急性上肢动脉栓塞患者手术与非手术治疗的比较

The comparison of operative and non-operative treatment for acute embolism of upper extremity artery

目的比较急性上肢动脉栓塞手术和非手术治疗的效果及影响预后的相关因素。方法分析比较了中国医科大学附属第一医院1990年1月至2007年10月间收治的所有急性上肢动脉栓塞患者的手术及非手术治疗的方法及结果。结果本组60例患者，男32例，女28例，年龄21～86岁，平均（63±15）岁。手术组31例行肱动脉切开Fogarty导管取栓术，非手术组29例行抗凝溶栓祛聚治疗。经统计学分析，手术组Cooley疗效分级优于非手术组（P〈0．05）。手术组治疗后桡动脉、尺动脉搏动恢复情况与治疗前临床表现、体征及血栓位于远近端等因素无明显相关性，而非手术组治疗后桡动脉、尺动脉搏动恢复情况与临床体征中无动脉搏动和血栓位于远端或近端相关性明显（P〈0．05）。Cox比例风险回归模型进行生存分析，患者年龄和Cooley疗效与生存时间有关。结论积极的手术取栓对患者栓塞上肢的血运及功能恢复具有重要意义。

Objective To compare surgical and non-surgical therapy of the upper extremity after acute arterial occlusion. To analyze the relation between prognosis and relevant factors of different therapeutic methods. Methods Sixty patients with acute upper extremity arterial embolism treated between January 1990 and October 2007 were retrospectively studied in The First Hospital of China Medical University. Results There were 60 patients , 32 men and 28 women , with a mean age of 63 years （21--86 years）. Among them, 31 underwent thrombembolectomies with the Fogarty catheter and 29 received anti-coagulation and thrombolytic therapy. Therapeutic effects were evaluated by Cooley＇s standard. Therapeutic efficacy was better in the surgical group than in the non-surgical group （ P 〈 0. 05 ）. There was no relationship between post-operative ischemic recovery and pre-operative ischemia severity and the site of embolism in the surgical group, while there were significant relationships in the nonsurgical group. The result of Cox propprtional hazard regression model showed that the age and Cooley＇s standard of the patient was correlated with survival time. Conclusions A more active surgical approach is better for the treatment of acute arterial occlusion of the upper extremity.