肢体慢性缺血伴急性血栓形成患者再灌注后无复流现象影响因素分析

INFLUENCING FACTOR ANALYSIS OF NO-REFLOW PHENOMENON AFTER REPERFUSION IN PATIENTS WITH CHRONIC LIMB ISCHEMIA ASSOCIATED WITH ACUTE THROMBOSIS

目的分析影响肢体慢性缺血伴急性血栓形成患者再灌注后发生无复流现象的影响因素。方法 2009年1月-2010年12月,收治慢性缺血伴急性血栓形成患者59例67条肢体,按照血管重建术后是否发生无复流现象分为复流组(40例46条肢体)和无复流组(19例21条肢体),采用logistic回归分析急性缺血时间、缺血程度、吸烟、高血压、心脑血管疾病、糖尿病、手术方式、血小板计数、纤维蛋白原(fibrinogen,FBG)、前列腺素I2(prostaglandin I2,PGI2)及血栓素A2(thromboxane A2,TXA2)对肢体缺血再灌注后无复流现象的影响。结果 logistic回归分析显示,急性缺血时间、缺血程度、吸烟、糖尿病、PGI2和TXA2是发生无复流现象的高危因素,OR值(95%CI值)分别为7.196(1.679～27.960)、5.116(1.399～109.338)、6.893(3.704～2 291.003)、3.864(1.009～421.702)、7.985(1.001～1.043)和7.643(1.011～1.065)。与复流组相比,术后无复流组中TXA2、FBG升高,PGI2下降,差异均有统计学意义(P<0.05);血小板计数差异无统计学意义(P>0.05)。结论缺血程度和急性缺血时间是肢体慢性缺血伴急性血栓形成患者血管再通后发生无复流现象的主要影响因素,合并吸烟、糖尿病患者是发生无复流现象的高危人群;术后无复流患者体内的血栓前状态更严重,前列腺素在其中扮演重要角色。

Objective To analyze the influencing factors of no-reflow phenomenon after reperfusion in patients with chronic limb ischemia associated with acute thrombosis.Methods Between January 2009 and December 2010,59 patients（67 limbs） with chronic limb ischemia associated with acute thrombosis were treated.According to whether the no-reflow phenomenon occurred or not,the patients were divided into no-reflow group（19 patients,21 limbs） and reflow group（40 patients,46 limbs）.Logistic regression was used to analyze the roles of ischemia time,ischemia extent,smoking,hypertension,cardiovascular and cerebrovascular disease,diabetes,surgical procedure,platelet count,fibrinogen（FBG）,prostaglandin I2（PGI2）,and thromboxane A2（TXA2） on no-reflow phenomenon after reperfusion.Results The results of the logistic regression analysis indicated that ischemia time（OR=7.196;95%CI： 1.679-27.960）,ischemia extent（OR=5.116;95%CI： 1.399-109.338）,smoking（OR=6.893;95%CI： 3.704-2 291.003）,diabetes（OR=3.864;95%CI： 1.009-421.702）,PGI2（OR=7.985;95%CI： 1.001-1.043）,and TXA2（OR=7.643;95%CI： 1.011-1.065） were the high risk factors of no-reflow phenomenon.The levels of TXA2 and FBG in no-reflow group were significantly increased and the level of PGI2 was decreased,showing significant differences when compared with the reflow group（P 0.05）.However,no significant difference was found in the platelet count between 2 groups（P 0.05）.Conclusion Ischemia extent and ischemia time are the main influencing factors of no-reflow phenomenon after reperfusion in patients with chronic limb ischemia associated with acute thrombosis,and the patients combined with smoking or diabetes are high risk population of the no-reflow phenomenon.Postoperative patients with no-reflow phenomenon are at a hypercoagulable state in vivo,in which prostacyclin plays an important role.