急性腓动脉缺血综合征的诊断与治疗  

DIAGNOSIS AND TREATMENT OF ACUTE PERONEAL ARTERY ISCHEMIA SYNDROME

作　　者：佘康 张宪生[1] 尹杰[1] 郭宏杰[1] 成功[1] 王维亮[1] 

机构地区：[1]北京大学第一医院介入血管外科,北京100034

出　　处：《中国修复重建外科杂志》2014年第10期1273-1277,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的首次提出＂急性腓动脉缺血综合征＂的概念,探明其典型临床表现和影像学特点,为急性腓动脉缺血的诊断、治疗提供依据。方法 2009年10月-2012年12月收治3例急性腓动脉缺血综合征患者,其中男2例,女1例;年龄57、68、71岁。均存在典型的＂腓动脉供血区苍白/发红＋腓肠肌剧痛＋足下垂＂三联征,查体均有腓肠肌外下方局限性压痛;患侧足背动脉、胫后动脉均可触及搏动;凝血功能和生化检验示D-二聚体、纤维蛋白原降解产物或肌酸激酶、肌红蛋白等明显升高;磁共振血管造影检查均发现患肢腓动脉近端狭窄。入院后予以静脉溶栓、抗凝、扩张血管、改善循环治疗。结果 3例患者治疗后下肢肿胀、疼痛、乏力症状明显好转,凝血功能和生化检测示D-二聚体、纤维蛋白原降解产物、肌酸激酶、肌红蛋白等逐渐降低;治疗9-13 d后好转出院,随访1年症状无复发。结论急性腓动脉缺血综合征是一类特殊类型的急性下肢缺血,以＂腓动脉供血区苍白/发红＋腓肠肌剧痛＋足下垂＂三联征为主要特点,需早期行积极抗凝及血管再通治疗。Objective To put forward the concept of acute peroneal artery ischemia syndrome, and to study its typical clinical manifestations and imaging features so as to provide the basis of the evidence-based medicine for the diagnosis and treatment of acute peroneal artery ischemia. Methods Between October 2009 and December 2012, 3 cases（2 males and 1 female, aged 57, 68, and 71 years） of acute peroneal artery ischemia syndrome were treated. All the patients displayed typical three symptoms of ＂peroneal artery blood supply zone pale/red ＋ severe pain of the gastrocnemius muscle ＋ acute drop foot＂. Medical examination revealed that they all had localized tenderness in the lateral and inferior part of the gastrocnemius muscle, with decreasing of skin temperature. The pulse of dorsalis pedis artery and the posterior tibial artery on affected limbs could be felt. Blood coagulation function and biochemical assay showed that D-dimer, fibrinogen degradation products, creatine kinase, or myoglobin markedly elevated. Magnetic resonance angiography revealed proximal peroneal artery stenosis. All patients were treated with intravenous thrombolysis, anticoagulation, vasodilation, and improving circulation therapy. Results The symptoms of lower limb swelling, pain, and fatigue were improved obviously in all patients after treatment. Blood coagulation function and biochemical assay showed D-dimer, fibrinogen degradation products, creatine kinase, or myoglobin were gradually reduced. The patients were discharged at 9-13 days after treatments, without recurrence during the follow-up of 1 year. Conclusion Acute peroneal artery ischemia syndrome is a special type of acute lower limb ischemia, with the three symptoms of ＂peroneal artery blood supply zone pale/red ＋ severe pain of the gastrocnemius muscle ＋ acute drop foot＂ as the main characteristics and should be treated by early active anticoagulant and recanalization therapy.

关 键 词：急性下肢缺血 腓动脉 血管区域 溶栓 

分 类 号：R543[医药卫生—心血管疾病]