何景良 梁志会 李亮

[摘要] 目的 探討介入治疗急性下肢动脉栓塞的临床效果。 方法 选择2016年6月～2017年6月解放军白求恩国际和平医院诊治的急性下肢动脉栓塞60例，按照治疗方式的不同分为两组，其中对照组30例行大腔导管抽吸血栓治疗，实验组30例行大腔导管抽吸血栓+置管溶栓治疗。比较两组治疗效果和两组患者凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、纤维蛋白原（FIB）及D-二聚体（D-D）水平，观察两组患者的复发率及截肢率。 结果 治疗后，实验组总有效率明显高于对照组，差异有统计学意义（P < 0.05）。治疗后，两组APTT及PT水平均高于治疗前，且实验组显著高于对照组，差异有统计学意义（P < 0.05）；两组FIB、D-D水平均明显低于治疗前，且实验组明显低于对照组，差异有统计学意义（P < 0.05）。治疗后，实验组栓塞复发发生率低于对照组，差异有统计学意义（P < 0.05），两组截肢率比较差异无统计学意义（P > 0.05）。 结论 临床中对急性下肢动脉栓塞患者应用大腔导管抽吸血栓+置管溶栓治疗效果显著，且并发症少，临床效果优于单纯应用大腔导管抽吸血栓治疗，可进行推广。

[关键词] 急性下肢动脉栓塞；介入治疗；大腔导管抽吸血栓；置管溶栓

[中图分类号] R654.4 [文献标识码] A [文章编号] 1673-7210（2018）09（a）-0071-04

[Abstract] Objective To investigate the clinical efficacy of interventional therapy for acute lower extremity arterial embolism. Methods From June 2016 to June 2017， in PLA Bethune International Peace Hospital， 60 patients with acute arterial embolism of lower extremity were selected， according to the treatment methods， they were divided into two groups， 30 cases in the control group were treated with large cavity catheter sucking thrombus， and 30 cases in the experiment group were treated with large cavity catheter sucking thrombolytic thrombolysis plus catheter thrombolytic therapy. The treatment effect， prothrombin time （PT）， activated partial thromboplastin time （APTT）， fibrinogen （FIB） and D-Dimer （D-D） level of the two groups were compared， and the recurrence rate and amputation rate of the two groups were observed. Results After treatment， the total effective rate of experiment group was significantly higher than that of control group， the difference was statistically significant （P < 0.05）. After treatment， the levels of APTT and PT in the two groups were higher than those before treatment， and those in the experiment group were significantly higher than those of control group， the differences were statistically significant （P < 0.05）， and the levels of FIB and D-D in the two groups were significantly lower than those before treatment， and those in the experiment group were significantly lower than those of control group， the differences were statistically significant （P < 0.05）. After treatment， the incidence of embolic recurrence in the experiment group was lower than that of control group， the difference was statistically significant （P < 0.05）. There was no significant difference in amputation rate between the experiment group and control group （P > 0.05）. Conclusion The clinical effect of large cavity catheter suction thrombolysis plus catheter thrombolysis for patients with acute lower extremity arterial embolization is remarkable， and the complications are few， the clinical effect is better than that of the simple use of large cavity catheter suction thrombolytic therapy， and it can be popularized.

[Key words] Acute lower extremity arterial embolism； Interventional therapy； Large lumen catheter thrombus embolism； Catheter thrombolysis

急性下肢动脉栓塞是导致患者截肢的一个重要病因，该病的发病机制为：患者心脏或动脉血管中的栓子发生脱落进而导致血栓形成，或斑块阻塞血管，引起动脉栓塞，导致患肢循环障碍，引发缺血性疾病[1]。该病可导致患者患肢功能异常，造成不可逆的损伤，严重者可造成截肢或死亡[2]。对于急性下肢动脉栓塞，及时、快速、有效的治疗是改善患者预后的关键。大腔导管抽吸血栓是常用的治疗方法，但单独使用容易复发，且复通效果有限。本研究选择急性下肢动脉栓塞患者采取大腔导管抽吸血……