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目的探讨急性外周动脉闭塞行血管内溶栓治疗的价值、方法及影响因素。方法22例患者,男17例、女5例,年龄31-75岁,平均43.8岁。均经血管造影证实动脉闭塞,病变涉及动脉24段;病程时间2～480小时(平均122.5小时);病变长度3～65cm(平均30.5cm)。22例均行血管内溶栓治疗,尿激酶用量为50～300万单位(平均127万单位),2例尚行经皮穿血管内成形术(PTA)治疗。结果溶栓治疗后,18例血管复通,4例溶栓失败;复通率为81.8%(18/22),包括完全复通8例(44.4%,8/18)和部分复通10例(55.6%,10/18)。行PTA治疗的2例,狭窄血管直径分别由0.2cm扩为0.5cm和由0.2cm扩为0.4cm。18例的症状和体征明显改善,未见严重副反应和并发症。结论血管内溶栓是急性外周动脉闭塞首选的治疗方法。必要时可结合PTA治疗。
Objective To investigate the value, method and influencing factors of intravascular thrombolysis in patients with acute peripheral arterial occlusive disease. Methods Twenty-two patients, 17 males and 5 females, aged 31-75 years, with an average of 43.8 years old. Arterial occlusion was confirmed by angiography. The lesions involved 24 segments of arteries. The duration of the disease ranged from 2 to 480 hours (mean 122.5 hours). The length of the lesions varied from 3 to 65 cm (an average of 30.5 cm). Twenty-two patients underwent endovascular thrombolysis. The dose of urokinase was 50-3 million units (average 1.27 million units), and 2 cases were treated with percutaneous transluminal angioplasty (PTA). Results After thrombolysis, 18 cases of vascular recanalization and 4 cases of thrombolysis failed. The rate of recombination was 81.8% (18/22), including 8 cases (44.4%, 8/18) of complete recanalization and 10 cases of partial recanalization (55.6%, 10/18). In 2 cases treated with PTA, the stenotic vessel diameters were expanded from 0.2 cm to 0.5 cm and from 0.2 cm to 0.4 cm, respectively. 18 cases of symptoms and signs improved significantly, no serious side effects and complications. Conclusion Intravascular thrombolysis is the preferred treatment for acute peripheral arterial occlusive disease. When necessary, combined with PTA treatment.