李伟浩?张韬?张学民?李伟?李清乐?焦洋?徐海林

【摘要】目的 探討通塞脉片在糖尿病下肢动脉闭塞患者接受下肢动脉介入术后的治疗效果。方法 收集78例糖尿病下肢动脉闭塞严重肢体缺血患者的临床资料，根据患者术后是否服用通塞脉片分为观察组和对照组，对照组介入术后接受抗血小板药物治疗，观察组在抗血小板药物基础上加用通塞脉片。比较2组临床治疗效果。结果 总体手术成功率94%，观察组和对照组的手术成功率、补救性支架植入率、开通的膝下动脉支数比较差异均无统计学意义（P均> 0.05）。随访6个月时，观察组2例（5%）患者分别死于心肌梗死和脑梗死，对照组1例（3%）患者死于心肌梗死。观察组和对照组的总体保肢率分别为81%和67%，临床症状驱动的靶血管再血管化率分别为17%和14%。2组患者总体保肢率、再血管化率和全因死亡率比较差异均无统计学意义（P均> 0.05）。观察组患者小截肢率低于对照组（14% vs. 33%，P < 0.05）。对术前患者肾功能进行分层分析，肾功能正常患者中观察组的小截肢发生率低于对照组（11% vs. 35%，P < 0.05）。结论 糖尿病下肢动脉闭塞患者接受下肢动脉介入手术效果确切，通塞脉片有助减少患者术后小截肢的风险。

【关键词】通塞脉片;糖尿病;下肢动脉闭塞;介入术;截肢

Therapeutic effect of Tongsaimai tablets in diabetes mellitus patients with  lower extremity arterial occlusion after endovascular revascularization Li Weihao， Zhang Tao， Zhang Xuemin， Li Wei， Li Qingle， Jiao Yang， Xu Hailin. Department of Vascular Surgery， Peking University Peoples Hospital， Beijing 100044， China

Corresponding author， Xu Hailin， E-mail： hailinxu66@ qq. com

【Abstract】Objective To evaluate the therapeutic effect of Tongsaimai tablets in diabete mellitus patients with lower extremity arterial occlusion after endovascular revascularization. Methods Clinical data of 78 diabetes mellitus patients with severe extremity ischemia due to lower extremity arterial occlusion were retrospectively collected. All patients were divided into the control and observation groups according to whether they were administered with Tongsaimai tablets after surgery. In the control group， patients received anti-platelet drugs after intervention， and those in the observation group were given with Tongsaimai tablets on the basis of anti-platelet drugs. The clinical therapeutic effects were statistically compared between two groups. Results The overall surgical success rate was 94%. The surgical success rate， salvage stent implantation rate， and the number of recanalized inferior knee arteries did not significantly differ between two groups （all P > 0.05）. At the follow-up at 6 months after surgery， two patients （5%） in the observation group died of myocardial infarction and cerebral infarction， and one patient （3%）in the control group died of myocardial infarction. The overall limb salvage rates in the observation and control groups were 81% and 67%， and the revascularization rates of target vessels driven by clinical symptoms were 17% and 14%. The overall limb salvage rate， revascularization rate and all-cause mortality did not significantly differ between two groups （all P > 0.05）. However， the rate of minor amputation in the observation group was significantly lower than that in the control group （14% vs. 33%， P < 0.05）. After stratified analysis of preoperative renal function， the rate of minor amputation in the  observation group was significantly lower compared with that in the control group for patients with normal renal function （11% vs. 35%， P < 0.05）. Conclusions Diabetes mellitus patients with lower extremity arterial occlusion can obtain clinical benefits after undergoing lower extremity arterial revascularization. Tongsaimai tablets can help to reduce the risk of minor amputation after surgery.

【Key words】Tongsaimai tablet;Diabetes mellitus;Lower extremity arterial occlusion;

Interventional therapy;Amputation

糖尿病足是糖尿病的严重慢性并发症之一，可导致足部溃疡、感染、缺血和截肢。据报道2019年美国非创伤性下肢截肢病例中，糖尿病足占了75%[1]。我国50岁以上糖尿病患者中，约20%患者合并下肢动脉闭塞[2]。糖尿病合并下肢动脉闭塞是糖尿病足发生缺血溃疡的重要原因之一，但常规内科治疗和传统开放外科手术效果均不理想[3]。近年来，下肢动脉腔内介入手术逐渐成熟，其有效性和安全性得到越来越多的研究证据支持，成为大多下肢动脉闭塞患者的首选治疗方式[4]。但介入术……