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Objective To compare the clinical effects of three treatment methods including systemic thrombolysis(ST),catheter-directed thrombolysis(CDT),and AngioJet percutaneous mechanical thrombectomy(PMT)in acute lower extremity deep venous thrombosis(LEDVT). Methods The data of 82 patients diagnosed with LEDVT in the Department of Vascular and Gland Surgery of the First Affiliated Hospital of Hebei North University from January 2017 to December 2020 were collected.The patients were assigned into a ST group(n=50),a CDT group(n=16),and a PMT group(n=16)according to different treatment methods.The efficacy and safety were compared among the three groups. Results Compared with that before treatment,the circumferential diameter difference of both lower limbs on days 1,2,and 3 of treatment in the ST,CDT,and PMT groups reduced(all P<0.001).The PMT group showed smaller circumferential diameter difference of lower limbs on days 1,2,and 3 of treatment than the ST group(all P<0.001)and smaller circumferential diameter difference of the lower patellar margin on day 1 of treatment than the CDT group(P<0.001).The PMT group showed higher diminution rate for swelling of the affected limb at the upper and lower edges of the patella than the ST group(P<0.001)and higher diminution rate for swelling at the upper edge of the patella than the CDT group(P=0.026).The incidence of complications after treatment showed no significant differences among the three groups(all P>0.05).The median of hospital stay in the PMT group was shorter than that in the ST and CDT groups(P=0.002,P=0.001).The PMT group had higher thrombus clearance rate than the ST group(P=0.002)and no significant difference in the thrombus clearance rate from the CDT group(P=0.361).The vascular recanalization rates in the PMT(all P<0.001)and CDT(P<0.001,P=0.002,P=0.009)groups 3,6,and 12 months after treatment were higher than those in ST group,and there were no significant differences between PMT and CDT groups(P=0.341,P=0.210,P=0.341). Conclusions ST,CDT,and PMT demonstrated significant efficacy in the treatment of LEDVT,and PMT was superior to ST and CDT in terms of circumferential diameter difference of the lower limbs,diminution rate for swelling of the affected limb,thrombus clearance rate,length of hospital stay,and long-term vascular recanalization.There was no obvious difference in safety among the three therapies.
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Humanos , Terapia Trombolítica/métodos , Fibrinolíticos/uso terapéutico , Resultado del Tratamiento , Trombectomía/métodos , Trombosis de la Vena/tratamiento farmacológico , Extremidad Inferior/irrigación sanguínea , Catéteres , Estudios RetrospectivosRESUMEN
Objective@#To explore the influence of integrated nursing care mode on the incidence of deep vein thrombosis in lower extremities in bedridden patients.@*Methods@#82 cases of chronic bed rest patients in our hospital were selected as clinical subjects. The time of admission was from December 2016 to December 2017. The patients were divided into control group (routine nursing, 41 cases) and observation group (medical nursing integrated nursing, 41 cases). To compare the influence of nursing intervention on the incidence of deep venous thrombosis of the lower extremities.@*Results@#After treatment, the incidence of deep vein thrombosis in the control group was 24.39% (10/41), and that in the observation group was 4.88% (2/41). The difference was statistically significant (χ2=6.248, P<0.05). The prevention disease score and nursing satisfaction score of the observation group were (35.01±4.21) points and (87.02±5.22) points, and the control group were (28.65±5.87) points and (68.75±4.64) points. The difference was statistically significant (t=5.638, 16.750, P<0.01). The DD dimer, aPTT and PT of the observation group were (448.82±56.27) ug/L, (29.75±2.01) s, (12.88±0.65) s, and the control group were (610.32±72.88) ug/L, (26.81±1.98) s, (10.54±0.59) s. The differences were statistically significant (t=11.231, 6.672, 17.068, P<0.05).@*Conclusion@#For the patients in bed, the effect of nursing intervention is obvious, which can effectively reduce the incidence of deep venous thrombosis and improve the blood coagulation function of the patients.
