我国急性下肢缺血外科治疗现状分析  

A analysis of surgical treatment status of acute limb ischemia in China

作　　者：卢勇[1] 郑月宏[1] 刘昌伟[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院血管外科,100032

出　　处：《临床外科杂志》2011年第5期302-307,共6页Journal of Clinical Surgery

摘　　要：目的分析我国急性下肢缺血（ALI）外科治疗现状和方法及并发症的预防以改善预后。方法通过荟萃分析方法，分析近10年国内发表的急性下肢缺血文献的文献资料，了解其发病特点，治疗及预后情况。结果47个中心共3294例患者纳入本研究。68．4％患者病因为房颤，10．7％患者合并高血压。股动脉是最常见的病变部位，45．2％患者股动脉受累。开放手术是ALI患者主要的治疗手段，89．4％患者行开放手术治疗，其中95．6％采用Fogarty导管取栓，救肢率为81．7％±12．7％。以CDT为代表的介入手术治疗在国内逐渐开展，93．4％为2005年以后文献报道，救肢率为98．1％±3．7％。总体水平的平均救肢率，并发症率，截肢率及30d死亡率分别为：82．9％±10．9％，17．8％±16．4％，11．7％±9．8％和5．4％±4．4％。术后最常见的并发症为肾功能不全及骨筋膜室综合征，分别占所有并发症的35．4％和17．5％。心脏意外是最常见的死亡原因，占所有死亡患者的32．7％，发生心脏意外者65．4％死亡。结论房颤是导致急性动脉栓塞的首要病因。动脉取栓是治疗急性下肢缺血的主要传统方法，而导管溶栓技术已有明显的逐年增加趋势以取代部分外科手术。早期诊断、及时治疗和围手术期的有效抗凝是提高治疗效果的关键。Objective Analysis of the status of surgical treatment of acute lower limb ischemia （ALI） and prevention of complications and methods to improve the prognosis. Methods Using meta - a- nalysis method to analyze the documents of ALI published in the past 10 years in China in order to under- stand the disease characteristics, treatment and prognosis. Results 47 articles consisting of 3294 patients were enrolled in this metaanalysis. 68.4% of patients＇ etiologies were atrial fibrillation, 10.7% of pa- tients with hypertension. Femoral artery was the most common lesion,45.2% of patients with femoral artery involvement. Open surgery was the main treatment in patients with ALl,89.4% of the patients underwent open surgery,95.6% of them using Fogarty catheter embolectomy and the limb salvage rate was 81.7% -± 12.7%. Catheter- directed thrombolysis （CDT）as the representative of the surgical interventions devel- oped rapid in China in last decade,which 93.4% was reported since 2005 ,and the limb salvage rate was 98.1% ± 3.7%. The average limb salvage rate, complication rate, amputation rate and mortality in 30 - day was ：82.9% - 10.9%, 17.8% ± 16.4% , 1 . 7% ± 9.8% and 5.4% ± 4.4%, respectively. The most common complications are renal dysfunction and osteofascial compartment syndrome, which accounted for 35.4% and 17.5% of all complications. Cardiac accidents were the most common cause of death, account- ing for 32.7% of all deaths of patients. Normally,65.4% of patients with accidental cardiac symptom would die. Conclusions Atrial fibrillation is the leading cause of acute arterial embolism. Arterial embo- leetomy was the main traditional treatment method for acute limb ischemia, while CDT had been employed to partially replace open surgery and shows as an increasing trend year by year. Early diagnosis, prompt treatment and effective perioperative anticoagulation treatment were the keys to improve the treatment results.

关 键 词：急性下肢缺血 动脉取栓 导管溶栓 中国 

分 类 号：R656[医药卫生—外科学]