POSSUM评分联合APACHE Ⅱ评分指导介入治疗下肢动脉硬化闭塞症的临床研究

Clinical study of POSSUM score combined with APACHE II score on interventional therapy of lower extremity arteriosclerosis obliterans

目的:探讨生理学和手术严重度(POSSUM)评分联合急性生理和慢性健康(APACHE)Ⅱ评分指导下肢动脉硬化闭塞症介入治疗的临床效果。方法:选取2013年5月至2018年4月本院收治的下肢动脉硬化闭塞症患者96例,其中实施常规介入治疗的48例为A组,以POSSUM及APACHEⅡ测评结果为指导而实施介入治疗的48例为B组。比较2组的介入手术成功率,住院时间,治疗前后胫后动脉、足背动脉血流量及踝肱指数(ABI),术后并发症发生情况及死亡情况。结果:B组的手术成功率明显高于A组(95.83%vs. 83.33%),住院时间明显短于A组[(9.47±2.64)d vs.(14.56±3.28)d],差异有统计学意义(χ2=4.019,t=8.375,P均<0.05);2组治疗后胫后动脉及足背动脉血流量均明显高于治疗前(P<0.05),B组治疗后胫后动脉及足背动脉血流量均明显高于A组(P<0.05);2组治疗前ABI指数无明显差异(P>0.05),2组治疗后ABI指数均明显高于治疗前(P<0.05),B组治疗后ABI指数明显高于A组,[(1.09±0.22)vs.(0.95±0.14)],差异有统计学意义(t=3.785,P<0.05);B组术后总并发症发生率低于A组(12.50%vs. 29.17%),病死率也低于A组(0%vs. 8.33%),差异有统计学意义(P均<0.05)。结论:POSSUM评分联合APACHEⅡ评分指导下肢动脉硬化闭塞症介入治疗可明显提高介入手术成功率,缩短住院时间,并可明显改善下肢血流及提高ABI,减少术后并发症及死亡的发生,值得在临床推广应用。

Objective:To explore the clinical effect of physiological and operative severity score for the enumeration of mortality and morbidity(POSSUM)score combined with acute physiology and chronic health evaluation(APACHE)II score on interventional therapy of lower extremity arteriosclerosis obliterans.Methods:The clinical data of 48 patients with lower extremity arteriosclerosis obliterans treated with routine interventional therapy were retrospectively analyzed from May 2013 to April 2018 in our hospital,who were set up as A group,and the clinical data of 48 patients with lower extremity arteriosclerosis obliterans treated with interventional therapy on the guiding of preoperative POSSUM and APACHE II evaluation were retrospectively analyzed at the same period in our hospital,who were set up as B group.The success rate of interventional operation and hospitalization time of the 2 groups were compared,and the blood flow of posterior tibial artery and dorsal pedal artery and ankle brachial index(ABI)before and after treatment were compared,then the incidence of postoperative complications and the death situation were compared.Results:The success rate of operation in B group was significantly higher than that in A group(95.83%vs.83.33%),and the hospitalization time of B group was significantly shorter than that of A group[(9.47±2.64)d vs.(14.56±3.28)d],with significantly statistical differences(χ^2=4.019,t=8.375,both P<0.05).The blood flow of posterior tibial artery and dorsal pedal artery of the 2 groups after treatment were significantly higher than those before treatment(P<0.05),and those in B group after treatment were significantly higher than those of A group(P<0.05).There was no significant difference in the ABI index before treatment between the 2 groups(P >0.05),and those in the 2 groups after treatment were significantly higher than those before treatment(P<0.05),and those in the B group after treatment was significantly higher than that of the A group[(1.09±0.22)vs.(0.95±0.14)],with a significantly statistical difference(t=3.785,P<0.05).The incidence rate of postoperative total complications of the B group was lower than that of the A group(12.50%vs.29.17%),and the mortality rate of the B group was lower than that of the A group(0%vs.8.33%),with significantly statistical differences(both P<0.05).Conclusions:POSSUM score combined with APACHE II score guiding the interventional therapy of lower extremity arteriosclerosis obliterans can obviously improve the success rate of interventional operation,shorten the hospitalization time,improve the blood flow of lower limbs and ABI,and reduce the postoperative complications and death.