流变血栓清除装置在老年患者急性下肢缺血治疗中的应用  

Application of rheolytic thrombus clearance device in the treatment of elderly patients with acute lower limb ischemia

作　　者：刘坤[1] 郭兴友 范卫东 张拓 李明[1] 付勇猛 吴菊花 Liu Kun;Guo Xingyou;Fan Weidong;Zhang Tuo;Li Ming;Fu Yongmeng;Wu Juhua(Department of Vascular Surgery,the Affiliated Suqian First People's Hospital of Nanjing Medical University/Jiangsu Province(Suqian)Hospital,Suqian 223800,Jiangsu,China;Department of Anesthesiology and Perioperative Medicine,the Affiliated Suqian First People's Hospital of Nanjing Medical University/Jiangsu Province(Suqian)Hospital,Suqian 223800,Jiangsu,China)

机构地区：[1]南京医科大学附属宿迁第一人民医院/江苏省人民医院宿迁医院血管外科,江苏宿迁223800 [2]南京医科大学附属宿迁第一人民医院/江苏省人民医院宿迁医院麻醉与围手术期医学科,江苏宿迁223800

出　　处：《血管与腔内血管外科杂志》2024年第9期1130-1135,共6页Journal of Vascular and Endovascular Surgery

摘　　要：目的探讨流变血栓清除装置在老年患者急性下肢缺血(ALLI)治疗中的疗效及安全性。方法收集2021年7月至2022年8月南京医科大学附属宿迁第一人民医院/宿迁市第一人民医院收治的13例老年ALLI患者的临床资料及随访结果。观察患者的血栓清除率及再通情况,比较患者手术前后红细胞计数、血红蛋白水平、肌酐水平、尿素氮水平、血钾水平、白细胞计数和白蛋白水平,记录患者术后并发症发生情况。通过随访观察患者的临床症状改善情况及预后。结果13例老年ALLI患者均使用血栓清除装置进行治疗,并辅以球囊扩张术,10例患者进行了支架植入术,平均植入1.5枚支架。平均手术时间为(137.08±48.60)min;平均血栓抽吸时间为180.00(135.00,304.00)s;平均术中失血量为90.00(67.50,159.50)ml。术后,患者的红细胞计数、血红蛋白水平、尿素氮水平和白细胞计数均低于术前,差异均有统计学意义(P﹤0.05),无需输血治疗。所有患者均出现不同程度的血红蛋白尿,平均持续时间为(13.46±2.76)h。所有患者术后即刻临床症状均有所改善,达到临床成功。3例患者术后24 h内血栓复发,其余患者获得至少1个月的随访,2例患者发生心衰,无穿刺部位相关并发症发生,亦无肾功能不全、其他心脑血管意外、胰腺炎等并发症发生,术后30 d内无死亡病例。结论对于老年ALLI患者,流变血栓清除装置具有微创、高效、简单、并发症少的优点,是一种安全、有效的药物机械吸栓装置。做好围手术期管理,可以减少并发症的发生。Objective To investigate the safety and efficacy of rheolytic thrombus clearance device for the treatment of elderly patients with acute lower limb ischemia(ALLI).Method The clinical data and follow-up results of 13 elderly patients with ALLI admitted to the Affiliated Suqian First People's Hospital of Nanjing Medical University/Suqian First People's Hospital from July 2021 to August 2022 were collected.The thrombus clearance rate and recanalization status of the patients were observed,the patient's red blood cell count,hemoglobin level,creatinine level,urea nitrogen level,blood potassium level,white blood cell count,and albumin level before and after surgery were compared,and the occurrence of postoperative complications was recorded.The improvement of clinical symptoms and prognosis of patients through follow-up was observed.Result Thirteen elderly ALLI patients were treated with thrombus clearing device and supplemented with balloon dilation.Stents were placed in 10 patients,with an average of 1.5 stents.The average operation time was(137.08±48.60)min,the mean time of thrombus aspiration was 180.00(135.00,304.00)s,the average intraoperative blood loss was 90.00(67.50,159.50)ml.After surgery,the patient's red blood cell count,hemoglobin level,urea nitrogen level,and white blood cell count were all lower than before surgery,and the differences were statistically significant(P<0.05),no need for blood transfusion treatment.All patients experienced varying degrees of hemoglobinuria,with average duration of(13.46±2.76)h.All patients showed immediate improvement in clinical symptoms after surgery,achieving clinical success.Three patients experienced thrombus recurrence within 24 h after surgery,while the remaining patients were followed up for at least one month,among them,two patients developed heart failure without any complications related to the puncture site,renal dysfunction,other cardiovascular accidents,pancreatitis or other complications.There were no deaths within 30 d after surgery.Conclusion The rheolyt

关 键 词：血栓清除装置 经皮机械血栓清除术 急性下肢缺血 老年患者 

分 类 号：R543[医药卫生—心血管疾病]