血管内溶栓治疗急性外周动脉闭塞(附22例报告)

Intravascular thrombolysis therapy for acute peripheral arterial occlusion(A report of 22 cases)

目的探讨急性外周动脉闭塞行血管内溶栓治疗的价值、方法及影响因素。方法22例患者,男17例、女5例,年龄31-75岁,平均43.8岁。均经血管造影证实动脉闭塞,病变涉及动脉24段;病程时间2～480小时(平均122.5小时);病变长度3～65cm(平均30.5cm)。22例均行血管内溶栓治疗,尿激酶用量为50～300万单位(平均127万单位),2例尚行经皮穿血管内成形术(PTA)治疗。结果溶栓治疗后,18例血管复通,4例溶栓失败;复通率为81.8%(18/22),包括完全复通8例(44.4%,8/18)和部分复通10例(55.6%,10/18)。行PTA治疗的2例,狭窄血管直径分别由0.2cm扩为0.5cm和由0.2cm扩为0.4cm。18例的症状和体征明显改善,未见严重副反应和并发症。结论血管内溶栓是急性外周动脉闭塞首选的治疗方法。必要时可结合PTA治疗。

Objective To investigate the efficacy and affecting factors of intravascular thrombolysis therapy for acute peripheral arterial occlusion.Methods 22 patients with 24 segments of occlusive arteries demonstrated angiographically underwent intravascular thrombolysis with urokinase in dose of 500,000～3,000,000u(mean 1,270,000u),2 patients also received percutaneous transluminal angioplasty(PTA)treatment.Among them,17men and 5 women,aged31～75years(43.8 years in average),The episode lasts 2～480 hours(122.5 hours in average) and the length of the target artery measured 3～65cm (30.5 cm in averager).Results Technical success was obtained in 18(81.8%)cases out of 22,including complete recanalization in 8(44.4%,8/18) cases and partial recanalization in 10(55.5%,10/18) cases. The diameter of the stenotic artery was widened from 0.2 cm to 0.4 cm and 0.5 cm respectively by PTA in 2 cases of partial recanalization.The symtoms and signs of 18 cases improved remarkably after interventional treatment.No severe side-effect and complications appeared.Conclusions Intravascular thrombolysis is an essential therapy for acute peripheral arterial occlusion.PTA should be performed in suitable cases.