利伐沙班联合支架植入术治疗下肢动脉硬化闭塞症的疗效及对患者血管内皮功能、血流动力学指标的影响

Therapeutic effect of rivaroxaban combined with stent implantation in the treatment of lower limb arteriosclerosis obliterans and its impact on vascular endothelial function and hemodynamic indicators in patients

目的探讨利伐沙班联合支架植入术治疗下肢动脉硬化闭塞症的临床效果,并分析其对患者血管内皮功能、血流动力学指标的影响。方法选取2021年9月至2023年4月青岛大学附属医院收治的108例下肢动脉硬化闭塞症患者,在组间基线特征可比的原则上,随机分为观察组和对照组,每组54例。对照组采取支架置入术进行治疗,术后口服拜阿司匹灵(100 mg/d),观察组在此基础上术后联合利伐沙班(5 mg/d)治疗。比较两组的临床疗效,治疗前和治疗1个月后血管内皮功能指标[硝酸甘油介导的非内皮依赖性舒张功能(NMD)、血流介导的血管扩张功能(FMD)、一氧化氮(NO)、内皮素(ET)]及血流动力学指标(足背动脉内径、血流量和血流速度峰值)的变化,以及术后并发症发生情况。结果观察组治疗总有效率(90.74%)明显高于对照组(75.93%),差异有统计学意义(P<0.05)。治疗前两组NMD、FMD、NO、ET水平比较差异无统计学意义(P>0.05);治疗1个月后两组患者的NMD、FMD、NO水平明显高于治疗前,且观察组高于对照组,而ET水平明显低于治疗前,且观察组低于对照组,差异均有统计学意义(P<0.05)。治疗前两组足背动脉内径、血流量和血流速度峰值比较差异无统计学意义(P>0.05);治疗1个月后两组足背动脉内径及血流量明显高于治疗前,且观察组高于对照组,而血流速度峰值明显低于治疗前,且观察组低于对照组,差异均有统计学意义(P<0.05)。观察组术后并发症总发生率为5.56%,明显低于对照组的20.37%,差异有统计学意义(P<0.05)。结论利伐沙班联合支架植入可提高下肢动脉硬化闭塞症的治疗效果,并能显著改善患者的血管内皮功能及血流动力学指标,减少术后并发症的发生,值得临床应用。

Objective To explore the efficacy of rivaroxaban combined with stent implantation in the treatment of lower limb arteriosclerosis obliterans,and to observe and analyze the impact of combined treatment on vascular endothelial function and hemodynamic indicators in patients.Method One hundred and eight patients with lower limb arteriosclerosis obliterans admitted to our hospital from September 2021 to April 2023 were selected as the research subjects and randomly divided into an observation group and a control group,with 54 patients in each group.Both groups of patients underwent stent implantation for treatment,and received oral administration of baiaspirin(100 mg/d)after the surgery,while the observation group received postoperative treatment in combination with rivaroxaban(5 mg/d).Compare the clinical efficacy of treatment between two groups of patients;Observe the changes in vascular endothelial function and hemodynamic indicators before and after 1 month of treatment in both groups of patients,and the occurrence of postoperative complications.Result The total effective rate of treatment in the observation group was significantly higher than that in the control group(90.74%vs 75.93%,χ2=4.2667,P=0.0389).After treatment,the nitroglycerin-mediated dilation(NMD),flow-mediated dilation(FMD)and nitric oxide(NO)level in both groups significantly increased,and the observation group showed a more significant increase compared to the control group(P<0.05).The endothelin(ET)levels in both groups were significantly reduced compared to before treatment,and the observed group showed a more significant decrease compared to the control group(P<0.05).After treatment,the inner diameter and bloodflow of the dorsalis pedis artery in both groups of patients significantly increased,and the observation group showed a more significant increase compared to the control group(P<0.05).The peak blood flow velocity significantly decreased,and the observation group showed a more significant decrease compared to the control group(P<0.05).The total incidence of complications in the postoperative observation group was significantly lower than that in the control group(5.56%vs 20.37%,χ2=5.2523,P=0.0219).Conclusion The combination of Levofloxacin and stent implantation can improve the clinical efficacy of treating lower limb arteriosclerosis obliterans,significantly improve vascular endothelial function and hemodynamic indicators in patients,and help reduce the incidence of complications.It is worthy of clinical promotion and application.