4602例单中心下肢动脉硬化闭塞症导致的下肢慢性缺血患者外科治疗临床研究  

Clinical study on surgical treatment of lower extremity chronic ischemia caused by arteriosclerosis obliterans of lower extremity-analysis of 4602 cases

作　　者：郭建明[1] 郭连瑞[1] 齐立行[1] 崔世军[1] 佟铸[1] 蔡志文 邢月浩 谷涌泉[1] Guo Jianming;Guo Lianrui;Qi Lixing;Cui Shijun;Tong Zhu;Cai Zhiwen;Xing Yuehao;Gu Yongquan(Capital Medical University Xuanwu Hospital Vascular Surgery Department, Capital Medical University Vascular Surgery Institute, Capital Medical University Lower Limb Arteriosclerotic Occlusive Lesions Clinical Research Center, Beijing 100053, China)

机构地区：[1]首都医科大学宣武医院血管外科,首都医科大学血管外科研究所,首都医科大学下肢动脉硬化闭塞症临床研究中心,北京100053

出　　处：《中国医师杂志》2018年第12期1787-1791,共5页Journal of Chinese Physician

基　　金：北京市医院管理局临床技术创新项目(扬帆计划)(XMLX201610);北京市医院管理局“登峰”人才培养计划(DFL20150801);首都卫生发展科研专项项目(首发2016-1-2012);国家重点研发计划项目(2017YFC1104100);北京市卫生系统高层次卫生技术人才培养计划学科骨干(2014-3-059);北京市优秀人才培养青年骨干个人项目(2016000020124G108);宣武医院“英才培养计划”;北京市属医院科研培育计划(PX2018035)

摘　　要：目的分析下肢动脉硬化闭塞症导致的慢性下肢缺血患者的病例资料,以期发现术式的改变对治疗效果和主要卫生经济学指标的影响。方法对单中心血管外科16年来患者资料进行回顾性分析,筛选出下肢动脉硬化闭塞症导致的慢性下肢缺血入院患者,收集其住院期间的手术信息、是否截肢、住院时间和住院费用等数据。结果总计纳入4 602例患者,其中糖尿病患者占57. 39%。入院患者数量、腔内治疗数量、住院费用呈逐年上升趋势,住院时间逐年下降。比较两时间段病例情况,截肢率由2002年至2007年的8. 12%下降至2008年至2017年的0. 92%(P <0. 01)。住院时间由2002年至2007年的(28. 20±6. 89) d下降至2008年至2017年的(11. 65±3. 01) d(t=8. 604,P <0. 01)。住院费用由2002年至2007年的(54 466. 94±11 459. 09)元上升至2008年至2017年的(73 685. 22±14 280. 52)元(t=3. 978,P <0. 01)。糖尿病组和非糖尿病组比较截肢率、住院时间和住院费用比较差异无统计学意义(P> 0. 05)。糖尿病亚组两时间段病例情况,截肢率由2002年至2007年的8. 83%下降至2008年至2017年的1. 05%(P <0. 01)。住院时间由2002年至2007年的(30. 12±7. 10) d下降至2008年至2017年的(12. 60±2. 79) d(t=7. 396,P <0. 01),住院费用由2002年至2007年的(58 530. 94±11 893. 66)元上升至2008年至2017年的(74 433. 75±15 031. 17)元,(t=3. 379,P <0. 01)。结论自2002年至2017年,慢性下肢缺血的住院病例数量逐渐增加,其中腔内治疗数量增加显著,同时截肢率和住院时间下降,住院费用增加。糖尿病亚组患者存在同样的变化趋势。截肢率明显下降,可能与腔内治疗和血管新生治疗技术的开展相关。Objective The incidence of chronic lower limb ischemia caused by arteriosclerotic obliteration of lower extremities is increasing recent years and there is a high risk of amputation and mortality. This study was to find out the changes in a single center for 16 years.Methods A retrospective analysis of the data of patients in single-center vascular surgery in the past 16 years was carried out. The patients with chronic lower limb ischemia caused by lower limb arteriosclerosis obliterans were screened out, and the data of operation information, amputation, length of stay and hospitalization expenses during hospitalization were collected.Results A total of 4 602 patients were included, of whom 57.39% were diabetic. It was found that the number of patients admitted, the number of endovascular treatment, the average cost of hospitalization increased year by year, and the average length of hospitalization decreased year by year. The amputation rate decreased from 8.12% (from 2002 to 2007) to 0.92% (from 2008 to 2017) (P<0.01). The average days of hospitalization decreased from 28.20 days (from 2002 to 2007) to 11.65 days (from 2008 to 2017) (P<0.01). The average hospitalization cost rose from 54 466.94 yuan (from 2002 to 2007) to 73 685.22 yuan (from 2008-2017) (P<0.01). There was no significant difference in amputation rate, hospitalization days and hospitalization costs between diabetic group and non-diabetic group. In diabetic subgroup, amputation rate decreased from 8.83% (between 2002 and 2007) to 1.05% (between 2008 and 2017) (P<0.01). The average hospitalization days decreased from 30.12 days (between 2002 and 2007) to 12.60 days (between 2008 and 2017) (P<0.01). The average cost of hospitalization rose from 58 530.94 yuan (between 2002 and 2007) to 74 433.75 yuan (between 2008 and 2017) (P<0.01).Conclusions From 2002 to 2017, the number of patients with chronic lower limb ischemia increased gradually, and so as the number of endovascular treatment. While the amputation rate and average hospitalization time dec

关 键 词：动脉硬化 闭塞性/并发症 下肢/血液供给 缺血/病因学 糖尿病 截肢术 

分 类 号：R654.4[医药卫生—外科学]