下肢大动脉损伤术后血管危象的监测及危险因素分析

Monitoring of vascular crisis after reconstruction of lower extremity artery injury and analysis of its risk factors

目的:探讨下肢大动脉损伤术后血管危象的监测措施,分析血管危象发生的危险因素。方法:回顾性总结我院自2004年1月至2010年1月收治的114例下肢大动脉损伤病例中发生血管危象11例患者的临床监测及护理措施,对下肢动脉术后发生血管危象的主要可能危象因素进行单因素与多因素Logistic回归分析。结果:11例血管危象皆发生于术后72 h内,患肢皮温减低是血管危象发生后的早期征象,与健侧温差平均为(3.6±0.41)℃(3.1～4.5℃);肢端切口放血无血、缓慢或色泽暗紫是血管危象发生的直接客观指标;单因素分析及多因素Logistic回归分析结果显示年龄与损伤机制为血管危象发生的主要危险因素,性别与修复方式对血管危象的发生无显著影响。结论:术后72 h内密切观察肢端血运,注意皮温的监测,尤其关注与健侧皮温的对比,皮温减低是较直观准确的简易观察指标,肢端放血法是简单客观的监测方法;

Objective ：To explore the monitoring measures of vascular crisis after reconstruction of lower extremity artery injury and analyze its risk factors. Methods：The clinical data of 114 cases of lower extremity artery injury from Jan 2004 to Jan 2010, of which there were 11 cases sustained vascular crisis after arterial reconstruction, were investigated retrospectively. The monitoring measures performed were summarized and the possible risk factors of vascular crisis were analyzed using Chi-square and Logistic regression analysis. Results：All the 11 cases of vascular crisis occurred within 72h postoperatively. The continuous skin temperature dropping was the early sign of vascular crisis with 3.6 ± 0.41 （3.1 - 4.5 ）℃ lower than that of the normal side averagely and bleeding slowly in dark color or even no bleeding using blood-letting technique was the solid evidence of vascular crisis. Chi-square and Logistic regression analysis showed that age and causes of injury were the major predictors of vascular crisis after reconstruction of lower extremity artery injury, while no evidence of the sex and repair mode was found to contribute to the vascular crisis. Conclusion：Obvious skin temperature dropping compared with the unaffected site within 72h postoperatively is the simple and precise method for monitoring the vascular crisis, together with the blood-letting technique. Ad- vanced age and extensive blunt trauma are the main risk factors of vascular crisis after reconstruction of lower extremity artery injury.