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Objective To observe the impact of enhancing perioperative care on the clinical efficacy of the patients with intravascular intervention for treatment of patients with acute lower extremity deep venous thrombosis (LEDVT) complicated with pulmonary embolism (PE). Methods Twenty-nine patients with LEDVT complicated with PE admitted to the Tianjin First Center Hospital from May 2015 to February 2019 were enrolled, the pulmonary angiography + pulmonary thrombolysis was applied for all the patients, and 25 cases used inferior vena cava filter implantation, 1 patient underwent catheter-directed thrombolysis (CDT), 4 patients underwent mechanical endovascular aspiration of thromboembolism (PTM), etc intravascular interventional treatment, the peri-operative care was strengthened, including closely observation on the patient's condition, correct use of anticoagulant and thrombolytic drugs, in the mean time, after operation, the nursing care and observation on thrombolysis catheters, involved limbs, complications should be well performed, and health education and discharge guidance ought to be carried out. Before the patient was discharged from the hospital, the improvement of clinical symptoms and the changes of coagulation indexes D-dimer, fibrinogen (Fib), prothrombin time (PT), and activated partial thromboplastin time (APTT) were observed; the Bartel index evaluation quantitative scale was used to assess the patient's activity of daily living (ADL) score; WeChat was used to investigate patient's satisfaction. Results In this group of 29 patients, postoperative chest tightness, shortness of breath symptoms were improved significantly, no fatal PE etc complications occurred. The pulmonary artery computed tomographic angiography (CTA) showed that the pulmonary artery and its branches PE basically disappeared or the measured range or area was obviously decreased. Re-examination of blood gas analysis showed that the arterial oxygen partial pressure (PaO2) was increased. Echocardiography revealed the improvement in pulmonary hypertension. 12 patients with pulmonary infection were improved after anti-inflammatory treatment, the swelling of the affected limb was significantly relieved, and the patients had no distending pain after activities on the ground. After treatment, the coagulation indexes D-dimer and fibrinogen (Fib) were significantly lower than those before treatment [D-dimer (μg/L):2 389.45±2 061.02 vs. 6 093.45±2 586.99, Fib (g/L): 3.18±0.91 vs. 4.07±1.49, both P < 0.01], there were no significant differences in PT and APTT before and after treatment [PT (s): 13.12±2.27 vs. 12.33±2.06, APTT (s):34.51±11.79 vs. 31.84±3.05, both P > 0.05]. After treatment, the ADL score of patients was obviously higher than that before treatment (scores: 79.66±6.26 vs. 17.24±8.30, P < 0.01). WeChat was used to investigate the patients' satisfaction, the nursing score was 95-100 points with an average of (97.38±1.37) points. Conclusion High quality nursing care can minimize the suffering to the largest extent in the patients with pulmonary thrombosis, elevate the quality of life, and reduce the disability and recurrence rates.
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Objective To explore the influence of integrated nursing care mode on the incidence of deep vein thrombosis in lower extremities in bedridden patients. Methods 82 cases of chronic bed rest patients in our hospital were selected as clinical subjects. The time of admission was from December 2016 to December 2017. The patients were divided into control group (routine nursing, 41 cases) and observation group (medical nursing integrated nursing, 41 cases). To compare the influence of nursing intervention on the incidence of deep venous thrombosis of the lower extremities. Results After treatment, the incidence of deep vein thrombosis in the control group was 24.39% (10/41), and that in the observation group was 4.88% (2/41). The difference was statistically significant (χ2=6.248, P<0.05). The prevention disease score and nursing satisfaction score of the observation group were (35.01±4.21) points and (87.02 ± 5.22) points, and the control group were (28.65 ± 5.87) points and (68.75 ± 4.64) points. The difference was statistically significant (t=5.638, 16.750, P<0.01). The DD dimer, aPTT and PT of the observation group were (448.82±56.27) ug/L, (29.75±2.01) s, (12.88±0.65) s, and the control group were (610.32 ± 72.88) ug/L, (26.81 ± 1.98) s, (10.54 ± 0.59) s. The differences were statistically significant (t=11.231, 6.672, 17.068, P<0.05). Conclusion For the patients in bed, the effect of nursing intervention is obvious, which can effectively reduce the incidence of deep venous thrombosis and improve the blood coagulation function of the patients.
