急性肢体动脉栓塞患者的外科诊治及预后分析

目的 探讨急性肢体动脉栓塞的诊治要点及影响预后的因素.方法 回顾性分析1998年1月至2008年10月中国医科大学附属第一医院收治的346例急性肢体动脉栓塞患者的临床资料,采用Logistic回归 模型分析年龄、性别、肢体(上肢、下肢)、栓塞部位、缺血时间、缺血程度、治疗方式、术后并发症等因素对预后的影响.结果 男210例,女136例,年龄13 ～98岁,平均年龄(63±14)岁.上肢动脉栓塞56例,下肢290例;心源性栓子301例,血管源性33例,原因不明12例;发病至就诊时间为1h～7d,其中＞8h的302例,≤8 h的44例;缺血分级Ⅰ级17例,ⅡA级69例,ⅡB级221例,Ⅲ级39例.Fogarty导管取栓280例,介入溶栓19例,保守治疗47例;成功保肢289例(83.53％),截肢44例(12.72％),围于术期死亡13例(3.76％).随防5年,38例复发动脉栓塞,33例死亡,主要死亡原因为脑梗死、肢体坏疽及心肌梗死.Logistic回归分析表明:缺血时间、缺血分级、治疗方式及术后并发症对预后均有显著影响(均P ＜0.05),而年龄、性别、肢体、栓塞部位对预后均无显著影响(均P＞0.05).结论 急性动脉栓塞经积极外科治疗可获得良好疗效.缺血时间、缺血分级、治疗方式、术后并发症对预后有显著影响,有效抗凝等系统内科治疗对防止动脉栓塞复发非常重要.

Management and prognosis of acute arterial embolism: a multivariable analysis of 346 patients

Objective To evaluate the management of acute arterial embolism (AAE) and its prognostic factors.Methods The clinical data of 346 AAE patients treated at our hospital between January 1998 and October 2008 were retrospectively reviewed.The prognostic factors,including age,gender,extremities,location of embolism,ischemic duration,ischemic categories,and therapeutic methods,postoperative complications were evaluated by multivariate Logistic regression analysis.Results There were 210 males and 136 females with a mean age of (63 ± 14) years old.Fifty-six patients occurred in the upper extremities and 290 patients in the lower extremities.The causes included cardiogenic embolism (n =301 ),vasogenic embolism ( n =33 ) and unknown origin ( n =12 ).The duration of ischemia ranged from 1 h to 7 d.Only 44 patients were admitted ≤8 h and the remainder ＞ 8 h.The categories of extremity ischemia were level Ⅰ (n=17),level ⅡA (n=69),level Ⅱb (n=221) and level Ⅲ (n=39).The procedures included embolectomy ( n =280 ),interventional thrombolysis ( n =19 ) and conservative treatment ( n =47).Thirteen patients (3.76％) died of complications during the perioperative periods.And 44(12.72％ ) underwent amputations and 289 (83.53％) had excellent clinical outcome with extremity salvage.During a 5-year follow-up period,38 patients had a recurrent embolism.The Logistic regression analysis showed that ischemic duration,ischemic category,therapeutic methods and complications had significant prognostic influences (all P ＜0.05 ).And other factors such as age,gender,extremities and the location of embolism had insignificant influences (all P ＞ 0.05 ).Conclusion Embolectomy is the firstchoice therapy for AAE with an excellent outcome.Ischemic duration,ischemic grading,surgical treatment and complications have significant prognostic influences.Systematic medical treatments,such as effective anticoagulation,are vital in the prevention of recurrent AAE.