急性下肢动脉缺血溶栓治疗的临床研究

Clinical study on intra-arterial thrombolysis for acute ischemia of lower extremity

目的总结溶栓治疗对急性下肢动脉缺血的疗效及其安全性。方法回顾性分析2009年1月～2011年12月收治43例急性下肢动脉缺血患者的临床资料,均进行动脉腔内溶栓治疗,其中27例进行导管直接溶栓,6例导管直接溶栓前行血管内球囊扩张,7例导管直接溶栓后进行血管内球囊扩张和支架置入,溶栓前后均进行球囊扩张有3例。腔内溶栓治疗无效转而手术取栓13例。结果 30例(69.8%)患者血管再通及肢体保存,但其中1例因出血并发症死亡,发生脑梗死1例。8例(18.6%)截肢,均为移植物血栓形成。1例肢体坏死但未行截肢。4例溶栓无效但肢体未坏死而最终采取药物保守治疗。结论溶栓治疗对急性下肢动脉缺血总体安全有效,可优先考虑,根据病情的需要采取综合治疗方案。

Objective To investigate the efficacy and safety of intra-arterial thrombolysis for acute ischemia of lower extremity. Methods From January 2009 to December 2011, the clinical data of 43 patients (aged 48～96 years) with acute ischemia of lower extremities were analyzed retrospectively. All of the cases underwent intra-arterial thrombolysis with different procedures,including direct intra-arterial thrombolysis (27 cases), endovascular angioplasty before thrombolysis (6 cases), endovascular angioplasty and stent implantation after thrombolysis (7 cases) and angioplasty before and after thrombolysis (3 cases). Thirteen cases underwent thromboectomy promptly when failed to thrombolysis. Results Thirty patients (69.8%) gained vascular recanalization and limb salvage, however, 1 case died of hemorrhage during hospital stay and 1 case occured stroke attack. Eight patients (18.6%) received amputation, while 1 patient with limb necrosis didn′t undergo amputation. Conservative treatment was administrated in other 4 patients who failed of thrombolysis and without limb necrosis. Conclusion Intra-arterial thrombolysis is an effective and safe treatment for acute ischemia of lower extremities accompanied with the other methods. Comprehensive treatment can be performed according to the needs and conditions.