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BACKGROUND@#Venous thromboembolism (VTE) is a recognized complication in lung cancer patients with higher morbidity and mortality. The purpose of this study is to determine the incidence of lower extremity venous thrombosis (LEDVT) in lung cancer patients and to reveal the risk factors for LEDVT during admission in our center.@*METHODS@#We first connected 231 patients with lung cancer admitted to the Department of Lung Cancer Surgery, Tianjin Medical University General Hospital from July 2017 to December 2017. All these patients underwent color ultrasound examination of lower extremity vein on admission to analyze the incidence of LEDVT. At the same time, the incidence of LEDVT in patients with benign lung diseases on admission was used as control. In order to explore the possible risk factors for LEDVT in these patients with lung cancer, we further analyze the correlations between LEDVT and their clinical features. At the same time, we also analyze the relationship between LEDVT and Plasma D-Dimmer, fibrinogen (FIB), thrombin time (TT), activated partial thrombin time (APTT), prothrombin time (PT) and platelet (PLT) in these patients with lung cancer.@*RESULTS@#Among 231 patients with lung cancer, the incidence rate of LEDVT on admission was 5.2% (12/231), and in 77 patients with benign lung disease, there was none of patients with LEDVT on admission. This result indicated that the admitted incidence rate of LEDVT in patients with lung cancer was significantly higher than that in patients with benign lung disease (P0.05).@*CONCLUSIONS@#The overall incidence of LEDVT in our central lung cancer patients was approximately 5%, significantly higher than that in patients with benign lung disease. Lung cancer patients with distant metastasis (including N3 lymph node metastasis) at admission were more likely to develop LEDVT, and these patients with higher D-Dimer values should be considered the possibility of VTE events.
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Femenino , Humanos , Masculino , Persona de Mediana Edad , Incidencia , Extremidad Inferior , Neoplasias Pulmonares , Cirugía General , Terapéutica , Admisión del Paciente , Factores de Riesgo , Tomografía Computarizada por Rayos X , Trombosis de la Vena , Diagnóstico por ImagenRESUMEN
OBJECTIVE:To investigate the anticoagulation effects of warfarin on the lower extremity deep venous thrombosis (LEDVT),and to analyze its influential factors,in order to provide scientific basis for individualized medication of warfarin in the clinic. METHODS:Totally 140 cases of LEDVT were selected and treated with warfarin on the and day after admission with initial dose of 5.0 mg,qd,2.5 mg for following 2 days,orally,qd. The dose of warfarin was adjusted 72 h after medieation according to INR of patients. The dose of warfarin wasused as the maintenance dose when INR reached the anticoagulant target. Clinical data of patients were recorded,and blood biochemical indexes and coagulation function were detected. The influential factors of anticoagu-lation effects were analyzed by multiple-linear regression. At the same time,the results of INR were recorded before medication and 24,48,72 h after medication. RESULTS:INR of patients receiving warfarin had the potential to increase,compared to before medication;24,48,72 h after medication,INR value showed a gradual upward trend,without statistical significance(P>0.05). The change of INR within 24 h after medication was less than that within 24-48 h after medication;the change of INR within 24-48 h after medication was less than that within 48-72 h after medication,with statistical significance (P<0.01). The influence of various factors on the anticoagulant effect of warfarin in descending order was as follows:age,weight,low density lipoprotein cholesterol,plasma albumin,disease duration. Among them,age and low density lipoprotein cholesterol were positively correlated with anticoagulation,while body weight,plasma albumin and disease duration were negatively correlated with anticoagulation. CONCLUSIONS:Both age and body weight are the main influential factors for anticoagulation effect of warfarin. Individualized medication should be implemented in order to improve the anticoagulation effects of warfarin.
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Objective To investigate the efficacy of warfarin combined with urokinase in the prevention of deep venous thrombosis after hip replacement. Methods 58 patients undergoing hip replacement in our hospital from October 2014 to October 2016 were randomly divided into the observation group and the control group, 29 cases in each group. The control group were treated with oral warfarin, the observation group was treated with warfarin combined with urokinase, two groups of patients were treated for 14d, the incidence of lower limb deep vein thrombosis, follow-up statistics of two groups of patients within three months after operation, the diameter and blood rheology changes before and after weeks of treatment of lower extremity. Results During the treatment and follow-up of 14d patients in the control group, the incidence of deep venous thrombosis was 20.67% significantly higher than the observation group 3.45% (P<0.05); after treatment, the two groups of patients with lower limb circumference difference was significantly reduced (P<0.05), and the patients in the observation group the thigh circumference, calf circumference difference was significantly less than the control group (P<0.05); after treatment, the two groups of patients with high blood viscosity, low blood viscosity, plasma viscosity and hematocrit were significantly lower than those before treatment (P<0.05), and the indicators of the observation group were significantly lower than the control group (P<0.05). Conclusion Warfarin combined with urokinase can effectively prevent the formation of deep vein thrombosis of lower extremity after hip replacement, improve the hypercoagulability of patients and reduce the circumference of the lower extremity, so it is worthy of clinical application.
