目的 探討達(dá)肝素鈉聯(lián)合阿替普酶治療產(chǎn)后下肢深靜脈血栓形成的臨床療效。方法 選取2014年9月-2017年9月在渭南市婦幼保健院治療的下肢深靜脈血栓形成患者94例，隨機(jī)分為對照組（47例）和治療組（47例）。對照組靜脈泵入注射用阿替普酶，20 mg加入生理鹽水500 mL，14~20 mL/h。治療組在對照組基礎(chǔ)上皮下注射達(dá)肝素鈉注射液，每次200 U/kg，1次/d。兩組均治療6 d。觀察兩組患者臨床療效，比較治療前后兩組患者血液流變學(xué)指標(biāo)、臨床癥狀、炎性因子和細(xì)胞黏附因子變化。結(jié)果 治療后，對照組和治療組總有效率分別為80.85%和97.87%，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，兩組D-二聚體（D-D）、纖維蛋白原（FIB）、血漿黏度（CP）、紅細(xì)胞聚集指數(shù)（RCAI）、超敏C反應(yīng)蛋白（hs-CRP）、白細(xì)胞介素-6（IL-6）、腫瘤壞死因子-α（TNF-α）、基質(zhì)金屬蛋白酶-9（MMP-9）、血小板內(nèi)皮細(xì)胞黏附分子-1（PECAM-1）和血管細(xì)胞黏附分子-1（VCAM-1）水平均顯著降低（P<0.05），且治療組上述細(xì)胞因子水平明顯低于對照組（P<0.05）。治療后，兩組肢體周徑和色素沉著評分及潰瘍面積均顯著減少（P<0.05），且治療后治療組上述指標(biāo)明顯優(yōu)于對照組（P<0.05）。結(jié)論 達(dá)肝素鈉聯(lián)合阿替普酶治療下肢深靜脈血栓形成可顯著改善患者臨床癥狀，降低機(jī)體血液粘稠度，下調(diào)機(jī)體炎癥反應(yīng)和血管細(xì)胞黏附分子水平。

Objective To explore the clinical efficacy of dalteparin sodium combined with alteplase in treatment of deep venous thrombosis of lower limb. Methods Patients (94 cases) with deep venous thrombosis of lower limb in Weinan Maternal and Child Health Hospital from September 2014 to September 2017 were randomly divided into control (47 cases) and treatment (47 cases) groups. Patients in the control group were intravenous pumping administered with Alteplase for injection, 20 mg added into normal saline 500 mL, 14-20 mL/h. Patients in the treatment group were sc injection administered with Dalteparin Sodium Injection on the basis of the control group, once 200 U/kg, once daily. Patients in two groups were treated for 6 d. After treatment, the clinical efficacy was evaluated, and the hemorheological indexes, the clinical symptoms, the inflammatory factors and the cell adhesion factors in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the control and treatment groups was 80.85% and 97.87%, respectively, and there were differences between two groups (P<0.05). After treatment, the D-D, FIB, CP, RCAI, hs-CRP, IL-6, TNF-α, MMP-9, PECAM-1, and VCAM-1 levels in two groups were significantly decreased (P<0.05), and these cytokine levels in the treatment group after treatment were significantly lower than those in the control group (P<0.05). After treatment, the limb circumference scores, chromatosis scores and ulcer area in two groups were significantly decreased (P<0.05), and these clinical symptoms in the treatment group after treatment were significantly better than those in the control group (P<0.05). Conclusion Dalteparin sodium combined with alteplase has efficacy in treatment of deep venous thrombosis of lower limb can significantly improve the clinical symptoms, reduce blood viscosity, downregulate inflammatory and vascular cell adhesion molecule levels.