置管溶栓联合腔内介入术治疗下肢动脉硬化闭塞症效果观察

Observation on effect of catheterization thrombolysis combined with intracavitary intervention in treatment of arteriosclerosis obliterans of lower limbs

目的观察置管溶栓联合腔内介入治疗下肢动脉硬化闭塞症(arteriosclerosis obliterans of lower extrem-ity,ASO)的疗效。方法选择郑州大学第一附属医院血管外科2019年1月—2022年12月96例下肢ASO患者为研究对象,按治疗方法不同分为对照组(48例,直接行腔内介入治疗)和研究组(48例,置管溶栓后行腔内介入治疗)。评估两组治疗效果、血管通畅情况,检测足背动脉血流动力学与下肢神经传导速度,统计并发症发生情况,并对上述指标进行比较。结果研究组总有效率93.75%,高于对照组的72.92%(P<0.05);研究组术后7 d、3个月及6个月血管通畅率分别是97.92%、95.83%和93.75%,均高于对照组的85.42%、81.25%和79.17%(P<0.05);术后两组血流量、收缩期峰值流速(SPV)和血管内径均高于术前(P<0.05),但研究组血流量、SPV和血管内径为(0.63±0.13)s·mm^(2)、(45.58±6.71)cm/s和(1.49±0.30)mm,与对照组的(0.66±0.15)s·mm^(2)、(46.51±6.80)cm/s和(1.52±0.33)mm对比差异无统计学意义(P>0.05);术后两组运动神经传导速度(MCV)和感觉神经传导速度(SCV)均高于术前(P<0.05),但研究组MCV和SCV为(47.08±9.03)m/s和(37.17±7.25)m/s,与对照组的(45.61±8.32)m/s和(36.24±7.12)m/s对比差异无统计学意义(P>0.05);研究组并发症总发生率6.25%,低于对照组的8.33%,但差异无统计学意义(P>0.05)。结论下肢ASO采用置管溶栓后行腔内介入术与直接行腔内介入均并发症少,可增加下肢神经传导速度和足背动脉血流量,临床症状改善明显,但置管溶栓后行腔内介入术临床价值更高。

Objective To observe the effect of catheterization thrombolysis combined with intracavitary intervention in the treatment of arteriosclerosis obliterans of lower limbs.Methods A total of 96 patients with ASO in the lower extrem-ity in the Department of Vascular Surgery of our hospital from January 2019 to December 2022 were selected as the study objects,and were divided into control group(48 cases,direct intracavitary intervention)and study group(48 cases,in-tracavitary interventional therapy was performed after thrombolysis)according to different treatment methods.The thera-peutic effect and the vascular patency of the two groups was evaluated,the hemodynamics of the dorsal artery of the foot and the nerve conduction velocity of the lower extremity were detected,and the incidence of complications was statistical-ly analyzed.Results The total effective rate of the study group was 93.75%,which was higher than that of the control group 72.92%(P<0.05).The vascular patency rates of the study group were 97.92%,95.83%and 93.75%at 7d,3 months and 6 months after operation,respectively,which were higher than those of the control group(85.42%,81.25%and 79.17%,P<0.05).Postoperative blood flow,SPV and vascular diameter in both groups were higher than those before surgery(P<0.05),but in the study group,blood flow,SPV and vascular diameter were(0.63±0.13)s·mm^(2),(45.58±6.71)cm/s and(1.49±0.30)mm,compared with the control group,there were no signif-icant differences in(0.66±0.15)s·mm^(2),(46.51±6.80)cm/s and(1.52±0.33)mm(P>0.05).After opera-tion,MCV and SCV in both groups were higher than those before operation(P<0.05),but in the study group,MCV and SCV were(47.08±9.03)m/s and(37.17±7.25)m/s,compared with the control group,the difference was not statistically significant in(45.61±8.32)m/s and(36.24±7.12)m/s(P>0.05).The total incidence of complica-tions in the study group was 6.25%,lower than 8.33%in the control group,but the difference was no statistically sig-nificant(P>0.05).Conclusion Both intracavity intervention and direct intracavity intervention after catheterization of thrombolysis in lower extremity ASO have fewer complications,can increase lower extremity nerve conduction velocity and dorsal foot arterial blood flow,and significantly improve clinical symptoms,but intracavity intervention after cathe-terization of thrombolysis has higher clinical value.