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Objective To study the effect of gradient pressure socks combined with intermittent pneumatic pressure pump on lower extremity deep venous thrombosis after gynecological laparoscopy.Methods Toally 45 patients to underwent gynecological laparoscopy during April 2013 to February 2015 were assigned as observation group and from April 2012 to March 2013 another 45 ones to undergo the same therapy were as control group.The latter was treated with routine nursing and the former with gradient pressure socks combined with intermittent pneumatic pressure pump apart from the routine nursing.The effective rate was conpared between two groups.Result The observation group was significantly more effective in the prevention of lower extremity deep venous thrombosis than that of the control group (P<0.05).Conclusion The gradient pressure socks combined with intermittent pneumatic pressure pump can be effective in the prevention of lower extremity deep venous thrombosis after gynecological laparoscopy and thus deserves clinical popularization.
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OBJECTIVE:To observe therapeutic efficacy and safety of Danshen chuanxiongqin injection combined with flunari-zine hydrochloride in the benign prevention and treatment of paroxysmal positional vertigo (BPPV) and lower extremity deep ve-nous thrombosis (DVT) in post-operative long-term bedridden patients with lower limb fractures. METHODS:300 post-operative long-term bedridden patients with lower limb fractures were selected and randomly divided into observation group and control group,with 150 cases in each group. Control group was given Flunarizine hydrochloride capsules orally 10 mg,qd;observation group was additionally given Danshen chuanxiongqin injection 10 ml+5% Glucose injection 250 ml,ivgtt,qd. The incidence of BPPV and DVT were observed in 2 groups after intervention,and the circumference of lower limb,blood coagulation indexes, blood rheology indexes and inflammatory factor were observed before and after intervention,and the incidence of ADR was com-pared. RESULTS:The incidence of BPPV and DVT in observation group were 18.0% and 16.7%,which were significantly lower than in control group(48.7% and 52.7%),with statistical significance(P0.05). CONCLUSIONS:Danshen chuanxiongqin injection combined with flunarizine hydrochloride is effective in the prevention of BPPV and DVT in long-term bed-ridden patients with lower limb fractures,with low incidence of ADR.
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Objective To evaluate the clinical significance of monitoring of D‐dimer ,fibrinogen and fibrin degradation products after hip replacement for diagnosing and preventing the lower extremity deep venous thrombosis .Methods A total of 66 cases of patients who carried out hip replacement from April 2013 to April 2015 in the department of orthopaedic in this hospital were se‐lected .Patients complicated with lower extremity deep venous thrombosis were enrolled into the observation group ,while patients without lower extremity deep venous thrombosis were enrolled into the control group .Levels of D‐dimer ,fibrinogen and fibrin deg‐radation products were strictly monitored after hip replacement and were comparatively analysed .Results There were no statisti‐cally significant differences in levels of fibrinogen and fibrin degradation products between the two groups (P>0 .05) ,while statisti‐cally significant difference was found in level of D‐dimer between the two groups(P<0 .05) .Conclusion The monitoring of D‐di‐mer ,fibrinogen and fibrin degradation products after hip replacement could have clinical significance for diagnosing and preventing lower extremity deep venous thrombosis .
