长球囊血管成形术联合长支架置入术治疗糖尿病下肢缺血患者的疗效  

Effects of long balloon percutaneous transluminal angioplasty plus long stent implantation in patients with diabetes complicated with lower extremity ischemia

作　　者：宋延彬[1] 吕安林[1] 于军[1] 赵晓梅[1] 孟小雪[1] 梁炎华[1] 温俊娜[1] 胡艳[1] 

机构地区：[1]第四军医大学西京医院心血管内科,陕西西安710032

出　　处：《心血管康复医学杂志》2008年第1期61-64,共4页Chinese Journal of Cardiovascular Rehabilitation Medicine

摘　　要：目的:比较长球囊血管成形术联合长支架置入术(long balloon percutaneous transluminal angio plasty plus long stent implantation,LBPTALS))与普通球囊血管成形术联合普通支架置入术(ordinary balloon percutaneous transluminal angioplasty plus ordinary stent implantation,OBPTAOS)对血管内皮分泌功能的影响。方法:选择经下肢血管造影证实为股浅动脉狭窄单支病变的糖尿病下肢缺血患者43例,随机分为两组,分别接受LBPTALS,OBPTAOS术。术前、术后即刻、术后2h、术后7d分别抽取患肢静脉血样,以硝酸还原酶法比色测定血清一氧化氮(NO)浓度和一氧化氮合酶(NOS)活力,非平衡法放射免疫测定血浆内皮素(ET-1)浓度。结果:两组患者靶病变情况差异无统计学意义。LBPTALS组的手术时间、夹层数、置入支架数明显低于OBPTAOS组(P<0.05)。LBPTALS组的球囊扩张次数明显少于OBPTAOS组(P<0.01),LBPTALS组术后即刻、术后2h、术后7d的血清NO浓度、NOS活力高于OBPTAOS组(P<0.05),血浆ET-1浓度低于OBPTAOS组(P<0.05)。术后7d血清NO浓度、NOS活力开始恢复,但仍低于术前(P<0.05)。术后7d血浆ET-1浓度开始恢复,但仍高于术前(P<0.05)。结论:LBPTALS对糖尿病下肢缺血患者血清NO浓度、NOS活力、血浆ET-1浓度的影响,即对血管内皮功能减退的影响小于OBPTAOS,可能是前者减少内皮损伤所致。Objective： To investigate the effects of long balloon percutaneous transluminal angioplasty plus long stent implantation （LBPTALS） on serum secretion of endothelium cell in patients with diabetes complicated with lower extremity ischemia. Methods： A total of 43 patients with single superficial femoris artery stenosis were randomly divided into LBPTALS group and ordinary balloon percutaneous transluminal angioplasty plus ordinary stent implantation （OBPTAOS） group. Lower extremity vein blood was collected before angioplasty and immediately as well as 2h and 7d after stent implantation to measure the content of serum nitric oxide （NO）, plasma endothelin （ET-1） and serum vigor of nitric oxide synthase （NOS）. Results： There was no significant difference of target lesions between two groups. The operating time of LBPTALS group was significantly less than that of OBPTAOS group （P〈0.05）. The number of dissecting or implanted stent number of LBPTALS group was significantly less than those of OBPTAOS group （P〈0.05） . The number of balloon expanding of LBPTALS group was significantly less than that of OBPTAOS group （P〈0.01）. The serum levels of NO and vigor of NOS were significantly higher in LBPTALS group than those in OBPTAOS group immediately, 2h and 7d after angioplasty （P〈0.05） . The plasma level of ET-1 was significantly lower in LBPTALS group than that in OBPTAOS group immediately , 2h and 7d after angioplasty （P〈0.05） . The serum level of NO and vigor of NOS recovered after 7d, but lower than that of pre-operation （P〈0.05） . The plasma level of ET-1 recovered after 7d, but higher than that of pre-operation （P〈0.05）. Conclusion： LBP- TALS can significantly reduce the production of ET-1 and has lower influence on serum level of NO and activity of NOS than those of OBPTAOS, suggest that LBPTALS produce less vessel wall injury.

关 键 词：血管成形术 经腔 经皮冠状动脉 糖尿病 一氧化氮 

分 类 号：R543[医药卫生—心血管疾病]