活动方式结合导管溶栓治疗对下肢深静脉血栓的治疗效果及中期影响

The Therapeutic Effect and Mid-Term Impact of the Combined Use of Catheter Thrombolysis Treatment in the Treatment of Deep Vein Thrombosis in the Lower Extremities

摘要: 目的：本研究主要探究不同活动方式对经导管接触性溶栓(CDT)临床疗效的影响，为临床下肢深静脉血栓形成(LEDVT)患者围治疗期加速康复活动管理提供循证依据。方法：回顾性收集2020年1月~2022年6月我科接受标准化治疗的LEDVT患者128例，分为卧床组(62例)与早期下床组(66例)。对比两组基线资料、疗效指标、安全性及中期预后，采用相应统计学方法分析数据，另对溶栓后血管通畅性评分改善值行分位数回归分析、PTS发生率行多因素Firth校正Logistic回归分析明确其相关影响因素。结果：下床行走组及卧床组经CDT溶栓治疗前、后静脉通畅性评分、VCSS评分均显著改善(P < 0.001)；组间对比提示下床组远端及整体静脉通畅性评分显著高于卧床组(P = 0.002, P = 0.017)。两组围术期不良事件发生率、中期血栓后综合征(PTS)发生率及Villalta评分均无统计学差异(P > 0.05)。以溶栓后血栓通畅性评分改善值为连续结局变量，采用中位数分位数回归可见下床活动对整体静脉通畅性评分改善值显著高于卧床组(β = 1.003, 95% CI: 0.003~2.983, P = 0.003)，溶栓管置于远端亦有利于患者整体血管通畅性的改善(β=0.797, 95% CI: 0.048~1.998, P = 0.048)，术后整体通畅性评分(基线)是影响溶栓后血管通畅性评分改善值的重要因素，对近端、远端及整体血管通畅性评分改善均存在显著正向影响(均P < 0.05)。多因素Firth校正回归证实，早期下床活动可能与PTS发病率风险降低相关(OR = 0.30, 95% CI: 0.11~0.77, P = 0.012)。结论：本回顾性研究提示：LEDVT患者在滤器保护与规范抗凝前提下，早期下床活动联合踝泵锻炼及同侧远端置管能促进下肢远端及整体CDT溶栓效率的提升、降低PTS发病率风险。

Abstract: Objective: This study aims to investigate the impact of different activity protocols on the clinical efficacy of catheter-directed thrombolysis (CDT), providing evidence-based support for enhanced recovery activity management during the peri-treatment period in patients with lower extremity deep venous thrombosis (LEDVT). Methods: A total of 128 LEDVT patients who received standardized treatment in our department from January 2020 to June 2022 were retrospectively enrolled and divided into a bed rest group (62 cases) and an early ambulation group (66 cases). Baseline data, efficacy outcomes, safety indicators, and mid-term prognosis were compared between the two groups, and corresponding statistical methods were applied for data analysis. Additionally, quantile regression was performed on the improvement value of venous patency score after thrombolysis, and multifactorial Firth-corrected logistic regression analysis was conducted on the incidence of post-thrombotic syndrome (PTS) to identify related influencing factors. Results: Both the early ambulation group and the bed rest group showed significant improvements in venous patency scores and VCSS scores before and after CDT thrombolysis (P < 0.001). Intergroup comparison indicated that distal and overall venous patency scores in the early ambulation group were significantly higher than those in the bed rest group (P = 0.002, P = 0.017). No statistically significant differences were observed between the two groups in terms of perioperative adverse event rates, mid-term PTS incidence, or Villalta scores (P > 0.05). Using the improvement value of thrombus patency score after thrombolysis as a continuous outcome variable, median quantile regression revealed that early ambulation contributed to a significantly greater improvement in overall venous patency scores compared to the bed rest group (β = 1.003, 95% CI 0.003~2.983, P = 0.003). Placement of the thrombolytic catheter in the distal vein was also beneficial to the improvement of overall vascular patency (β = 0.797, 95% CI: 0.048~1.998, P = 0.048). Postoperative overall patency score (baseline) was an important factor influencing the improvement value of post-thrombolysis vascular patency score, exerting a significant positive effect on the improvement of proximal, distal, and overall vascular patency scores (all P < 0.05). Multifactorial Firth-corrected regression confirmed that early ambulation might be associated with a reduced risk of developing PTS (OR = 0.30, 95% CI: 0.11~0.77, P = 0.012). Conclusion: This retrospective study suggests that for LEDVT patients under the premise of filter protection and standardized anticoagulation, early ambulation combined with ankle pump exercises and ipsilateral distal catheter placement can enhance the thrombolytic efficiency of CDT in the distal and overall lower extremity, and reduce the risk of post-thrombotic syndrome (PTS).