Short-term Efficacy Of Thrombolytic Therapy For Moderate And Severe Pulmonary Embolism Complicated With Deep Venous Thrombosis Of Lower Extremities

Objective:To investigate the effects of catheter thrombolysis and multi-segment peripheral venous thrombolysis on acute and medium-risk pulmonary embolism in middle-aged and elderly patients.Methods:From October 2016 to October 2018,middle-aged and elderly patients with acute middle-risk pulmonary embolism and deep venous thrombosis of lower extremities admitted to Yunnan Vascular Surgery Center,Fourth Affiliated Hospital of Kunming Medical University were screened and included in this study.After admission,the patient communicates with the patient and informs the patient of three treatment options:catheter thrombolysis,peripheral intravenous thrombolysis and simple anticoagulation therapy.The patient chooses and signs the consent for treatment.Thirty-six patients with catheter thrombolysis were enrolled in group A(experimental group 1),48 patients with peripheral intravenous thrombolysis were enrolled in group B(experimental group 2),and 30 patients with simple anticoagulation therapy were enrolled in group C(control group).The therapeutic effect was evaluated according to the clinical symptoms,pulmonary artery CTA,color Doppler echocardiography,angiography,limb circumference changes before and after treatment,and related blood tests.The follow-up period was 1 month.Comparing the three groups of patients with different treatment methods,whether there is difference,whether there is statistical significance.Results:1.After 7 days of treatment,the indexes of patients in each group before and after treatment were compared.:(1)the pulmonary embolism area or section number:group A(7.72±1.03)before treatment and after treatment(2.56±1.48)and group B(8.06±1.64)before treatment and after treatment(2.35±1.28),group C(5.37±1.63)before treatment and after treatment(2.20±1.30)section,three groups of pulmonary embolism after treatment area is reduced,or number of interclass difference had statistical significance(p<0.05),group A and group B after treatment there was no statistically significant difference(p>0.05),group A and group B after treatment compared with group C,the effect is better than that of group C,The difference was statistically significant(p<0.05);(2)Pulmonary artery systolic pressure:group A(54.03±1.81)mmHg before treatment,after treatment(33.47±3.38)mmHg,group B(54.2±2.51)mmHg before treatment,after treatment(31.38±2.89)mmHg,group C(51.07±5.19)mmHg before treatment,after treatment(33.10±2.35)mmHg,three groups of both the pulmonary artery systolic blood pressure after treatment decreases,and the differences were statistically significant(p<0.05),there was no statistically significant difference between groups(p>0.05);(3)oxygen saturation:before treatment(87.67±1.31)%in group A,after treatment(93.83±1.98)%in group B,before treatment(87.79±2.00)%in group B,after treatment(94.44±1.56)%in group C,before treatment(87.37±3.85)%in group C,after treatment(93.37±2.22)%.(4)oxygen partial pressure:Group A(58.58±0.94)mmHg before treatment,after treatment(86.28±1.88)mmHg,group B(58.52±1.81)mmHg before treatment,after treatment(87.48±1.66)mmHg,group C(58.63±3.59)mmHg before treatment,after treatment(81.53±4.65)mmHg,interclass difference was statistically significant(p<0.05),group A and group B after treatment there was no statistically significant difference(p>0.05),group A and group B after treatment compared with group C,the effect is better than that of group C,The difference was statistically significant(p<0.05).(5)the total effective rate of each group was 88.88%in group A,87.50%in group B,and 66.67%in group C.There were statistically significant differences between group A and group C,and between group B and group C(p<0.05),but no statistically significant differences between group A and group B(p>0.05).2.The detumescence rate of patients in the three groups after 7 days of treatment:the thigh detumescence rate of group A was(66.49±8.86)%,the calf detumescence rate was(72.17±7.48)%,the thigh detumescence rate of group B was(64.89±18.13)%,the calf detumescence rate was(68.56±8.84)%,the thigh detumescence rate of group C was(47.94±14.87)%,the leg detumescence rate was(60.37±10.34)%,the difference was statistically significant(p<0.05).When the course of disease was less than 7 days,the detumescence rate of group A and group C was statistically significant(p<0.05),while that of group B and group C was not statistically significant(p>0.05),indicating that the earlier treatment was given to venous thrombosis patients,the better the curative effect would be.At 7-14 days,the detumescence rate of group A and group C was statistically significant(p<0.05),while the difference between group A and group B was not statistically significant(p<0.05).There was no significant difference between group A and group B(p>0.05).3.Comparison of adverse events among the three groups:there were 6 patients in group A had adverse events,with an incidence of 16.67%;there were;8 patients in group B have adverse events,with an incidence of 16.67%;there were 3 patients with adverse events in group C,with an incidence of 10%.There was no significant difference in the incidence of adverse events among the three groups(p>0.05).Conclusion:1.Catheter thrombolysis,peripheral venous thrombolysis and simple anticoagulation are effective in the treatment of middle-aged and elderly patients with acute and medium-risk pulmonary embolism combined with lower limb deep venous thrombosis;2.Catheter thrombolysis and multi-segment peripheral venous thrombolysis have better efficacy than simple anticoagulation therapy.