导管直接溶栓治疗急性下肢缺血并发症的分析

Analysis of the complications of catheter-directed thrombolysis in the treatment of acute lower limb ischemia

目的探讨导管直接溶栓(catheter-directed thrombolysis,CDT)治疗急性下肢缺血(acute lower limb ischemia,ALLI)并发症的发生原因和防治措施。方法回顾性总结2012年1月至2014年1月收治的82例(82条肢体)ALLI患者中行CDT治疗的临床资料。结果本组患者均成功实施CDT治疗,术后并发症的总发生率为30.49%(25/82),其中穿刺点血肿2.44%(2/82),穿刺点假性动脉瘤1.22%(1/82),肝素诱导的血小板减少症(heparin-induced thrombocytopenia,HIT)1.22%(1/82),结膜下出血2.44%(2/82),CDT治疗中血栓脱落引起2次栓塞6.10%(5/82),溶栓导管引起的动脉穿孔1.22%(1/82),骨-筋膜室综合征15.85%(13/82)。结论术前严格掌握适应证,术中精细规范操作,术后及时发现异常并且妥善处理,可以有效减少并发症的发生率。

Objective To investigate the causes and preventive measures of complications in patients with acute lower limb ischemia （ALLI） accepted catheter-directed thrombolysis （CDT）. Methods The clinical data of 82 patients （82 limbs） with ALLI from Januray 2012 to Januray 2014 who received CDT treatment were analyzed retrospectively. Results CDT treatment was applied on those patients successfully and the postoperative complication rate was 30.49% （25/82）, including hematoma of puncture point （2.44%, 2/82）, false aneurysm （1.22%, 1/82）, heparin-induced thrombocytopenia （1.22%, 1/82）, subconjunctival hemorrhage （2.44%, 2/82）, re-embolism （6.10%, 5/82） caused by failing of thrombosis in CDT treatment, arterial perforation （1.22 %, 1/82） induced by catheter, osteofascial compartment syndrome （15.85 %, 13/82）. Conclusions Accurately mastering the indications of CDT treatment and exquisite surgical procedure, as well as timely detection and proper treatment can decrease the incidence rate of the complications effectively.