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

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