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Objective To explore the risk factors of lower extremity deep venous thrombosis (LEDVT) of neurosurgical patients, and to provide references for identifying the most susceptible population and taking preventive measures. Methods A total of 68 cases of neurosurgical patients with LEDVT in three general hospitals from August 2010 to August 2013 were collected. The design method of one to one matching case-control study was used controlling age, sex and neurosurgical disease. Univariate and multivariate analyses were performed to determine the probable risk factors among two groups. Results The univariate analysis showed that coma, paralysis and limb immobilization, infection, trauma and fracture, lower limbs central venous catheterization, trachea cannula or tracheotomy, mechanical ventilation, surgical operation, dehydration and blood transfusion were significantly related to the incidence of LEDVT ( Χ2=4.50-33.23, P<0.05 or 0.01). The Logistic multivariate regression analysis showed that coma (OR=9.410, 95%CI 1.689-52.423), paralysis and limb immobilization (OR=4.950, 95%CI 1.432-17.105), infection (OR=2.927, 95%CI 1.162-7.373) and lower limbs central venous catheterization (OR=6.072, 95%CI 2.187-16.858) were independent risk factors for the development of LEDVT. Conclusions We should pay attention to patients with high risk factors of LEDVT and take preventive measures early to avert the formation of LEDVT.
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Objective To compare the clinical effect of manual aspiration thrombectomy versus systemic thrombolysis for acute lower extremity deep venous thrombosis of mixed type.Methods The clinical data of 380 patients with acute lower extremity deep venous thrombosis of nixed type was analyzed retrospectively,who were classified into two groups according to treatment methods.Group A (229 cases):the ipsilateral femoral vein was accessed under local anesthesia,a 12-14 F sheath was introduced via a guide wire to aspirate iliofenoral thrombus.As for the femoropopliteal thrombus,a Fogarty balloon catheter was introduced to pull thrombus to iliac vein,then mechanical aspiration thrombectomy was performed.One hundred and thirteen patients with stenosis or occlusion of comnon iliac vein were treated with adjunctive PTA and stenting.As for the residual thrombus bclow popliteal vein,a small dose urokinase vas given to thrombolysis and heparin anticoagulation after procedure.Group B(151 cases) were treated by systemic thrombolysis and anticoagulation with heparin.Results The swelling and pain of affected limbs of group A began to relief after operation immediately,but these times of group B was 3-7 days after operation.The thrombus was eliminated completely(Grade Ⅰ):goup A was better than group B (63.32% vs 37.09%) (x2 =20.53,P =0.002).Conclusions The manual aspiration thrombectomy was superior to simple systemic thrombolysis in treating acute lower extremity deep venous thrombosis of mixed type,especially in protecting the normal valve function that was better than thrombolysis,aspiration thrombectomy with adjunctive iliac vein angioplasty was a more reasonable method to treat acute LEDVT.
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OBJECTIVE: We wanted to evaluate the feasibility of catheter-directed thrombolysis with a continuous infusion of low-dose urokinase for treating non-acute (less than 14 days) deep venous thrombosis of the lower extremity. MATERIALS AND METHODS: The clinical data of 110 patients who were treated by catheter-directed thrombolysis with a continuous infusion of low-dose urokinase for lower extremity deep venous thrombosis was analysed. Adjunctive angioplasty or/and stenting was performed for the residual stenosis. Venous recanalization was graded by pre- and post-treatment venography. Follow-up was performed by clinical evaluation and Doppler ultrasound. RESULTS: A total of 112 limbs with deep venous thrombosis with a mean symptom duration of 22.7 days (range: 15-38 days) were treated with a urokinase infusion (mean: 3.5 million IU) for a mean of 196 hours. After thrombolysis, stent placement was performed in 25 iliac vein lesions and percutaneous angioplasty (PTA) alone was done in five iliac veins. Clinically significant recanalization was achieved in 81% (90 of 112) of the treated limbs; complete recanalization was achieved in 28% (31 of 112) and partial recanalization was achieved in 53% (59 of 112). Minor bleeding occurred in 14 (13%) patients, but none of the patients suffered from major bleeding or symptomatic pulmonary embolism. During follow-up (mean: 15.2 months, range: 3-24 months), the veins were patent in 74 (67%) limbs. Thirty seven limbs (32%) showed progression of the stenosis with luminal narrowing more than 50%, including three with rethrombosis, while one revealed an asymptomatic iliac vein occlusion; 25 limbs (22%) developed mild post-thrombotic syndrome, and none had severe post-thrombotic syndrome. Valvular reflux occurred in 24 (21%) limbs. CONCLUSION: Catheter-directed thrombolysis with a continuous infusion of low-dose urokinase combined with adjunctive iliac vein stenting is safe and effective for removal of the clot burden and for restoration of the venous flow in patients with non-acute lower extremity deep venous thrombosis.
