血管腔内治疗脑梗死合并下肢严重缺血的探讨  

Percutaneous transluminal angioplasty in treatment of critical lower limb ischimia in stroke patients

作　　者：马鲁波[1] 于春利[1] 张童[1] 杨淼[1] 石波 庄百溪[1] 

机构地区：[1]中国中医科学院西苑医院血管外科,北京100091

出　　处：《中华老年多器官疾病杂志》2016年第3期165-168,共4页Chinese Journal of Multiple Organ Diseases in the Elderly

基　　金：国家自然科学基金（81302979,81403411）

摘　　要：目的观察血管腔内治疗脑梗死患者合并下肢严重缺血病变的技术成功率和临床疗效。方法回顾性地分析2008年1月至2014年12月期间收治的Fontaine分级Ⅲ～Ⅳ级脑梗死伴肢体活动障碍患者280例（326条患肢），采用以血管腔内治疗为主治疗。观察技术成功率、并发症、临床疗效、踝／肱指数（ABI）、治疗血管再狭窄等。结果280例患者（326条患肢）共进行342次血管腔内治疗，309条患肢治疗成功，技术成功率为94．8％（309／326），无严重并发症。患者手术成功后临床症状均明显改善。术前所有患者ABI为0．26±0．24，成功治疗术后ABI为0．72±0．29，手术前后患者ABI差异有统计学意义（P〈0．05）。共有210例患者（242条患肢）经术后〉6个月随访，平均随访27个月（3～90个月），术后6个月、12个月ABl分别为0．65±0．26、0．54±0．31，均较术前显著增加；超声检查示术后1年随访期间有87条患肢（35．9％）治疗血管再狭窄或闭塞，其中70例（28．9％）症状复发再次行血管腔内治疗。结论下肢动脉病变行血管腔内治疗手术技术成功率较高、并发症发生率较低、疗效确切，可作为下肢动脉病变的首选治疗；由于脑梗死肢体活动障碍患者术后功能锻炼受限，血管再狭窄发生率较高，需进一步研究以提高闭塞性病变的手术成功率和术后治疗血管的通畅率。Objective To observe the technical success rate and short-term clinical outcomes of percutaneous transluminal angioplasty （PTA） in treatment of critical lower limb ischemia in stroke patients with limb dysfunction. Methods Clinical data of 280 consecutive stroke patients with Fontaine Ⅲ-Ⅳstages and limb dysfunction （326 limbs） admitted in our hospital from January 2008 to December 2014 were collected and retrospectively analyzed. All these patients were treated with PTA. Technical success rate, incidences of complications, clinical efficacy, ankle-brachial index （ABI）, and vascular restenosis were observed and evaluated. Results There were 342 PTA performed in 280 patients （326 limbs）, and technical success rate achieved 94.8% （309/326）. No serious complications occurred. Clinical symptoms were obviously improved after successful PTA. The ABI was significantly increased from 0.26 ± 0.24 before operation to 0.72 ± 0.29 postoperatively, with significant difference （P 〈 0.05）. For the 210 patients （242 limbs） who were followed up for average 27 months （ranging from 3 to 90 months）, the ABI was 0.65 ±0.26 and 0.54± 0.31 respectively in 6 and 12 months after treatment, significantly improved than before treatment. Duplex ultrasound imaging showed that the cumulative restenosis ratio was 35.9% in 1 year after operation, and 70 patients of them （28.9%） received reintervention due to recurrence of symptoms. Conclusion PTA is a good approach for lower limb peripheral arterial disease, with higher technical success rate, lower incidence of complications, and exact curative effect, and is the first choice for the disease. Because of the limited functional exercise in the stroke patients with limb dysfunction, they had a higher incidence ofrestenosis. Further research is needed to improve the surgery success rate and postoperative vascular patency for the occlusive lesions.

关 键 词：脑梗死 下肢严重缺血 经皮腔内血管成形术 治疗结果 

分 类 号：R654.3[医药卫生—外科学]