短时rt-PA导管接触溶栓联合腔内介入治疗下肢缺血疗效分析  

Efficacy of short-term catheter-directed thrombolysis used with rt-PA combined with endovascular interventional therapy in patients with lower limb ischemia

作　　者：张杨[1] 张望德[1] 李谈[1] 原标[1] 宋盛晗[1] 

机构地区：[1]首都医科大学附属北京朝阳医院血管外科,100020

出　　处：《中华医学杂志》2014年第13期1017-1020,共4页National Medical Journal of China

摘　　要：目的 评价不同剂量短时重组人组织型纤溶酶原激活剂（rt-PA）导管接触性溶栓联合血管腔内介入治疗对急性和亚急性下肢缺血患者的治疗效果.方法 将北京朝阳医院血管外科自2006年11月至2011年12月诊断为急性或亚急性下肢缺血的84例患者随机分成两组,分别给予总剂量20 mg（A组）和10 mg（B组）的rt-PA进行导管接触溶栓,根据再次造影结果对病变明显部位进行腔内介入治疗.术后随访,对疗效、并发症及术后30 d、6个月和12个月患肢保全情况进行评价.统计学分析采用SPSS 16.0软件,使用t检验和x2检验.结果 两组患者一般情况和病变情况差异无统计学意义（P＞0.05）,操作成功率和临床成功率均为100％,rt-PA剂量对溶栓效果无影响（P＞0.05）,PTA和支架的比例差异无统计学意义（P＞0.05）.两组并发症发生率及随访30 d、6个月和12个月的截肢率差异无统计学意义（P＞0.05）.结论 短时导管接触溶栓联合血管腔内介入治疗对急性和亚急性下肢缺血患者的治疗效果好,且rt-PA剂量对溶栓效果无影响,值得临床推广应用.Objectives To evaluate the performance effect of short-term catheter-directed thrombolysis with different dosage of rt-PA allied with endovascular interventional therapy for patients with acute lower limb ischemia.Methods To separate 84 consecutive patients suffered from acute lower limb ischemia into two groups at random,then adopt catheter-directed thrombolysis for each group of patients injected 20 mg （Group A） or 10 mg （Group B） rt-PA into the occlusive lesion correspondingly,and subsequently perform endovascular intervention on significant underlying lesions on the base of angiography results.Adopt statistical methods to assess treatment effectiveness,rates of complication and amputation rates within 30 days,6 months or 12 months.The statistic analysis was performed under SPSS 16.0 format,and adopts t test and x2 test.Results There was no statistical difference on patient characteristics and lesions between both groups （P ＞ 0.05）.Procedural success rates as well clinical success rates were all 100％.Not incur any diversity on thrombolysis effectiveness between both groups injected different dosage of rt-PA （P ＞ 0.05）.Not found major differences on ratios of PTA or implant stent between both groups （P ＞ 0.05）.During the follow-up period of 30-day,6-,12-months,there were no statistical differences on the amputation-free survival rates and complication rates between both groups.Conclusions Whereas short-term catheter-directed thrombolysis combined with endovascular interventional therapy won good operation effectiveness on patients with acute lower limb ischemia,moreover the dosage of rt-PA did not impact on thrombolysis,it is worthy to be applied in the clinical practice.

关 键 词：组织型纤溶酶原激活剂 溶栓 经皮腔内血管成形术 下肢缺血 

分 类 号：R654.4[医药卫生—外科学]