小剂量尿激酶导管内溶栓治疗急性下肢缺血的临床结局研究  

Study on the clinical outcome of low dose Urokinase in the treatment of acute lower limb ischemia

作　　者：张军波[1] 吕颖[2] 马强[1] 孟燕[1] 刘仲伟[2] 田红燕[1] ZHANG Junbo;LV Ying;MA Qiang;MENG Yan;LIU Zhongwei;TIAN Hongyan(Department of Peripheral Vascular Disease,the First Affiliated Hospital of Xi′an Jiaotong University,Xi′an 710061,China;Department of Cardiovascular Medicine,Shaanxi Provincial People′s Hospital/the Third Affiliated Hospital of Xi′an Jiaotong University,Xi′an 710068,China)

机构地区：[1]西安交通大学第一附属医院周围血管科,西安710061 [2]陕西省人民医院/西安交通大学第三附属医院心内一科,西安710068

出　　处：《新疆医科大学学报》2020年第2期178-182,共5页Journal of Xinjiang Medical University

基　　金：国家自然科学基金(81600646)

摘　　要：目的探讨小剂量尿激酶导管内溶栓治疗急性下肢肢体缺血的疗效及安全性。方法收集2013年5月-2016年1月因急性下肢缺血入住西安交通大学第一附属医院周围血管科的50例患者作为研究对象。采用介入血管造影明确诊断后送溶栓导管至病变部位,根据病情在手术中及手术后导管内给予小剂量尿激酶。其中,手术当日尿激酶用量为50~75万U,术后每日用量25~50万U,共3~5 d。观察术后下肢血供改善情况、是否截肢以及出血情况等。结果50例患者中,心房颤动占64%,主动脉血栓占8%,冠心病左心室血栓占4%,动脉粥样硬化血栓形成占2%,反常栓塞占6%,而未发现明确病因占16%。经小剂量导管内溶栓治疗后,截肢者4例,其中1例截肢死亡,截肢率为8%,死亡率为2%;放弃治疗者4例,占8%;遗留轻度间歇性跛行症状者13例,占26%;症状完全消失者25例,占50%。总保肢率达84%,治疗有效率(轻微跛行+症状完全消失)达76%。2例患者发生小出血,出血率为4%,未发生大出血,无介入操作相关严重并发症。缺血程度是降低保肢率的独立危险因素(OR=45.57,P=0.01),而年龄、发病时间、是否早期介入手术以及是否合并房颤对保肢率的影响均不显著(P>0.05)。结论小剂量尿激酶导管内溶栓治疗急性下肢肢体缺血是一种安全有效的治疗方法,值得临床推广应用。Objective To investigate the efficacy and safety of catheter-directed thrombolysis with low dose urokinase in treatment of acute lower extremity ischemia.Methods A retrospective analysis of 50 patients admitted to the hospital from May 2013 to January 2016 due to acute lower extremity ischemia was carried out.The diagnosis was confirmed by interventional angiography,and then the thrombolytic catheter was sent to the lesion site.According to the situation,small doses of urokinase were administered in the catheter during and after the operation.The daily dosage of urokinase was 500000-750000 U during the operation and 250000-500000 U after the operation for 3-5 days.The improvement of blood supply,amputation and bleeding were observed.Results In these 50 patients,atrial fibrillation accounted for 64%,aortic thrombus 8%,left ventricular thrombus 4%,atherothrombotic thrombus 2%,anomalous embolism 6%,and no clear cause found 16%.After the low-dose catheter-directed thrombolysis treatment,4 cases were amputated,of which 1 case died,the amputation rate was 8%,the mortality rate was 2%;4 cases gave up treatment,accounting for 8%;13 cases left with mild intermittent claudication,accounting for 26%;25 cases completely disappeared,accounting for 50%.The total rate of limb salvage was 84%,and the effective rate(slight claudication+complete disappearance of symptoms)was 76%.Small bleeding occurred in 2 cases,the bleeding rate was 4%,no major bleeding occurred.There was no serious complication related to interventional operation.The degree of ischemia is an independent risk factor to reduce the rate of limb salvage,but age,time between onset and treatment,early intervention and complicated with atrial fibrillation have little effect on the rate of limb salvage.Conclusion Low-dose urokinase used for Catheter-directed thrombolysis is a safe and effective treatment for acute lower limb ischemia.

关 键 词：急性下肢缺血 导管内溶栓 尿激酶 安全性 

分 类 号：R543.5[医药卫生—心血管疾病]