急性下肢动脉缺血的临床研究

Clinical study of diagnosis and treatment for acute lower limb ischemia

目的探讨急性下肢动脉缺血(ALLI)的治疗策略和预后。方法回顾性分析2003年1月至2009年12月收治的ALLI患者的临床资料。结果 ALLI130例,包括急性动脉栓塞82例和急性动脉血栓形成48例。单纯全身溶栓和抗凝治疗12例,Fogarty导管取栓81例,行取栓及动脉旁路术15例,9例行导管性溶栓,骨筋膜室切开减压27例。一期截肢13例;死亡9例,死亡率为6.9%,二期截肢8例;总体截肢率为19.3%(21/109)。吸烟史、合并糖尿病和起病时间超过24小时是影响保肢的独立危险因素。结论尽早开始治疗ALLI和选择适当的治疗方法有助于提高疗效。

Objective To analyze the clinical data of acute lower limb ischemia(ALLI),and to evaluate its treatment strategy and prognosis.Method The data of patients who were admitted and treated in our hospital for ALLI from January 2003 to December 2009 were analyzed retrospectively.Results A total of 130 patients with ALLI were enrolled in the study,including 82 cases of acute arterial embolism and 48 cases of acute arterial thrombosis..Twelve patients were treated with systemic thrombolysis and anticoagulation therapy and 9 patients underwent catheter directed thrombolysis.Fogarty catheter embolectomy was performed on 81 cases,.and 15 patients received immediate graft bypass after the removal of thrombus..A total of 27 patients underwent open decompression of compartment..An amputation was the first choice for 13 patients,.and 8 patients underwent amputation of the second phase..Overall amputation rate was 19.3%,and hospital mortality was 6.9%.Smoking history,diabetes and onset time over 24 hours were independent risk factors.Conclusion An immediate and appropriate treatment may help to improve the outcomes of ALLI.