本文關(guān)鍵詞： 下肢缺血 動脈硬化 閉塞性 腔內(nèi)治療 切開取栓 術(shù)后 死亡　出處：《安徽醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的通過分析患者的臨床資料(包括手術(shù)方式、伴隨疾病、病史、相關(guān)檢查結(jié)果),探討影響急慢性下肢缺血患者缺血再通治療的圍手術(shù)期死亡相關(guān)因素。方法收集安徽醫(yī)科大學第一附屬醫(yī)院血管外科2011年1月至2016年9月住院手術(shù)治療的249例下肢急慢性缺血患者中11例死亡患者的臨床資料,內(nèi)容包括病案號、性別、年齡、發(fā)病到就診時間、并存疾病、血液檢查指標、踝肱指數(shù)、Rutherford缺血分級、手術(shù)治療方式。將上述資料與同期接受手術(shù)治療的生存組相比較,采用單因素分析,分析影響圍手術(shù)期死亡的相關(guān)因素。結(jié)果249例術(shù)后病例中11例死亡患者,動脈硬化閉塞癥(Arteriosclerosis occlusion,ASO)行血管腔內(nèi)治療5例,包括支架置入后置管溶栓6小時1例,動脈切開取栓6例,其中行雙側(cè)股動脈切開取栓2例,單側(cè)股動脈切開取栓4例;死亡原因:心功能衰竭4例;多臟器功能衰竭3例;急性心肌梗塞2例;腦梗塞1例;腎功能衰竭1例;心功能衰竭與多臟器功能衰竭死亡占63.6%(7/11)。手術(shù)死亡率4.4%(11/249),其中急性肢體缺血行動脈切開取栓死亡率8.9%(6/67),慢性肢體缺血行血管腔內(nèi)治療死亡率2.8%(5/180)。死亡的單因素統(tǒng)計分析結(jié)果顯示:嚴重下肢缺血(Critical Limb Ischemia CLI)、合并心臟疾病、合并慢性腎功能不全、高血壓、貧血、低蛋白血癥死亡率分別較無上述合并癥的死亡率高,單因素分析顯示差異均有統(tǒng)計學意義(P0.05),是圍手術(shù)其死亡的的相關(guān)危險因素。缺血再灌注損傷對下肢缺血再通患者的圍手術(shù)期死亡有一定的影響。結(jié)論1.影響下肢缺血患者圍手術(shù)期死亡的獨立危險因素是CLI、CK、LDH、貧血、COPD、高血壓病、低白蛋白血癥及心臟疾病,死亡原因與影響因素及重要臟器功能密切相關(guān);2.3.缺血再灌注損傷對下肢缺血手術(shù)患者的圍手術(shù)期死亡有一定的影響;
[Abstract]:Objective to analyze the clinical data of the patients (including surgical methods, concomitant diseases, medical history, etc.). To explore the factors related to perioperative death in patients with acute and chronic ischemia of lower extremity. Methods the hospital hands were collected from January 2011 to September 2016 in the vascular surgery department of the first affiliated hospital of Anhui Medical University. Clinical data of 11 cases of death in 249 patients with acute and chronic ischemia of lower extremities treated by surgery. The contents included medical record number, sex, age, time from onset to visit, co-existing diseases, blood examination, ankle brachial index Rutherford ischemic grading, and surgical treatment. The above data were compared with the survival group undergoing surgical treatment at the same time. Results among the 249 postoperative patients, 11 patients died, 5 patients with Arteriosclerosis occlusion ASO were treated with endovascular therapy, including 1 patient who received stent placement for 6 hours after placement of the stent for thrombolytic therapy, and 11 patients who died after the operation, and 5 patients with arteriosclerosis obliterans (Arteriosclerosis obliterans) received endovascular treatment, including 6 hours of thrombolytic therapy with stent implantation. Among them, 2 cases received bilateral femoral artery thrombectomy and 4 cases unilateral femoral artery thrombectomy. The causes of death were heart failure in 4 cases, multiple organ failure in 3 cases, acute myocardial infarction in 2 cases, cerebral infarction in 1 case, acute myocardial infarction in 2 cases, cerebral infarction in 1 case, cardiac failure in 4 cases, multiple organ failure in 3 cases, acute myocardial infarction in 2 cases, cerebral infarction in 1 case. Renal failure in 1 case; Death rate of cardiac function failure and multiple organ failure accounted for 63.6% / 110.Surgical mortality was 4.4%. Among them, the mortality rate of acute limb ischemia with arterial thrombectomy was 8.9%, and that of chronic limb ischemia with endovascular therapy was 2.8% 5180%. The single factor statistical analysis of death was concluded. The results showed that severe lower extremity ischemia, critical Limb Ischemia CLI, combined with heart disease, The mortality rates of chronic renal insufficiency, hypertension, anemia and hypoproteinemia were higher than those without these complications. Univariate analysis showed that the difference was statistically significant (P 0.05), which was the risk factor of perioperative death. Ischemia-reperfusion injury had a certain effect on perioperative mortality of patients with lower extremity ischemia reperfusion. Conclusion 1. The independent risk factors for perioperative death in ischemic patients were CLI CKD LDH, anemia, and hypertension. Hypoalbuminemia and heart disease, the cause of death is closely related to the influencing factors and important organ function. Ischemia-reperfusion injury has a certain effect on perioperative death of patients with lower extremity ischemia surgery.
【學位授予單位】：安徽醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R654.4

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