持续高流量血液滤过在重度急性下肢动脉缺血治疗围术期的应用价值初探  

Primary exploration on application value of continuous high-volume hemofiltration in perioperative period of severe acute lower extremity arterial ischemia

作　　者：方昌文 徐国雄[1] 俞靖凡 许晨 金一琦[1] 张志轩[1] Fang Changwen;Xu Guoxiong;Yu Jingfan;Xu Chen;Jin Yiqi;Zhang Zhixuan(Department of Vascular Surgery,Suzhou Hospital of Nanjing Medical University,Suzhou 215000,China)

机构地区：[1]南京医科大学附属苏州医院血管外科,江苏苏州215000

出　　处：《中国血管外科杂志（电子版）》2022年第4期328-331,共4页Chinese Journal of Vascular Surgery(Electronic Version)

摘　　要：目的初步探讨持续高流量血液滤过(high-volume hemofiltration,HVHF)在重度急性下肢动脉缺血治疗围术期的应用价值。方法回顾性分析南京医科大学附属苏州医院32例卢瑟福分级Ⅱb级或以上的重度下肢动脉缺血患者(34条患肢)的临床资料。比较2019年6月至2020年5月未进行HVHF治疗的18例患者(非HVHF组)和2020年6月至2021年10月进行HVHF治疗的14例患者(HVHF组)的围术期存活和保肢情况。结果手术成功率100%,患者均成功取出血栓,下肢动脉血流开通。HVHF组围术期死亡率为7.14%,明显低于非HVHF组的38.89%;HVHF组保肢率为86.67%,明显高于非HVHF组的52.63%,差异均有统计学意义。HVHF组和非HVHF组患者发生足下垂的概率差异无统计学意义(53.85%vs 50.00%,P=0.593)。结论重度急性下肢动脉缺血患者在围术期尽早开始HVHF治疗对降低患者死亡率、提高保肢率有重要意义。Objective To explore the application value of continuous high-volume hemofiltration(HVHF)in patients with severe acute lower limb ischemia during perioperative period.Methods The clinical data of 32 patients(34 limbs)with severe lower extremity arterial ischemia of RutherfordⅡb or above in Suzhou Hospital of Nanjing Medical University were analyzed retrospectively.The perioperative survival rate and limb salvage rate of 18 patients who did not receive HVHF treatment from June 2019 to May 2020(non-HVHF group)and 14 patients who received HVHF treatment from June 2020 to October 2021(HVHF group)were compared.Results The success rate of the operation was 100%.The thrombus was successfully removed from all limbs,and the arterial blood flow of the lower limbs was opened.The perioperative mortality rate in the HVHF group was 7.14%,which was significantly lower than that in the non-HVHF group(38.89%).The limb salvage rate in the HVHF group was 86.67%,which was significantly higher than that in the non-HVHF group(52.63%),and the differences were both statistically significant.There was no significant difference in the footdrop rate between the HVHF group and the non-HVHF group(53.85%vs 50.00%,P=0.593).Conclusion Starting HVHF treatment as soon as possible for patients with severe acute lower limb ischemia has great significance on reducing the mortality rate and improve the limb salvage rate during the perioperative period.

关 键 词：高流量血液滤过 急性下肢动脉缺血 乳酸酸中毒 

分 类 号：R654.4[医药卫生—外科学]