【摘要】：目的:分析評(píng)價(jià)動(dòng)脈內(nèi)經(jīng)導(dǎo)管直接溶栓術(shù)在治療下肢慢性缺血性疾病中的效果及安全性。方法:回顧性總結(jié)2013年3月至2014年11月期間我科對(duì)下肢慢性缺血性疾病行介入治療的36例患者臨床資料。所有的病例均有明顯的慢性缺血病史,出現(xiàn)間歇性跛行或靜息痛時(shí)間為2-20個(gè)月;間歇性跛行距離為20-150米,平均84米。分組情況:先行動(dòng)脈內(nèi)經(jīng)導(dǎo)管直接溶栓、后行經(jīng)皮腔內(nèi)血管成形術(shù)17例;直接行經(jīng)皮腔內(nèi)血管成形術(shù)19例。結(jié)果:先行溶栓組行導(dǎo)管溶栓術(shù)前后狹窄閉塞段血管長(zhǎng)度為[(136.8±22.9)mm,(115.4±17.8)mm,t=11.9,P0.05],溶栓術(shù)后病變血管段長(zhǎng)度明顯縮短。先行溶栓組行導(dǎo)管溶栓術(shù)前后患肢ABI為[(0.26±0.13),(0.32±0.12),t=-0.46,P0.05]。先行溶栓組和直接經(jīng)皮腔內(nèi)血管成形組置入支架數(shù)量為[(1.6±0.8)個(gè),(2.1±0.7)個(gè),t=2.1,P0.05];先行溶栓組和直接經(jīng)皮腔內(nèi)血管成形組置入支架長(zhǎng)度為[(117.6±33.1)mm,(142.1±29.7)mm,t=2.3,P0.05],置入支架數(shù)量和長(zhǎng)度明顯減少。兩組間出現(xiàn)并發(fā)癥情況(先行溶栓組6例,直接經(jīng)皮腔內(nèi)血管成形組5例,P0.05)對(duì)比無統(tǒng)計(jì)學(xué)意義。全部病例得到隨訪12個(gè)月,6個(gè)月、12個(gè)月血管通暢率[(72.7%vs 66.7%)和(70.6%vs 63.2%),P0.05]兩組間對(duì)比無統(tǒng)計(jì)學(xué)意義。結(jié)論:動(dòng)脈內(nèi)經(jīng)導(dǎo)管直接溶栓術(shù)輔助經(jīng)皮腔內(nèi)血管成形術(shù)對(duì)下肢慢性重癥缺血性疾病的治療有很好的效果及安全性,可以有效縮短病變血管長(zhǎng)度,減少支架施放數(shù)量及長(zhǎng)度,減輕患者經(jīng)濟(jì)負(fù)擔(dān)。
[Abstract]:Objective: to evaluate the efficacy and safety of direct catheter thrombolysis in the treatment of lower extremity chronic ischemic diseases. Methods: the clinical data of 36 patients with chronic ischemic disease of lower extremity who were treated with interventional therapy from March 2013 to November 2014 were retrospectively summarized. The duration of intermittent claudication or resting pain was 2-20 months, and the distance of intermittent claudication was 20-150 m, with an average of 84 m. Group: 17 cases received percutaneous transluminal angioplasty and 19 cases received direct percutaneous transluminal angioplasty. Results: in the thrombolytic group, the length of stenosis and occlusion was (136.8 鹵22.9) mm, (115.4 鹵17.8) mm,t=11.9,P0.05 before and after catheter thrombolysis. In the thrombolytic group, the ABI of the affected limb before and after catheter thrombolysis was (0.26 鹵0.13), (, 0.32 鹵0.12); The number of stents in thrombolytic group and direct percutaneous angioplasty group was (1.6 鹵0.8), (2.1 鹵0.7), (2.1 鹵0.7) respectively. The length of stent in thrombolytic group and direct percutaneous angioplasty group [(117.6 鹵33.1) mm, (142.1 鹵29.7) mm,t=2.3,P0.05] was significantly decreased. There was no significant difference in complications between the two groups (6 cases in thrombolytic group and 5 cases in direct percutaneous angioplasty group (P0.05). All patients were followed up for 12 months, 6 months, 12 months, the patency rate of blood vessel [(72.7%vs 66.7%) and (70.6%vs 63.2%), P0.05] there was no significant difference between the two groups. Conclusion: direct transcatheter thrombolysis combined with percutaneous transluminal angioplasty is effective and safe in the treatment of chronic ischemic diseases of the lower extremities. It can effectively shorten the vascular length and reduce the number and length of stent placement. Lighten the patient's economic burden.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R654.4

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