经皮机械血栓清除术治疗不同中医证型下肢动脉血栓  

Percutaneous mechanical thrombectomy for treating different traditional Chinese medicine syndrome type lower extremity arterial thromboses

作　　者：王路遥 宋明珠 张钰涵 何文烨 郝清智[2] 王彬[3] WANG Luyao;SONG Mingzhu;ZHANG Yuhan;HE Wenye;HAO Qingzhi;WANG Bin(the First Clinical Medical College of Shandong University of Traditional Chinese Medicine,Jinan 250022,China;Department of Peripheral Vascular,Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Jinan 250013,China;School of Medicine,Shandong University of Traditional Chinese Medicine,Jinan 250399,China)

机构地区：[1]山东中医药大学第一临床医学院,山东济南250022 [2]山东中医药大学附属医院周围血管病科,山东济南250013 [3]山东中医药大学医学院,山东济南250399

出　　处：《中国介入影像与治疗学》2024年第11期649-653,共5页Chinese Journal of Interventional Imaging and Therapy

基　　金：山东省自然科学基金联合基金项目(ZR2022LZY011)。

摘　　要：目的观察经皮机械血栓清除术(PMT)治疗不同中医证型下肢动脉血栓效果。方法回顾性分析40例接受PMT的下肢动脉血栓患者,根据中医证型将其分为湿热证组(n=18)与血瘀证组(n=22);比较组间技术成功率、治疗后12个月踝肱指数(ABI)、Rutherford分级及血管通畅率,记录围术期并发症及随访期间不良事件。结果PMT技术成功率在湿热证组与血瘀证组分别为94.44%(17/18)及100%(22/22);治疗后12个月2组ABI依次为0.45±0.11及0.52±0.14、血管通畅率分别为94.44%(17/18)及81.82%(18/22);组间差异均无统计学意义(P均>0.05)。治疗前组间Rutherford分级差异无统计学意义(P>0.05);治疗后12个月湿热证组Rutherford分级高于血瘀证组(P<0.05)。围术期湿热证组1例出现肱动脉假性动脉瘤,血瘀证组1例出现骨筋膜室综合征、1例出现心房颤动,均经治疗后好转。随访期间未见截肢或死亡等严重不良事件。结论PMT治疗不同中医证型下肢动脉血栓均有效且较为安全;血瘀证型下肢动脉血栓预后优于湿热证型。Objective To observe the efficacy of percutaneous mechanical thrombectomy(PMT)for treating different traditional Chinese medicine(TCM)syndrome type lower extremity arterial thromboses.Methods Forty patients with lower extremity arterial thromboses who underwent PMT were retrospectively enrolled and divided into dampness-heat syndrome group(n=18)and blood stasis syndrome group(n=22)according to TCM syndrome types.The technical success rate,ankle-brachial index(ABI),Rutherford grade and vascular patency rate 12 months after PMT were compared between groups.Perioperative complications and adverse events during follow-up were recorded.Results The technical success rate of PMT in dampness-heat syndrome group and blood stasis syndrome group was 94.44%(17/18)and 100%(22/22),respectively.Twelve months after PMT,ABI was 0.45±0.11 and 0.52±0.14,and vascular patency rate was 94.44%(17/18)and 81.82%(18/22)in dampness-heat syndrome group and blood stasis syndrome group,respectively,both not significantly different between groups(all P>0.05).No significant difference of Rutherford grade before treatment was found between groups(P>0.05),while 12 months after PMT,Rutherford grade in dampness-heat syndrome group was higher than in blood stasis syndrome group(P<0.05).During perioperative period,false aneurysm of brachial artery occurred in 1 case in dampness-heat syndrome group,while osteofascial compartment syndrome and atrial fibrillation occurred each in 1 case in blood stasis syndrome group,both relieved after treatments.No serious adverse event such as amputation nor death occurred during follow-up.Conclusion PMT was effective and safe for treating different TCM syndrome type lower extremity arterial thromboses.The prognosis of patients with blood stasis syndrome type lower extremity arterial thromboses was better than that of those with dampness-heat syndrome.

关 键 词：动脉闭塞性疾病 血栓栓塞 机械溶栓 湿热证 血瘀证 

分 类 号：R654.4[医药卫生—外科学] R815[医药卫生—临床医学]