58.67±13.67)years of age,17 cases of the left leg,right leg in 11 cases,central vein thrombosis in 13,15 cases were mixed venous thrombosis,acute phase of the 21 cases,subacute phase of the 7 cases,9 cases of trauma and 19 cases of trauma.Group B: 22 cases of male,female 20 cases,age 31-87,the average age(58.44±16.43),the left leg 32 cases,10 cases of right lower limb,central enous thromboembolism 27 cases,15 cases mixed venous thrombosis.31 cases acute stage,middle stage 11 cases,23 cases of trauma,19 cases of trauma.Two sets of data in the distribution of gender,age,blood clots,duration index comparison,there were no statistically significant difference(P > 0.05).70 cases of patients with thrombus site FIB,DD and CRP values respectively(2.39 ± 4.22)g/L,(2.54 ± 6.26)μg/ml,(2.57 ± 8.30)mg/L,the upper extremity peripheral venous sampling check index values respectively corresponding(1.87 ± 2.83)g/L,(1.67 ± 3.78)μg/ml,(1.76 ± 4.84)mg/L the comparison,the difference was statistically sig-nificant(P < 0.05).Acute thrombosis site and upper extremity peripheral venous blood FIB,DD and CRP difference mean respectively(0.65±1.64)g/L,(0.52±2.38)μg/ml,(0.68±3.34)mg/L,phase subacute thrombosis parts and upper extremity peripheral venous blood FIB,DD and CRP difference mean respectively(0.2 ± 0.87)g/L,(0.31 ± 2.45)μg/ml,(0.58 ± 2.02)mg/L,acute and subacute phase of FIB difference comparative difference was statistically significant(P< 0.05),acute stage significantly higher than the subacute stage,DD and CRP index difference comparative differences had no statistical significance(P> 0.05).Thrombosis patients with injury of FIB,DD and CRP values mean respectively(1.91±4.25)g/L,(2.73±5.22)μg/ml,(3.19±7.84)mg/L,thrombosis patients without damage to site of FIB,DD and CRP values meanrespectively(2.78±4.12)g/L,(2.23±6.77)μg/ml,(2.32±9.71)mg/L,to compare similar between the two groups had no statistical significance(P > 0.05).Thrombus site and upper extremity peripheral venous blood FIB,DD and CRP ratio,mean standard deviation respectively(0.72±2.05)g/L,(1.07±1.91)μg/ml,(1.12±1.68)mg/L.A,B two groups of patients with curative effect evaluation: venous patency degree score,residual volume,the thrombus clearance,by the repeated measurement variance results available,there was no statistically significant difference between the groups(F=0.379,P=0.540).A,B two groups of patients in 3 days,5 days,7days venous blood circulation chang rating change trend was statistically significant(F=43.425,P=0.000).A,B two groups of patients in 3 days,5 days,7 days blood clots residual volume,time change tendency was statistically significant(F=177.277,P=0.000),two groups of A decrease in the overall trend.A,B two groups of patients in3 days,5 days,7 days of thrombus clearance change trend was statistically significant(F=179.370,P=0.000),the overall trend is rising,two groups of patients with thrombus clearance at three time points measured values change no statistical differences(F=0.729,P=0.431).A,B two groups of the whole curative effect comparison: group A(Pearson coefficient r=0.225,P=0.249)and group B(Pearson coefficient r=0.77,P=0.628)in the blood circulation of venous blood chang rating,residual volume,the thrombus clearance comparison,two groups of patients at three time points measured values change no statistical difference(P>0.05).By the binary Logistic regression analysis of single factor and FIB were higher than in patients with acute thrombosis site subacute stage,with venous patency degree score,residual volume,the thrombus clearance between were significantly correlated(P<0.05),blood clots site FIB levels were positively correlated with blood urokinase thrombolysis treatment effects.Bleeding complications is A,B two groups,A group of 28 cases,6 cases of bleeding complications,accounting for 21.4%,B group of 42 cases,complications in 1 case,accounted for 2.4%,the difference was statistically significant(P<0.05).Parts get cut off value,according to the results of the ROC thrombosis and upper extremity peripheral venous blood FIB in low ratio of the high value of≥1.725 or low< 1.725,DD in low ratio of the high value of≥1.150 or low< 1.150,the high value of 1.475 or higher CRP ratio,low< 1.475,FIB,DD and CRP ratio by the ROC results,classify the cutoff value of 19 patients with FIB ratio of 1.725 or higher,the thrombus clearance rate>50% in 17 cases,thrombus clearance < 50% in 2 cases,FIB ratio 1.725 patients there are 51 cases,including thrombus clearance rate more than 50% of the 30 cases,less than 50% o-f the 21 cases,the curative effect of the differences between two groups was statistically significant(P<0.05),and FIB ratio of 1.725 group or curative effect is better than that of FIB ratio<1.725 group.And DD,the curative effect of the differences between th-e high low CRP ratio has no statistical significance(P>0.05).Conclusion: Thrombus site FIB,DD,CRP values above the level of the peripheral venous blood values,and significantly associated with DVT course.Among them,the thrombus parts and peripheral venous blood ratio in a FIB values with anticoagulant thrombolytic effect into positive correlation.Small dose of urokinase anterograde intravenous thrombolysis can achieve the same as the dosage of peripheral intravenous urokinase treatment effect,at the same time can reduce bleeding complications. |
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