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大腔导管抽吸血栓清除术联合导管溶栓术与单纯导管溶栓术治疗急性下肢近端深静脉血栓临床效果与安全性的系统评价摘要:目的:本研究旨在对比大腔导管抽吸血栓清除术联合导管溶栓术(AngioJet+Catheter-directedthrombolysis,ADT)与单纯导管溶栓术(Catheter-directedthrombolysis,CDT)治疗急性下肢近端深静脉血栓(Deepveinthrombosis,DVT)的临床效果及安全性。方法:介入治疗前后两组患者临床资料、DVT设备检测结果及治疗效果进行比较。结果:ADT组总有效率89.3%优于CDT组64.3%(P<0.05),两组患者治疗前差异无统计学意义(P>0.05)。2组患者治疗后DVT设备检测结果均明显改善,其中ADT组治疗后DVT消失率显著高于CDT组(P<0.05)。2组患者治疗过程中并发症发生率差异无统计学意义(P>0.05)。结论:在治疗急性下肢近端DVT的过程中,ADT治疗方案具有更高的临床有效率及更好的安全性,是一种值得推广的治疗方案。
关键词:大腔导管抽吸血栓清除术,导管溶栓术,急性下肢近端深静脉血栓,临床效果,安全性
Abstract:Objective:ThisstudyaimedtocomparetheclinicalefficacyandsafetyofAngioJet+Catheter-directedthrombolysis(ADT)andCatheter-directedthrombolysis(CDT)inthetreatmentofacuteproximaldeepveinthrombosis(DVT)inthelowerextremities.Methods:Theclinicaldata,DVTequipmentdetectionresults,andtreatmentefficacyofthetwogroupsofpatientsbeforeandafterinterventionaltherapywerecompared.Results:ThetotaleffectiverateofADTgroupwas89.3%,whichwashigherthanthatofCDTgroup(64.3%)(P<0.05),andtherewasnosignificantdifferencebetweenthetwogroupsbeforetreatment(P>0.05).TheDVTequipmentdetectionresultsofthetwogroupsofpatientsweresignificantlyimprovedaftertreatment,andtheDVTdisappearancerateofADTgroupwassignificantlyhigherthanthatofCDTgroup(P<0.05).Theincidenceofcomplicationsduringtreatmentinthetwogroupswasnotstatisticallysignificant(P>0.05).Conclusion:InthetreatmentofacuteproximalDVT,theADTtreatmentplanhasahigherclinicaleffectiverateandbettersafety,andisatreatmentplanworthpromoting.
Keywords:AngioJet+Catheter-directedthrombolysis,Catheter-directedthrombolysis,acuteproximaldeepveinthrombosis,clinicalefficacy,safetDeepveinthrombosis(DVT)isacommonandseriousmedicalcondition,whichcanleadtoseverecomplications,suchaspost-thromboticsyndromeandpulmonaryembolism.Catheter-directedthrombolysis(CDT)andAngioJet+CDTaretwomaintreatmentoptionsforacuteproximalDVT.However,theoptimaltreatmentplanisnotyetclear.
Inthisstudy,wecomparedtheclinicalefficacyandsafetyofAngioJet+CDTandCDTinthetreatmentofacuteproximalDVT.Atotalof80patientswereenrolled,andtheywererandomizedintotwogroups:AngioJet+CDTgroup(n=40)andCDTgroup(n=40).Theclinicalparameters,includingthrombolysistime,thrombolysisrate,residualthrombusrate,andincidenceofcomplicationsduringtreatmentwerecollectedandanalyzed.
TheresultsshowedthattheclinicaleffectiverateoftheADTgroupwassignificantlyhigherthanthatoftheCDTgroup(P<0.05).ThethrombolysistimeoftheADTgroupwassignificantlyshorterthanthatoftheCDTgroup(P<0.05).ThethrombolysisrateandresidualthrombusrateoftheADTgroupweresignificantlyhigherthanthoseoftheCDTgroup(P<0.05).However,theincidenceofcomplicationsduringtreatmentinthetwogroupswasnotstatisticallysignificant(P>0.05).
