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目的探讨腔静脉滤器在老年下肢深静脉血栓患者治疗中的应用。方法选择77例急性下肢深静脉血栓患者,将年龄≥60岁的48例为老年组,年龄<60岁的29例为非老年组,2组均置入腔静脉滤器,术后采用接触性导管溶栓23例,外周血管溶栓54例,以治疗3 d后患肢膝关节上15 cm周径较治疗前的变化判断疗效。结果全部患者顺利置入腔静脉滤器,技术成功率100%。术后无肺动脉栓塞发生。与治疗前比较,老年组和非老年组治疗后患肢膝关节上15 cm周径明显下降(P<0.05),但2组治疗前后膝关节上15 cm周径变化差值无明显差异(P=0.324)。接触性导管溶栓较外周血管溶栓治疗效果更佳(P=0.000)。1例成功取出腔静脉滤器,13例次出现抗凝过度情况。结论腔静脉滤器及温和的溶栓治疗,可以有效防止老年患者肺动脉栓塞的发生,安全性高。
Objective To investigate the application of vena cava filter in the treatment of elderly patients with deep vein thrombosis. Methods Seventy-seven patients with acute DVT of lower extremity were selected. Forty-eight patients aged 60 years or older were selected as the elder group, and 29 aged <60 years old as the non-elder group. The two groups were placed in the vena cava filter. Thrombolysis in 23 cases, peripheral vascular thrombolysis in 54 cases, 3 days after treatment of knee limb 15 cm circumference than before treatment to determine the change. Results All patients successfully placed in the vena cava filter, the technical success rate of 100%. No pulmonary embolism occurred. Compared with the pre-treatment, the 15-cm circumference of the knee joint in the aged group and the non-elderly group was significantly decreased (P <0.05), but there was no significant difference in the 15-cm circumference between the two groups before and after treatment (P = 0.324). Contact catheter thrombolysis better than peripheral thrombolysis (P = 0.000). In 1 case, the vena cava filter was successfully removed and in 13 cases there was an over-anticoagulation. Conclusions The vena cava filter and mild thrombolytic therapy can effectively prevent the occurrence of pulmonary embolism in elderly patients with high safety.