老年患者急性下肢动脉缺血介入溶栓及支架置入治疗  

The interventional intra-arterial thrombolysis of acute ischemia of lower limb in elderly patients

作　　者：李子川[1] 杨军[2] 耿树军[2] 莫爵飞[2] 杨超波[2] 汪平[1] 

机构地区：[1]中国中医科学院广安门医院放射科,100053 [2]中国中医科学院广安门医院外科,100053

出　　处：《介入放射学杂志》2010年第8期651-654,共4页Journal of Interventional Radiology

摘　　要：目的探讨介入溶栓治疗对老年急性下肢动脉缺血治疗的疗效和安全性。方法回顾性总结2007年9月-2009年3月通过介入溶栓方法治疗的18例老年下肢动脉缺血患者治疗方式的选择、介入治疗过程中及介入治疗后发生合并症、并发症的处理,分析总结介入溶栓治疗对老年急性下肢动脉缺血治疗的疗效和安全性。结果本组患者从下肢缺血症状出现到明确诊断时间为4h～12d;患者多合并有多系统慢性病。采用动脉内导管溶栓治疗1～3d,溶栓治疗后对残余病变行腔内成形术及支架置入。15例治疗过程中分别出现出血、术后发热、肢体再灌注损伤、肺栓塞等。经治疗,3例患者行1～3趾经跖骨截趾术,14例患者保肢成功;1例患者动脉开通后2d,因再灌注损伤致多脏器功能衰竭死亡。结论介入溶栓治疗对老年急性下肢动脉缺血的治疗安全、有效,对此类患者可优先考虑。Objective To investigate the efficacy and safety of intra-arterial thrombolysis by using interventional procedure for the treatment of acute ischemia of lower limb in elderly patients. Methods During the period of Sep. 2007-March 2009 intra-arterial thrombolysis through interventional manipulation was performed in 18 elderly patients （aged 60 -87 years） with acute ischemia of lower limb. The clinical data,diagnoses,therapeutic schemes,perioperative complications and their managements,etc. e treatment of acute iswere retrospectively analyzed. The efficacy and safety of intra-arterial thrombolysis for thchemia of lower limb in elderly patients were evaluated. Results The interval between the onset of symptom to confirmation of the diagnosis ranged from 4 hours to 12 days. Most patients were accompanied with several kinds of multi-system chronic diseases. Intra-arterial thrombolysis lasting for 1 -3 days was carried out,which was followed by endovascular angioplasty and stent implantation for the residual vascular lesions. The main complications that occurred in 15 patients included bleeding,postoperative fever,limb reperfusion injury,pulmonary embolism,etc. After the treatment,three patients had to receive toe amputation surgery （1 -3 toes）,and successful limb salvage was obtained in 14 patients. One patient died of multiple organ failure due to reperfusion injury after revascularization. Conclusion Intra-arterial thrombolysis with the aid of interventional manipulation is a safe and effective treatment for acute ischemia of lower limb in elderly patients,and in such clinical setting this technique should be considered as the treatment of first choice.

关 键 词：急性下肢缺血 导管溶栓 血管成形术 

分 类 号：R543[医药卫生—心血管疾病]