肢体动脉急性缺血的处理147例临床分析

The treatment of acute arterial ischemia of the extremity:an analysis of 147 cases

目的 探讨不同阶段肢体动脉急性缺血（ＡＥＩ） 患者的处理，以提高其生存率，降低致残率或残废程度。 方法 回顾性总结了１４７ 例ＡＥＩ患者临床处理的经验教训。 结果 手术处理１３６例，占９２－５％ （１３６／１４７） ；无术中死亡，术后死亡率４－４％ （６／１３６）；非手术死亡率３６％ （４／１１）。手术处理组中：单纯血流重建术８３ 例，肢体挽救率９４％ （７８／８３）；血流重建加筋膜室切开术１７ 例，肢体挽救率６５％ （１１／１７）；取栓加低位静脉动脉化３ 例，２ 例肢体得到挽救；截肢同时作髂股动脉取栓术２７ 例；单纯截肢术６ 例。 结论 （１）ＡＥＩ发病后，手术处理并不困难；（２） 患者原伴有的心、肝、肾疾病与功能状态、缺血组织无氧代谢毒物的释放及组织再灌注损伤是影响预后的因素；（３） 必须依据患者不同情况采取不同的处理措施。总的原则是尽快恢复缺血组织血供。

Objective To evaluate the treatment modalities in patients with acute arterial ischemia of the extremity (AEI),and ways to reduce the mortality and the disability.Methods Clinical experience in 147 patients with AEI was retrospectively analyzed.Results 136 out of 147 (92 5%) patients underwent surgery.Postoperative mortality was 4 4%(6/136),non operative mortality was 36%(4/11).In our operative group,83 patients underwent revascularization,limb salvage was 94%(78/83),17 patients underwent revasculazization plus faciotomy.The limb salvage was 65% (11/17).27 patients underwent immediate amputation and embolectomy.7 patients underwent simple amputation.Conclusions (1) Emergent surgery is effective in most patients of AEI.(2)The accompanying heart and liver and kidney disease,the release of toxic produts of anaerobic metabolism and ischemic tissue reperfusion injury are the factors influencing prognosis.(3) Individual treatment modality method should be adopted according to the status of patients with AEI.Prompt restoring blood supply,decreasing the absorption of toxic products and protect the function of kidneys were all mandatory for the treatment of AEI patients.