伤口呈色显影用于预测重症肢体缺血患者血管腔内治疗后溃疡愈合的价值初探

目的 探讨伤口呈色显影预测重症肢体缺血患者血运重建术后溃疡愈合的价值.方法 回顾性分析上海交通大学医学院附属仁济医院血管外科2011年6月1日-2014年6月30日收治成功实施Angiosome概念指导腔内血运重建的重症肢体缺血的缺血性溃疡患者临床资料.根据血管腔内血运重建术后伤口呈色显影情况分组,其中伤口呈色(+)组109例,伤口呈色(-)组64例,分别比较患者保肢率,溃疡愈合时间的差异,试分析其作为重症肢体缺血的缺血性溃疡愈合预测因子的价值.采用SPSS 19.0软件进行统计学分析.正态分布计量资料以均数±标准差(x±s)表示,两组比较采用t检验.计数资料以频数和百分比表示,两组比较采用Pearson x2检验或Fisher确切概率法.结果 纳入研究患者共173例(173条患肢),两组患者年龄、性别比例、吸烟史、冠心病、糖尿病、慢性肾功能不全、术前踝肱指数、术后踝肱指数差异均无统计学意义,溃疡愈合时间:伤口呈色(+)组(3.9±1.9)个月低于伤口呈色(-)组(7.9±2.6)个月,差异有统计学意义(P＜0.05).累积保肢率:伤口呈色(+)组(90.2％)高于伤口呈色(-)组(78.0％),差异有统计学意义(P＜0.05).通过Logistic回归分析,校正年龄、性别、吸烟史、高血压异常等因素后,伤口呈色(-)(OR=4.5,P＜0.05)、IRc(间接血供有侧支)血运重建(OR =2.6,P＜0.05)均是溃疡难愈合的独立危险因素.结论 伤口呈色显影阳性显示足部循环较好,可以作为重症肢体缺血的缺血性溃疡愈合的预测因子,而伤口呈色显影阴性是溃疡难愈合的独立危险因素.

Value of wound blush in predicting ulcer healing in patients with critical limb ischemia after endovascular revascularization

Objective To explore the value of wound blush in predicting patients' ulcer healing whom with critical limb ischemia after revascularization.Methods Retrospectively analyze the clinical data of 173 cases of critical limb ischemia with ischemic ulcers under thetreatment of endovascular therapy followed the concept of angiosome.According to the condition of wound blush after endovascular therapy,by compared the difference of limb salvage rate and ulcer healing time,and try to analyze the value of wound blush in predicting ulcer healing in patients.Results Included in the study with a total of 173 cases (173 limbs),group wound blush(+) 109 patients,group wound blush (-) 64 cases,the age,proportion of male patients,smoking history,diabetes,coronary heart disease,chronic renal insufficiency,pre and post operative ankle brachial index,were no statistical difference between the two groups.The ulcer healing time of group wound blush (+) was significantly shorter than that of group wound blush(-) (P ＜ 0.05).The rate of ulcer healing in group wound blush(+) was significantly higher than that in group wound blush(-) (P ＜ 0.05).In group wound blush(+),the cumulative rate of limb salvage was statisticallyhigher than group wound blush (-) (P ＜ 0.05).By logistic regression analysis,wound blush(-) (OR =4.5,P ＜ 0.05),IRc revascularization (OR =2.6,P ＜ 0.05) were independent risk factors of ulcer healing.Conclusions The resoult of wound blush(+) shows a good distal perfusion of foot.It can be used as a predictive factor for critical limb ischemia ischemic ulcer healing,and wound blush (-) was an independent risk factor for ulcer nonhealing.