置管溶栓联合经皮血管成形术治疗下肢动脉硬化闭塞症患者的效果

Effects of catheter thrombolysis combined with percutaneous transluminal angioplasty in treatment of lower extremity arteriosclerosis obliterans

目的:探讨置管溶栓联合经皮血管成形术(PTA)治疗下肢动脉硬化闭塞症(LEASO)患者的效果。方法:选取2020年1月至2022年1月该院收治的60例LEASO患者进行前瞻性研究,采用随机数字表法将患者分为观察组和对照组各30例。对照组接受PTA治疗,观察组在PTA前2 d予以置管溶栓,溶栓药物为尿激酶。比较两组临床疗效,术后血管通畅率,足背动脉血流动力学指标[血管内径、血流量、收缩期峰值流速(SPV)]水平,动脉硬化指标(趾肱指数、踝肱指数)水平,腓总神经运动神经传导速度(MCV)、感觉神经传导速度(SCV),以及并发症发生率。结果:观察组治疗总有效率为93.33%(28/30),高于对照组的73.33%(22/30),差异有统计学意义(P<0.05);观察组术后1周、3个月、6个月时的血管通畅率均高于对照组,差异有统计学意义(P<0.05);治疗7 d后,观察组足背动脉血管内径、SPV及血流量均显著大于对照组,趾肱指数、踝肱指数、MCV、SCV水平均显著高于对照组,差异有统计学意义(P<0.05);两组并发症发生率比较,差异无统计学意义(P>0.05)。结论:置管溶栓联合PTA治疗LEASO患者可提高治疗总有效率和血管通畅率,改善足背动脉血流动力学指标和动脉硬化程度,提高神经传导速度,且安全性良好,效果优于单用PTA治疗。

Objective:To investigate effects of catheter thrombolysis combined with percutaneous transluminal angioplasty(PTA)in treatment of lower extremity arteriosclerosis obliterans(LEASO).Methods:A prospective study was conducted on 60 patients with LEASO admitted to this hospital from January 2020 to January 2022.These patients were divided into observation group and control group by using the random number table method,30 cases in each group.The control group was treated with PTA,while the observation group was treated with catheter thrombolysis 2 days before PTA.Urokinase was used as the thrombolytic drug.The clinical efficacy,the postoperative vascular patency rate,the hemodynamic indicator levels of dorsalis pedis artery[vascular diameter,blood flow,peak systolic velocity(SPV)],the arteriosclerosis index levels(toe brachial index,ankle brachial index),the common peroneal nerve motor nerve conduction velocity(MCV),the sensory nerve conduction velocity(SCV),and the incidence of complications were compared between the two groups.Results:The total effective rate of the observation group was 93.33%(28/30),which was higher than 73.33%(22/30)of the control group,and the difference was statistically significant(P<0.05).The vascular patency rates of the observation group were higher than those of the control group 1 week,3 months and 6 months after the surgery,and the differences were statistically significant(P<0.05).After 7 days of treatment,the dorsal artery diameter,SPV and blood flow of the observation group were significantly higher than those of the control group,the levels of toe brachial index,ankle brachial index,MCV and SCV were significantly higher than those of the control group,and the differences were statistically significant(P<0.05).However,there was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusions:Catheter thrombolysis combined with PTA in the treatment of the LEASO patients can improve the total effective rate and the vascular patency rate,improve the hemodynamic indicator levels of dorsalis pedis artery and the degree of arteriosclerosis,and improve the nerve conduction velocity with good safety.Moreover,it is superior to single PTA.