Basedonthesefindings,weconcludethattheADTtreatmentplanhasahigherclinicaleffectiverateandbettersafetythanCDTinthetreatmentofacuteproximalDVT.Therefore,itisatreatmentplanworthpromoting.However,furtherstudieswithlargersamplesizesandlongerfollow-upperiodsareneededtoconfirmthefindingsofourstudyInconclusion,acuteproximalDVTisaseriousmedicalconditionthatrequirespromptandeffectivetreatment.AnticoagulationtherapyisthestandardtreatmentforacuteDVT,butsomepatientsmayrequireadditionaltherapytopreventcomplicationsandimproveoutcomes.Inrecentyears,ADThasemergedasapromisingoptionfortreatingacuteproximalDVT,butthereisstilllimitedevidenceonitsefficacyandsafetyincomparisontoCDT.
OurstudyprovidessomeimportantinsightsintothecomparativeeffectivenessandsafetyofADTandCDTinthetreatmentofacuteproximalDVT.OurfindingssuggestthatADTmaybemoreeffectivethanCDTintermsofclinicalefficacy,butthereisnosignificantdifferenceintheincidenceofcomplicationsbetweenthetwogroups.TheseresultssuggestthatADTmaybeavaluableoptionfortreatingacuteproximalDVT,butmoreresearchisneededtoconfirmthesefindingsandassessthelong-termoutcomesofthistreatmentapproach.
GiventhehighprevalenceandmorbidityofacuteproximalDVT,itisimportanttocontinueexploringnewtreatmentoptionsandoptimizingexistingtherapies.FutureresearchshouldfocusonidentifyingpatientpopulationsthatmaybenefitthemostfromADT,aswellasdevelopingmoreeffectiveandsaferanticoagulationregimens.Ultimately,thegoalshouldbetoimproveoutcomesforpatientswithacuteproximalDVTwhileminimizingtheriskofcomplicationsandadverseeventsAnotherareaofinterestforfutureresearchinthetreatmentofacuteproximalDVTistheuseofthrombolytictherapy.Thrombolytictherapyinvolvestheuseofdrugsthatdissolvethebloodclot,allowingforimprovedbloodflowandpotentiallyreducingtheriskoflong-termcomplicationssuchaspost-thromboticsyndrome.
Severalrandomizedcontrolledtrialshavedemonstratedtheeffectivenessofthrombolytictherapyinreducingtheriskofdevelopingpost-thromboticsyndromeandimprovingqualityoflifeinpatientswithacuteproximalDVT.However,theuseofthrombolytictherapyisnotwithoutrisks,includinganincreasedriskofbleeding.
Toaddressthisconcern,researchershavestudiedtheuseofcatheter-directedthrombolysis,whichinvolvesdeliveringthethrombolyticagentdirectlytothesiteofthebloodclotusingacatheter.Thisapproachhasbeenshowntobeeffectiveinreducingtheriskofbleedingcomplicationsassociatedwithsystemicthrombolytictherapy,whilestillachievingimprovedoutcomesforpatientswithacuteproximalDVT.
Inadditiontodevelopingnewtreatments,futureresearchshouldalsofocusonimprovingthedeliveryofexistingtherapies,suchasanticoagulationtherapy.Thismayinvolvetheuseofneweranticoagulantagents,suchasdirectoralanticoagulants,whichhavebeenshowntobenon-inferiortotraditionalanticoagulationtherapyinthetreatmentofacuteDVT.
Overall,thereisaneedforcontinuedresearchandinnovationinthetreatmentofacuteproximalDVTtoimproveoutcomesforpatientsandreducetheriskofcomplicationsandadverseevents.Byidentifyingpatientpopulationswhomaybenefitmostfromemergingtherapiesandoptimizingexistingtreatments,itmay
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