Sands J J, Patel S, Plaviak D J, Miranda C L
Renal Consultants of Wyoming Valley, Wilkes Barre, PA 18702-2699, USA.
ASAIO J. 1994 Jul-Sep;40(3):M886-8. doi: 10.1097/00002480-199407000-00123.
Seventy-one consecutively occluded polytetrafluoroethylene (PTFE) grafts treated with pharmacomechanical thrombolysis were compared with 75 surgical controls. The patients undergoing thrombomechanical lysis had a comparable rate of successful declotting (91% vs. 90.7%) and no significant difference in patency at 24 and 48 hr, 1 week, and 1 and 6 months. Patients undergoing thrombolysis required less overnight hospitalization (17 vs. 82%) (P < 0.001) and their hospital stays averaged 1.03 days versus 3.43 days in the surgical thrombectomy group (P < 0.0001). Complication rates were similar in both groups. Hospital charges and physician fees were significantly lower in the thrombolysis group, with total charges averaging $6,802 versus $12,740 (P = 0.0018). These cost differences were maintained even when patients with extended stays were excluded. In conclusion, pharmacomechanical thrombolysis provides efficacy and complications comparable to surgical thrombectomy, with the benefits of a decreased rate of hospitalization, decreased total number of days of hospitalization, and significant cost savings. The authors determined that pharmacomechanical thrombolysis is the preferable first intervention for acutely occluded PTFE grafts.
将71例接受药物机械性溶栓治疗的连续性闭塞聚四氟乙烯（PTFE）移植物与75例手术对照组进行比较。接受血栓机械溶解的患者成功溶栓率相当（91%对90.7%），在24小时和48小时、1周、1个月和6个月时通畅率无显著差异。接受溶栓治疗的患者过夜住院需求较少（17%对82%）（P<0.001），其住院时间平均为1.03天，而手术取栓组为3.43天（P<0.0001）。两组并发症发生率相似。溶栓组的住院费用和医生费用显著较低，总费用平均为6802美元，而手术组为12740美元（P=0.0018）。即使排除住院时间延长的患者，这些成本差异仍然存在。总之，药物机械性溶栓与手术取栓的疗效和并发症相当，具有降低住院率、减少住院总天数和显著节省成本的优点。作者确定药物机械性溶栓是急性闭塞PTFE移植物的首选首次干预措施。
