置管溶栓结合多种腔内介入术治疗下肢动脉硬化闭塞症48例效果观察  

Effects of catheter thrombolysis combined with multiple endovascular interventions in the treatment of 48 cases of lower extremity arteriosclerosis obliterans

作　　者：时明涛[1] SHI Mingtao(Department of Vascular Surgery,Nanyang Central Hospital,Nanyang,Henan 473000,China)

机构地区：[1]南阳市中心医院血管外科,河南南阳473000

出　　处：《安徽医药》2022年第7期1445-1448,共4页Anhui Medical and Pharmaceutical Journal

摘　　要：目的 探讨置管溶栓结合多种腔内介入术治疗下肢动脉硬化闭塞症(ASO)病人的临床效果。方法 回顾性分析2017年5月至2019年5月南阳市中心医院收治的下肢ASO病人的临床资料,直接行腔内介入的病人中选择48例为对照组,置管溶栓后行腔内介入治疗的病人中选择48例为观察组。观察两组病人手术前后临床症状[足部皮温、足趾血氧饱和度(SO2)、踝肱指数(ABI)、视觉模拟评分(VAS)]、足背动脉血流动力学指标(血管内径、血流量、血流峰速)、下肢神经传导速度(运动神经传导速度、感觉神经传导速度)变化情况,比较两组治疗效果(支架置入率、截肢率、并发症发生率)、临床观察指标(手术时间、术后住院时间)差异性。结果 术后1个月,观察组和对照组病人足部皮温[(16.25±2.17)℃比(27.67±3.27)℃,(15.81±2.41)℃比(26.84±3.56)℃]、足趾SO2[(25.31±5.64)%比(87.16±8.3)%,(24.71±5.97)%比(85.64±6.84)%]、ABI[(0.23±0.10)比(0.83±0.12),(0.25±0.09)比(0.85±0.11)]均较术前升高(P<0.05),VAS评分[(7.15±1.62)分比(0.98±0.16)分,(7.02±1.59)分比(1.02±0.15)分]、血流峰速[(51.67±9.23)cm/s比(40.75±7.19)cm/s,(52.64±8.71)cm/s比(41.62±7.62)cm/s]则较术前降低(P<0.05),血管内径、血流量和下肢运动神经传导速度、感觉神经传导速度均较术前增加(P<0.05);观察组病人支架置入率、截肢率分别为16.67%(8/48)、2.08%(1/48)低于对照组的43.75%(21/48)、16.67%(8/48)(P<0.05);观察组病人手术时间[(2.05±0.56)h比(4.12±1.03)h]、术后住院时间[(10.32±2.45)d比(15.18±3.17)d]短于对照组(P<0.05),两组病人并发症发生率比较差异无统计学意义(P>0.05)。结论 置管溶栓结合多种腔内介入术与单独腔内介入治疗下肢ASO均可有效改善病人临床症状,增加足背动脉血流量和下肢神经传导速度,且并发症少,但介入治疗前行置管溶栓可减少支架置入和截肢发生,且时间成本较低,具有较高的临床价Objective To investigate the clinical effect of catheter thrombolysis combined with multiple endovascular interventions in the treatment of patients with lower extremity arteriosclerosis obliterans(ASO).Methods The clinical data of lower extremity ASO patients admitted to Nanyang Central Hospital from May 2017 to May 2019 were retrospectively analyzed.Forty-eight patients who underwent direct endovascular intervention were selected as the control group,and the 48 patients who underwent endovascular intervention after catheter thrombolysis were selected as the observation group.The clinical symptoms [foot skin temperature,toe oxygen saturation(SO2),ankle-brachial index(ABI),visual analog scale(VAS)],dorsal artery hemodynamic indexes(vascular diameter,blood flow volume,blood flow peak velocity) and lower extremity nerve conduction velocity(motor nerve conduction velocity,sensory nerve conduction velocity) changes of the two groups of patients before and after surgery were observed,and the therapeutic effects(stent placement rate,amputation rate,complication rate) and clinical observation indicators(operation time,postoperative hospital stay) were compared between the two groups.Results One month after operation,the skin temperature of the feet of the patients [(16.25±2.17)℃ vs.(27.67±3.27)℃,(15.81±2.41)℃ vs.(26.84±3.56)℃],toe SO2[(25.31±5.64)% vs.(87.16±8.3)%,(24.71±5.97)% vs.(85.64±6.84)%] and ABI [(0.23±0.10) vs.(0.83±0.12),(0.25±0.09) vs.(0.85±0.11)] in the observation group and the control group were higher than those before operation(P < 0.05);the VAS score [(7.15±1.62) points vs.(0.98±0.16) points,(7.02±1.59) points vs.(1.02±0.15) points] and blood flow peak velocity [(51.67±9.23) cm/s vs.(40.75±7.19) cm/s,(52.64±8.71) cm/s vs.(41.62±7.62) cm/s] were lower than those before operation(P < 0.05);the vascular diameter,blood flow volume,lower extremity motor nerve conduction velocity and sensory nerve conduction velocity were higher than those before operation(P < 0.05).The stent place

关 键 词：闭塞性动脉硬化 机械溶栓 尿激酶型纤溶酶原激活物 支架 置管溶栓 腔内介入术 下肢 踝肱指数 神经传导速度 

分 类 号：R654.4[医药卫生—外科学]