急性下肢动脉缺血的解剖部位、性质与介入溶栓治疗的疗效分析  

Clinical Curative Effect Analysis of Interventional Thrombolytic Therapy to Acute Lower Limb Arterial Ischemia Anatomic Site and Nature

作　　者：陈国平[1] 顾建平[1] 何旭[1] 楼文胜[1] 陈亮[1] 苏浩波[1] 宋进华[1] 汪涛[1] 徐克[2] 

机构地区：[1]南京医科大学附属南京第一医院介入科,210006 [2]中国医科大学附属第一医院放射科,沈阳110001

出　　处：《临床放射学杂志》2011年第5期711-715,共5页Journal of Clinical Radiology

基　　金：国家"十一五"支撑计划项目资助(2007BAI05B04)

摘　　要：目的观察急性下肢动脉缺血(ALI)的介入溶栓治疗的临床疗效,对影响其治疗效果的相关因素进行探讨。资料与方法 31例ALI患者按阻塞部位分组后,分析ALI发病时间和阻塞性质对介入溶栓治疗效果的影响。结果髂股动脉组和腘动脉组介入治疗有效率(治愈+有效)分别为88.24%(15/17)和71.43%(10/14)。血栓性和栓子性ALI有效率分别为93.33%(14/15)和68.75%(11/16)。髂股动脉组:溶栓后72 h血管造影复查,6例血管开通或部分开通(≥50%),占35.29%(6/17)。10例需辅助行经皮血管腔内成形术(PTA)和(或)支架置入帮助血管开通。1例需外科手术切开取栓。1例并发急性心功能衰竭死亡。腘动脉组:溶栓后72 h血管造影复查,10例腘动脉及至少膝下1支血管开通,占71.43%(10/14)。3例需外科手术切开取栓或截肢。1例并发肌病肾病综合征死亡。结论 ALI发病时间和阻塞性质不影响介入溶栓治疗的血管开通,血栓性阻塞较栓子性阻塞有更好的治疗效果,阻塞的部位预示了介入治疗的效果。Objective To observe the clinical curative effect of interventional thrombolytic therapy for acute lower limb ischemia（ALI）,and to investigate the factors about it.Materials and Methods 31 ALI cases according to the embolic part,analyze the contribution of their onset and embolus property on the interventional thrombolytic therapeutic effect.Results The efficiency（cured and effective） of iliofemoral artery group and popliteal artery group were 88.24%（15/17） and 71.43%（10/14） respectively.After interventional therapy,the efficiency of thrombotic and embolic ALI were 93.33%（14/15） and 68.75%（11/16） respectively.In iliofemoral artery group,after 72h thrombolysis angiography showed there was 6 cases 35.29%（6/17） reopened and partly reopened（≥50%）.10 cases had PTA and/or stent.1 case had surgical embolectomy.1 case died of acute heart failure.In popliteal artery group,after 72h thrombolysis angiography showed 10 cases 71.43%（10/14） whose popliteal artery and one branch at least below knee were reopened.3 cases had surgical embolectomy or amputation.1 case died of myonephropathic metabolic syndrome.Conclusion The onset and embolus property of ALI has no effect on arterial reopening in interventional thrombolytic therapy.However,thrombotic ALI had better effect than that of embolic ALI,and the embolic part indicated the interventional therapeutic effect.

关 键 词：急性肢体缺血 动脉栓塞 动脉血栓形成 溶栓 放射学 介入性 

分 类 号：R543[医药卫生—心血管疾病]