心房颤动继发下肢动脉栓塞的急诊血管内介入治疗

Emergent endovascular intervention treatment for lower extremity arterial embolism secondary to atrial fibrillation

目的探讨机械性血栓抽吸术与导管取栓术对心房颤动继发下肢动脉栓塞的治疗效果。方法收集2021年2月至2023年10月首都医科大学宣武医院收治的186例急诊心房颤动继发下肢动脉栓塞患者的临床资料,按照手术方法的不同将其分为抽吸组(n=89)和取栓组(n=97),比较两组患者术后即刻复查造影的血管再通率、Cooley标准痊愈率、踝臂指数、患者自觉疼痛视觉评分、并发症发生率等。结果两组患者发病至穿刺时间、栓塞部位、术前踝臂指数比较,差异均无统计学意义(P﹥0.05)。抽吸组患者手术时间明显短于取栓组患者,术中出血量明显大于取栓组患者,差异均有统计学意义(P﹤0.01)。术后即刻复查造影的血管再通率为100%(186/186),术后Cooley痊愈率为91.94%(171/186),其中,抽吸组患者Cooley痊愈率为91.01%(81/89),与取栓组患者的92.78%(90/97)比较,差异无统计学意义(P﹥0.05)。取栓组患者术后即刻自觉疼痛视觉评分低于抽吸组患者,出院前踝臂指数高于抽吸组患者,差异均有统计学意义(P﹤0.05)。住院期间共发生21例并发症,其中,抽吸组患者并发症发生率为10.11%(9/89),与取栓组患者的13.40%(13/97)比较,差异无统计学意义(P﹥0.05),所有并发症经对症处理后均可好转。结论机械性血栓抽吸术和导管取栓术均可安全、有效治疗心房颤动继发下肢动脉栓塞,各有优缺点,在临床实践中可根据患者的实际病情进行选择。

Objective To investigate the effect of emergent mechanical thrombus aspiration and catheterization in the treatment of lower extremity arterial embolization secondary to atrial fibrillation.Method Clinical data of 186 patients with lower extremity arterial embolism secondary to atrial fibrillation admitted to Xuanwu Hospital,Capital Medical University from February 2021 to October 2023 were collected.According to different surgical methods,they were divided into aspiration group(n=89)and thrombectomy group(n=97).Vascular revascularization rate,Cooley standard recovery rate,ankle-brachial index,visual score of perceived pain and complication rate were compared between the two groups.Result There were no significant differences between the onset and puncture time,embolization site and preoperative ankle-brachial index between the two groups(P>0.05).The operative time in the aspiration group was significantly shorter than that in the thrombectomy group,and the amount of intraoperative blood loss was significantly higher than that in the thrombectomy group,with statistical significance(P<0.01).The vascular revascularization rate of immediately after surgery was 100%(186/186),and the Cooley recovery rate after surgery was 91.94%(171/186),among them,the Cooley recovery rate of patients in the aspiration group was 91.01%(81/89),compared with 92.78%(90/97)of patients in the thrombectomy group,the difference was not statistically significant(P>0.05).The visual score of postoperative perceived pain in thrombectomy group was lower than that in aspiration group,and the ankle-brachial index before discharge was higher than that in aspiration group,with statistical significance(P<0.05).A total of 21 cases with complications occurred during hospitalization,among which the incidence of complications in the aspiration group was 10.11%(9/89),compared with 13.40%(13/97)in the thrombectomy group,the difference was not statistically significant(P>0.05),and all complications could be improved after symptomatic treatment.Conclusion Both mechanical thrombus aspiration and catheterization can safely and effectively treat lower extremity arterial embolism secondary to atrial fibrillation.Each has its own advantages and disadvantages.In clinical practice,it can be selected according to the actual condition of patients.