容量泵输注尿激酶对老年下肢闭塞性动脉硬化患者下肢静息痛、间歇跛行及行走距离的影响(英文)

Effect of urokinase injected by volumetric infusion pump on rest pain, intermittent limp and walking distance in aged patients with arteriosclerosis obliterans of the lower limbs

背景:下肢闭塞性动脉硬化症常出现肢体发凉、麻木、疼痛、溃疡,重者发生肢体坏死,严重影响患者的下肢运动功能。目的:观察容量输液泵输注尿激酶对闭塞性动脉硬化性肢体缺血患者下肢疼痛及行走功能的改善作用。设计:随机分组,对照观察。单位:解放军沈阳军区总医院第二干部病房。对象:2000-01/2003-12解放军沈阳军区总医院第二干部病房诊断明确的77例下肢闭塞性动脉硬化患者,随机分为治疗组35例和对照组42例。方法:治疗组:经前臂静脉输注尿激酶50～70万U,每小时输注10万U,根据症状改善情况决定用药时间,5～8d一疗程。对照组:静脉滴注复方丹参30mL,1次/d,共15d。主要观察指标:两组治疗后下肢静息痛、麻木无力、间歇性跛行、行走距离的改善情况,以及不良反应。结果:按意向处理分析,两组77例均进入结果分析。①两组用药情况:治疗组每天应用容量泵输注尿激酶(60±12.1)万(50～70万)U,10万U/h,治疗(7±3.6)d(5～11d)。对照组均用复方丹参30mL×15d。②两组效果比较:治疗组静息痛消失率明显高于对照组[75%(9/35),30%(3/42),χ2=4.45,P<0.05],治疗组间歇性跛行改善率明显高于对照组[80.8%(17/35),39.1%(9/42),χ2=8.91,P<0.01],治疗组行走距离明显长于对照组[(120.2±23.5),(76.5±12.6)m,t=7.34,P<0.01]。③未发生出血病例。结论:应用容量泵输注尿激酶,可控制每小时用药量,改善了肢体的慢性缺血症状,75%的患者静息疼痛消失,80.8%的患者间歇性跛行改善,行走距离明显增加,显著提高了患者的下肢功能,且未出现出血现象。

BACKGROUND： Arteriosclerosis obliterans of the lower limbs often manifests such symptoms as cold, numb, pain and ulcer in the limbs. For severe cases, necrosis of limbs appears, which severely affects the motor function of the lower limbs. OBJECTIVE： To observe the improving effect of urokinase injected by volumetric infusion pump on the pain of lower limbs and walking function in patients with ischemic limbs due to arteriosclerosis obliterans. DESIGN： A randomly grouping and controlled observation SETTING： Second Carder＇s Ward, General Hospital of Shenyang Military Area Command of Chinese PLA PARTICIPANTS： Totally 77 cases of arteriosclerosis obliterans of lower limbs diagnosed at the Second Carder＇s Ward of General Hospital of Shenyang Military Area Command of Chinese PLA from January 2000 to December 2003 were recruited. The patients were randomly divided into the treatment group （n=35） and the control group （n=42）. METHODS： For treatment group, （500-700）×10^4 U of urokinase was injected into forearm intravenously, 10×10^4 U each hour, and the administration time was decided according to the improvement of the symptoms. 5 to 8 days was one course of treatment. For the control group, 30 mL of compound danshen root （Radix Salviae Miltiorrhizae） was injected intravenously, once a day, and 15 days in total. MAIN OUTCOME MEASURES： The improvement in rest pain, numbness, intermittent limp and walking distance of the lower limbs after the treatment in the two groups as well as the adverse effects. RESULTS： According to intention-to-treat analysis, 77 patients of the two groups all entered the stage of result analysis.①Administration：（60±12.1 ）×10^4U of urokinase [（50-70）×10^4U] was injected by volumetric infusion pump every day for the treatment group, and the treatment lasted for （7 ±3.6） days （ 5-11 days）. For the control group, compound dan.then 30 mL×15 days was administered. ②Comparison of the treatment effect between the two groups ： the elimination rate of rest pain in the treatment group was signifi- cantly higher than in the control group [75% （9/35） ,30%（3/42） ,x^2 = 4.45,P 〈 0.05]. The rate of improvement of intermittent limp was significantly higher in the treatment group than in the control group [80.8%（17/35） ,39.1% （9/42）,x^2= 8.91,P 〈 0.01].Walking distance was significantly longer in the treatment group than in the control group [（120.2±23.5）, （76.5±12.6）m,t =7.34,P 〈 0.01].③No cases of hemorrhage were found. CONCLUSION： Injection of urokinase by volumetric infusion pump can control the dosage of each hour and improve the chronic ischemia symptoms of the limbs. Rest pain of 75% patients disappeared. Intermittent limp and walking distance of 80% patients and funetion of lower limbs of the patients were significantly improved. Hemorrhage was not found.