风湿性心脏病并发下肢动脉栓塞的处置体会（附13例报告）  

Experience of 13 cases with lower limb arterial embolism induced by rheumatic heart disease

作　　者：齐胤尊 马云鹏[1] 李强[2] 

机构地区：[1]天水市第一人民医院心血管外科,甘肃省天水市741000 [2]天水市第一人民医院介入医学科,甘肃省天水市741000

出　　处：《中国心血管病研究》2016年第5期447-450,共4页Chinese Journal of Cardiovascular Research

摘　　要：目的总结风湿性心脏病并发下肢动脉栓塞的诊治经验。方法回顾分析天水市第一人民医院2005—2015年收治的13例风湿性心脏病并发下肢动脉栓塞患者的临床资料。在DSA下进行下肢动脉栓塞的介入治疗。根据栓塞特点选择血栓抽吸、导管取栓、置管溶栓、球囊扩张等不同的治疗方法，下肢缺血改善后及时行心脏手术，术后服用华法林及控制心室率的药物。结果本组13例患者经介入治疗后下肢缺血均改善，1例避免了膝上截肢，2例避免了截足趾。11例患者行心脏手术，二尖瓣置换8例，二尖瓣置换＋主动脉瓣置换3例，同期三尖瓣成形4例，左心房折叠3例，冠状动脉搭桥2例，均行左心耳闭合。本组有38．5％（5／13）的患者合并脑梗死，治疗中发生出血性脑梗死2例，其中1例死亡。随访半年以上无栓塞事件发生。结论接受有效抗凝治疗过少可能是本组患者发生下肢动脉栓塞的重要原因。对并发下肢动脉栓塞的患者，应常规行头颅CT检查，警惕无症状脑梗死的存在，预防出血性脑梗死的发生。推荐在DSA下进行下肢动脉栓塞的治疗。左心耳血栓的术前诊断与术中情况多不相符。术中合理处理左心房，术后规范抗凝治疗及有效控制心室率可预防再栓塞事件。Objective To investigate clinical features of lower limb arterial embolism induced by rheumat- ic heart disease （CHD）. Methods The clinical dates of lower limb arterial embolism induced by CHD admitted to our hospital from 2005 to 2015 were reviewed retrospectively. All patients with lower limb arterial embolism were performed interventional treatment under DSA monitoring, to choose different techniques according to the character- istics of the embolism, such as thrombus aspiration, catheter thrombectomy, catheter-directed thrombolysis and pereutaneous transluminal angioplasty. As lower limb ischemia was improved, cardiac operation was underwent timely. Postoperative patients were proposed with warfarin and drugs on ventricular rate control. Results A total of 13 patients with lower limb ischemia were improved after interventional treatment, 1 avoiding above-knee amputa- tion, 2 avoiding toe amputations. 11 patients underwent cardiac surgery, mitral valve replacement in 8, mitral and aortic valve replacement in 3, combined tricuspid valve annuloplasty in 4, left atrium plication in 3, coronary artery bypass grafting in 2 and left atrial appendage closure in all cases. There were 38.5%（5/13） of the patients with cerebral infarction, and among them 2 cases happened hemorrhagic cerebral infarction, and one died. No thromboembolic event happens during the period of follow-up over 6 months. Conclusion Maybe it is the leading cause of lower limb arterial embolism, that very few patients receive the treatment of effective anticoagulation. Pa- tients combined with lower limb arterial embolism should be performed head CT routinely, to guard against asymp- tomatic cerebral embolism, and to take precautions against hemorrhagic cerebral infarction. It is suggested that the therapy of lower limb arterial embolism should be carried out in the case of DSA. Preoperative and intraoperative diagnosis of left atrial appendage thrombus often is not consistent. Reasonable disposal of left atrium during opera- tion, standardiz

关 键 词：风湿性心脏病 下肢动脉栓塞 介入治疗 出血性脑梗死 心脏手术 

分 类 号：R541.2[医药卫生—心血管疾病]