持续性静脉滤过在老年危重急性下肢动脉栓塞患者取栓术后治疗的作用

Efficiency of continuous veno-venous haemodiafiltration in elderly patients with critical acute lower extremity arterial embolism after embolectomy

目的总结老年危重急性动脉栓塞患者取栓术后的诊治经验，探讨持续性静脉滤过（CVVHD）治疗在此类患者动脉栓塞取栓术后改善预后的作用。方法回顾性地分析2008年6月至2015年5月北京军区总医院血管外科收治的47例急性下肢动脉栓塞患者的临床资料。术后按照患者或家属意愿，根据是否采用CVVHD治疗将所有患者分为两组：治疗组（m=21）和对照组（Ⅳ=26）。对比分析两组患者的临床资料、住院时间、住院期间死亡率等情况，重点对比两组患者术后。肾功能的恢复情况。结果与对照组相比，治疗组患者术前出现肢体发绀、僵硬症状的比例更多（P〈0．05）；治疗组患者血钾、肌酐及尿素氮恢复至正常所需的时间明显缩短（P〈0．05）；治疗组患者的住院时间显著缩短[（13．5±1．6）vs（18．2±2．1）d，P=0．043]、住院期间死亡率显著降低（9．5％vs19．2％，P=0．027）。结论老年危重急性动脉栓塞患者术后积极进行CVVHD治疗可缩短患者的恢复时间，明显减少死亡率和术后住院时间，改善预后。

Objective To summarize our experience in treating the elderly patients suffering from critical acute lower extremity arterial embolism （CALEAE） and determine the role of continuous veno-venous haemodiafiltration （CVVHD） in improving the prognosis of these patients after arterial embolectomy. Methods Clinical data of 47 elderly patients suffering from CALEAE admitted in our department from June 2008 to May 2015 were collected in this study. According to the intentions of the patients or their families for taking CVVHD, they were divided into treatment group （n = 21） and control group （n = 26）. Their clinical data, length of stay, hospital mortality, especially postoperative renal function were compared between the 2 groups. Results There were more patients having peripheral cyanosis and muscle stiffness in the treatment group vs the control group before embolectomy （P 〈 0.05）. The times of the serum levels of potassium, creatinine and urea nitrogen recovering to normal levels were significantly shorter in the patients of the treatment group than in the control group （P 〈 0.05）. The treatment group had remarkably shorter length of stay [（13.5 ± 1.6） vs （18.2 ± 2.1）d, P = 0.043] and lower hospital mortality （9.5% vs 19.2%, P= 0.027）. Conclusion CVVHD can shorten the recovery duration, obviously reduce the mortality and length of stay, and improve the prognosis for the elderly patients suffering from CALEAE after operation.