数字减影血管造影引导下血管腔内成形术在下肢动脉硬化闭塞症中的疗效及其术后复发的影响因素分析  

Analysis of the therapeutic effect and influencing factors of postoperative recurrence of digital subtraction angiography guided endovascular angioplasty in lower extremity arteriosclerosis obliterans

作　　者：蒋伟兴[1] 丁晓娟[1] 白婧[1] 马维江[1] 袁美锦[1] 王萍[1] 郭飞[2] Jiang Weixing;Ding Xiaojuan;Bai Jing;Ma Weijiang;Yuan Meijin;Wang Ping;Guo Fei(Interventional Operating Room,the First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,Hebei,China;Department of Vascular Gland Surgery,the First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,Hebei,China)

机构地区：[1]河北北方学院附属第一医院介入手术室,河北张家口075000 [2]河北北方学院附属第一医院血管腺体外科,河北张家口075000

出　　处：《血管与腔内血管外科杂志》2024年第1期83-87,共5页Journal of Vascular and Endovascular Surgery

基　　金：河北省医学科学研究重点课题计划(20180846)。

摘　　要：目的探讨数字减影血管造影(DSA)引导下血管腔内成形术(TA)在下肢动脉硬化闭塞症(ASO)中的疗效及其术后复发的影响因素。方法选取2018年4月至2022年4月河北北方学院附属第一医院收治的180例ASO患者,采用随机数字表法将其分为A组(n=90,采用TA治疗)、B组(n=90,采用下肢动脉旁路移植术)。比较两组患者的临床疗效、视觉模拟评分法(VAS)评分、术后不良事件发生情况及术后复发情况。结果A组患者临床总有效率为92.22%(83/90),高于B组患者的78.89%(71/90)(P=0.011)。术后1 d、术后1个月,A组患者的踝肱指数(ABI)、趾肱指数(TBI)均高于B组患者,两组患者ABI、TBI以时间因素为源、以组别为源、以时间与组别交互为源的主体内效应间比较,差异均有统计学意义(P﹤0.05)。术后1 d、术后1个月,A组患者VAS评分均低于B组患者,两组患者VAS评分以时间因素为源、以组别为源、以时间与组别交互为源的主体内效应间比较,差异均有统计学意义(P﹤0.05)。A组患者不良事件总发生率为3.33%(3/90),低于B组患者的13.33%(12/90)(P=0.015)。术后6个月,共51例患者复发,多因素分析结果显示,高血压史、高脂血症、纤维蛋白原水平升高、手术方式、下肢动脉狭窄程度均是ASO复发的独立危险因素(P﹤0.05)。结论ASO患者在DSA引导下TA治疗效果显著,患者下肢血供状况明显改善,VAS评分及不良事件发生风险降低,高血压史、高脂血症、纤维蛋白原水平升高、手术方式及下肢动脉狭窄程度均是导致ASO复发的独立危险因素。Objective To investigate the effect of intravascular angioplasty(TA)guided by digital subtraction angiography(DSA)in lower extremity arteriosclerosis obliterans(ASO)and the influencing factors of postoperative recurrence.Method A total of 180 ASO patients admitted to the First Affiliated Hospital of Hebei North University from April 2018 to April 2022 were selected and divided into group A(n=90,treated with TA)and group B(n=90,treated with lower extremity artery bypass grafting)by random number table method.The clinical efficacy,visual analogue scale(VAS)score,postoperative adverse events and postoperative recurrence were compared between the two groups.Result The total clinical effective rate of group A was 92.22%(83/90),higher than that of group B 78.89%(71/90)(P<0.05).After surgery 1 d and 1 month,the ankle-brachial index(ABI)and toe brachial index(TBI)of group A were higher than those of group B(P<0.05).There were statistically significant differences in ABI and TBI between the two groups,which were derived from time factor,group source,and interaction between time and group source(P<0.05).After surgery 1 day and 1 month,the VAS scores of group A were lower than those of group B(P<0.05).There were statistically significant differences in VAS scores between the two groups,which were derived from time factor,group source and interaction between time and group source(P<0.05).The total incidence of adverse events in group A was 3.33%(3/90),lower than that in group B 13.33%(12/90)(P<0.05).Six months after surgery,a total of 51 patients relapsed,the results of multivariate analysis showed that history of hypertension,hyperlipidemia,elevated fibrinogen level,surgical method,and degree of lower extremity artery stenosis were all independent risk factors for recurrence of ASO(P<0.05).Conclusion Under DSA guidance,the treatment effect of TA on ASO patients is significant,with significant improvement in their lower extrimety blood supply,reduced VAS score,and reduced risk of adverse events.The history of hypertension,hy

关 键 词：数字减影血管造影 血管腔内成形术 下肢动脉硬化闭塞症 疗效 影响因素 

分 类 号：R543[医药卫生—心血管疾病]