急性周围动脉损伤211例的诊治经验

Diagnosis and treatment of acute peripheral artery injury

目的探讨急性周围动脉损伤的诊断和治疗方法及其预后。方法回顾性分析 1988年 1月至 2 0 0 2年 6月诊治的 2 11例急性周围动脉损伤患者的临床资料 ,有钝性伤 73例、锐性伤 99例、医源性损伤 37例、枪弹伤 2例。治疗包括动脉侧壁修补 (补片 ) 2 8例、单纯结扎 17例、端 端吻合41例、自体静脉移植 37例、人工血管移植 2 9例、单纯取栓 14例、假性动脉瘤切除 36例、介入溶栓 2例、超声引导下压迫 2例、保守治疗 2例。结果治愈 192例、截肢 10例、截趾 2例、垂足 3例、死亡 4例。治愈率 91 0 % ,截肢率为 4 7% ,死亡率为 1 8%。钝性损伤截肢率显著高于锐性损伤 (P <0 0 1)。严重的失血性休克和创伤后的多器官功能衰竭是致死的主要原因。结论早期诊断 ,有效的控制出血和抗休克治疗 ,快速优质的血管重建 ,早期筋膜切开 ,合理的处理动脉复合伤 。

Objectives To study the diagnosis, treatment and prognosis of acute peripheral artery injury, and ways to improve the treatment. Methods Clinical data of 211 cases of acute peripheral arterial injuries admitted between January 1988 and June 2002 in Anzhen hospital were analyzed retrospectively. Of the 211 cases,73 cases were with blunt injuries, 99 penetrating injuries, 37 iatrogenic injuries, 2 gunshot injuries. Management procedures included arterial primary or patch repair in 28 cases, ligation alone in 17, end-to-end anastomosis in 41, interposition reverse saphenous vein graft in 37, interposition prosthetic graft in 29, thrombectomy in 14, excision of pseudoanurysm in 36, interventional thrombolytise in 2, ultrosonic-guided packing in 2, conservative management in 2. One hundred and ninety-two patients were cured,10 patients amputed, 4 patients died respectively.Results Ratio of cure,amputation,and mortality was 90.1%,4.74%,1.8% respectively.Amputation rate in blunt injuries was significantly higher than that in penetrarting injuries (P<0.01), especially of popliteal artery injuries. Severe hemorrhagic shock and multiple organ failure were the main cause of death. Conclusions Prompt diagnosis, effective control of bleeding and anti-shock treatment, prompt revascularization, early fasciectomy and appropriate management of compound wounds can decrease mortality and morbidity.