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Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Angioplastia de Balón , Cateterismo Periférico , Terapia Combinada , Fibrinolíticos/administración & dosificación , Bombas de Infusión , Infusiones Intravenosas , Pierna/irrigación sanguínea , Flebografía , Terapia Trombolítica/métodos , Ultrasonografía Doppler , Activador de Plasminógeno de Tipo Uroquinasa/administración & dosificación , Grado de Desobstrucción Vascular , Trombosis de la Vena/tratamiento farmacológicoRESUMEN
Objective To explore the causes,risk factors,diagnosis and control methods of LEDVT after gynaecological surgery. Methods The clinical data of 20 inpatients with LEDVT after gynaecological surgery were analyzed retrospectively. Results The LEDVT distribution related to the factors:1.operation time:<2 h 3cases (15%),2 ~3 h 5cases(25%),> 3h 12 cases(60%);2.operation manners:TAH 0.23%(4/1746);TVH 0.91%(9/984);RH and ovarian cytoreductive surgery 4.6%(5/106); Myomectomy 0.29%(2/691);patient age:85% for > 50 years; 15% for ≤50 years.All the 20 patients were cured by means of positive treatment of thrombolysis and anticoagulation. Conclusion The patients who had the risk factors of LEDVT should strengthen the prevention and control cases actively,the standardized management could improve their prognosis significantly.
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Objective To investigate the preventative effect of perioperative intervention to lower extremity deep venous thrombosis (DVT) after gynecologic surgery. Methods The 1062 patients, who received gynecologic surgery during 2007 June to 2008 June, were derided into intervention and nonintervention groups randomizely. According to the risk factors of DVT, the patients in intervention group were divided into 4 subgroups: low, mid, high and extremely high rise Each group had its own preventive measures. If patients had spontaneous pain, tenderness and swelling, positivity of Neuhof or Homan syndrome, and extension of one low extremity superficial vein, the low extremity color Doppler ultrasound would be carried out immediately. The ultrasound would also be routinely carried out in the high and extremely high risk groups in intervention group after 2 and 7 days after surgery. A prospective study was carried out investigating incidence of DVT and coagulation function perioperation. The vein blood samples were taken at in a week before surgery and 48 hours post-operation. Results The incidence of DVT of intervention group was 1.10% (6/546), and in nonintervention group, the incidence was 3.29% (17/ 516). There was significant difference between two groups (P<0.05). The incidence of DVT in extremely high risk subgroup was 21.05% (4/19), which was significantly higher than that of low(0), mid(0) and high risk groups[2.13% (2/94), P<0.05]. D-dimer, antithrombin-Ⅲ(AT-Ⅲ) post-operation were all higher than that pre-operation in the two groups, but there was no significant difference (P>0.05). The indexes of coagulation system, such as blood platelet count, prothrombin time (PT), active partial throraboplastin time (APTT), fibrinogen (Fbg), thrombin time (TT), tissue-plasminogen activator (t-PA), plasminogen activator inhibitor(PAI), were not significantly changed perioperation (P>0.05 in all pre-or post-operation indexes). Conclusions Perioperative intervention measurement according to different risk of DVT could cut down the incidence of DVT. DVT preventive intervention is suggested to high and extremely high risk people.
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To study the significance of the levels of plasma inflammatory cytokines (IL-6,IL-8,IL-10 and TNF-?) in patients with acute deep venous thrombosis (DVT) of lower extremity. Methods Forty untreated DVT cases were selected as the subjects in the DVT group, while thirty healthy subjects, whose ages and genders showed no significant difference with the DVT patients, were collected as the control group. The plasma levels of IL-6, IL-8 and TNF-? were detected by radioimmunoassay (RIA), and the plasma level of IL-10 was measured by enzyme-linked immunosorbent assay (ELISA). Correlation analysis was used to investigate the relationships between the levels of different inflammatory cytokines within DVT group. Results The levels of plasma cytokines in the DVT group were all significantly higher than those in control group (P
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Objective Appraising the clinical curative effect on the lower extremity serious deep venous thrombosis through thrombolytic arterial catheterization.Methods With Seldinger's technique, placing catheter into popliteal artery through the contralateral healthy side femaral artery and then dripping the thrombolitic agents into the thrombotic popliteal artery. Results The cure rate reached 87% in the treatment group and for the controll group was 30%,( P