下肢缺血动脉重建后再灌注损伤

Reperfusion damage after arterial reconstruction for lower extremity ischemia

目的 探讨下肢缺血动脉重建后再灌注损伤的原因和预防措施。方法 回顾性总结了78例(92条下肢)急、慢性缺血病例的治疗经验。结果 动脉重建术79条下肢,PTA4条下肢,动脉切开取栓术9条下肢,小腿中段增粗0.8～3.7cm,平均1.8cm;大腿中段增粗1.9～5.6cm,平均增粗3.3cm。超过4cm有7例,其中5例作筋膜室切开。死亡3例,1例死于急性肾功能衰竭,2例死于急性心肌梗塞。结论 下肢缺血再灌注损伤可导致累及多器官的综合征,其损伤程度与术前缺血程度呈正相关性;氧自由基清除剂在再灌注损伤的预防和治疗上有重要作用;全身动脉硬化是影响预后的重要因素。

Objective To explore the causes and prevention of reperfusion damage after arterial reconstruction for lower extremity ischemia. Methods The therapeutic experience of 78 cases (92 lower limbs) of acute and chronic ischemia were summarized. Results 79 lower limbs were treated by arterial bypass grafting; 4 lower limbs, by PTA (percutaneous angioplasty) and 9 lower limbs, by oper embolectomy. The diameter of middle calf was 0. 8-3. 7cm (1. 8cm), the diameter of middle thigh was 1. 9-5. 6cm (3. 3cm). There were 5 cases with the diameter of middle thigh over 4cm operated with fascial compartment resection. 3 cases were dead : 1 case from acute renal failure and 2 cases from acute myocardial infarction. Conclusions Reperfusion damage of lower extremity with ischemia may lead to systematically functional disorders. The severity of clinical presentation is positively correlated with preoperative ischemic condition. The application of oxygen free radical scavengers plays an important role for preventing and reducing the severity of reperfusion damage. Systemic atherosclerosis is an important factor for predicting the patientrs prognosis.