下肢动脉硬化闭塞腔内治疗辅助罂粟碱的临床疗效观察

Clinical Observation of Intraoperative Treatment of Papaverine in Lower Extremity Arteriosclerosis

目的对下肢动脉硬化闭塞腔内治疗患者同时辅助罂粟碱,对其临床疗效加以观察和分析。方法选择我院心血管外科2017年1月至2019年1月收治的下肢动脉硬化闭塞患者83例,随机分成2组。对照组41例,采取腔内治疗血管重建,男性患者26例,女性患者15例,年龄26~73岁,平均年龄(60.3±8.5)岁,病程(11.7±6.2)个月;观察组42例,在腔内治疗血管重建的基础上辅助罂粟碱,男性患者25例,女性患者17例,年龄28~76岁,平均年龄(62.4±8.7)岁,病程(12.1±6.7)个月。近关节处的局限性病变和膝下动脉病变,采用单纯球囊成形治疗;对于主髂和股浅动脉病变较长、动脉硬化或钙化严重和闭塞性病变,行一期支架植入。罂粟碱30 mg肌内注射或通过微量泵静脉注射,注射时间不短于30 min,每日注射3次,注射2周。结果观察组患者显效25例,有效16例,无效1例,总有效率97.6%;对照组患者显效23例,有效13例,无效5例,总有效率87.8%,两组比较,差异值具有统计学意义(P<0.05)。观察组患者住院时间缩短,复发率降低,与对照组相比,差异值具有统计学意义(P<0.05)。结论下肢动脉硬化闭塞腔内治疗成功率高,对患者损伤小,已经成为首选治疗方案,但治疗后疗效的巩固受多因素的影响,如不能及时干预,可能造成血管再次狭窄闭塞。罂粟碱是磷酸二酯酶短效抑制剂,能增加血管平滑肌细胞内c GMP生成,降低钙离子浓度,从而引起血管舒张。在本研究中,经腔内治疗后的患者使用罂粟碱,有效改善患者血流动力学参数,患者治疗总有效率显著提高。此方法的安全性和有效性得到了临床验证,值得推广应用。

Objective The patients with lower extremity arteriosclerosis occlusion were treated with papaverine,and their clinical effects were observed and analyzed.Methods Eighty-three patients with lower extremity arteriosclerosis obstruction admitted to our hospital from January 2017 to January 2019 were randomly divided into two groups.In the control group,41 patients underwent endovascular treatment for revascularization,including 26 male patients and 15 female patients,aged 26-73 years,mean age(60.3±8.5)years,duration of disease(11.7±6.2)months;42 patients in the observation group,On the basis of intravascular treatment of vascular remodeling,papaverine was administered to 25 male patients and 17 female patients,aged 28-76 years,mean age(62.4±8.7)years,and duration of disease(12.1±6.7)months.The localized lesions near the joints and the infra-knee arterial lesions were treated with simple balloon plasty;for long aortic and superficial femoral artery lesions,severe arteriosclerosis or calcification and occlusive lesions,one-stage stent implantation was performed.Papaverine 30 mg was injected intramuscularly or intravenously through a micropump.The injection time was not less than 30 min.It was injected 3 times a day for 2 weeks.Results In the observation group,25 cases were markedly effective,16 cases were effective,1 case was ineffective,and the total effective rate was 97.6%.In the control group,23 cases were markedly effective,13 cases were effective,5 cases were ineffective,and the total effective rate was 87.8%.The difference between the two groups was statistically significant.Academic significance(P<0.05).In the observation group,the hospitalization time was shortened and the recurrence rate was decreased.Compared with the control group,the difference was statistically significant(P<0.05).Conclusion Lower extremity arteriosclerosis occlusion cavity treatment has a high success rate and little damage to patients.It has become the first choice for treatment.However,the consolidation of the therapeutic effect after treatment is affected by many factors.If it cannot be intervened in time,it may cause stenosis and occlusion of the blood vessel.Papaverine is a short-acting inhibitor of phosphodiesterase,which can increase the production of cGMP in vascular smooth muscle cells and reduce the concentration of calcium ions,thereby causing vasodilation.In this study,patients treated with papaverine after intraluminal treatment effectively improved the patient’s hemodynamic parameters,and the patient’s total treatment efficiency was significantly improved.The safety and effectiveness of this method have been clinically verified,and it is worthy of popularization and application.