经导管持续性溶栓治疗糖尿病足的临床价值

Consecutive Thrombolysis with Low Dose of Urokinase for Treatment of Diabetic Foot

目的探讨经导管持续小剂量灌注尿激酶治疗糖尿病足（DF）的临床价值。资料与方法12例DF患者，采取经导管血栓局部灌注尿激酶，首先20min内脉冲式给予尿激酶25—50万U，然后保留导管，持续小剂量溶栓，3—6万U／h，24min尿激酶用量75—100万U。结果11例溶栓成功，溶栓成功率为91．7％（11／12），1例肾动脉开1：3部以下腹主动脉闭塞患者，溶栓过程中因急性肾功能衰竭死亡。溶栓时间为24—240h，尿激酶总量为100～1000万U。11例中，闭塞血管完全开通（残存狭窄率〈30％）5例，部分性开通（残存狭窄率〉30％）6例，溶栓过程中出现下肢疼痛5例，穿刺点渗血3例，牙龈出血1例。溶栓成功后，对残存狭窄率〉30％的6例患者，3例行经皮球囊血管成形术（PTA）治疗，3例行PTA及腔内支架治疗。11例术后1个月内疼痛消失或明显减轻，2个月内溃疡全部愈合，2例行坏疽足趾截肢术。结论持续小剂量尿激酶溶栓治疗DF安全、有效，具有较好的临床应用价值。

Objective To evaluate the value of consecutive thrombolysis with low dose of urokinase in the treatment of diabetic foot. Materials and Methods 12 patients with diabetic foot received catheter directed regional thrombolysis. 250,000 - 500,000 IU pulses of UK were administered in 20 minutes, followed by low dose of urokinase continuous infusion 30,000 - 60,000 IU/h, a total dose of 750,000 - 1000,000 IU was infused in 24 hours. Results 11 patients resulted in lysis with the infusing time of 24 -240 hours. The total effective rate was 91.7%. 1 patient with thrombosis in abdominal aorta below renal artery was died from acute renal failure. The total dose of urokinase was 1000,000 - 10000,000 IU. Of 11 patients, complete open of the obstructed segment with residual stenosis ratio 〈 30 % was obtained in 5, partial open in 6. During the process 5 patients suffered pain, 3 patients suffered errhysis, 1 patient suffered gingiva bleeding. For the 6 patients who showed the residual stenosis ratio 〉 30%, PTA was carried out in 3, PTA with stent placement in 3. For 11 patients, pain disappeared or obviously relieved in 1 month, all ischaemic ulcers healed in 2 month, 2 patients with necrotic digiti pedis had amputation surgery. Conclusion As a valuable clinical application, catheter directed consecutive thrombolysis with low dose of urokinase is effective and safe in the treatment of diabetic foot.