糖尿病足的介入治疗

Interventional Treatment for Diabetic Foot

目的研究糖尿病足下肢动脉血管的DSA影像特征及血管内治疗的临床价值。方法对23例糖尿病足的下肢动脉行DSA血管造影证实全部患肢的供血动脉显示血管不同程度的狭窄、闭塞性病变。留置造影导管后,经导管注入尿激酶（万U）∶肝素钠（mg）∶NS（ml）为1∶1∶1的抗凝溶栓溶液,用量为2.0ml/h,用微量泵维持7天左右。结果靶血管周围侧支血管明显增多占全组病例的100%,狭窄段血管腔较前扩张占70.3%,闭塞段血管重新开通占60.5%。0~Ⅱ级病足溃疡面愈合,Ⅲ~Ⅳ级病足溃疡面干燥、缩小、周围炎症消退。结论DSA血管造影可以早期诊断糖尿病下肢血管病变的程度、范围。介入治疗能改善患足的血供,从而预防控制糖尿病足的发生、发展。

Objective To study the digital subtraction angiography （DSA） imaging features of peripheral arteries in diabetic foot and clinic value of interventional treatment for diabetic foot. Methods Twenty-three diabetic patients with foot problems were examined by DSA in lower extremity and arterial diseases of lower extremity were all confirmed. After the catheter was put in the target vessel, anticoagulation-thrombolysis liquors （urokinase： heparin sodium： normal sodium = 1 ： 1 ： 1） were infused by micropump at dose of 2. 0ml/h for 7 days. Results Increasing of collateral arteries was seen in all patients. Peripheral arterial stenosis was improved by 70. 3% and arterial obstruction was reopened by 60. 50%. Ulcers in 0- Ⅱ grade typically healed, and those in Ⅲ - Ⅳ grade dried and contracted with reducing inflammation. Conclusion DSA can assess the extent of arterial changes and interventional treatment can improve arterial blood perfusion to prevent deterioration of diabetic foot.