急性周围动脉栓塞预后的多因素分析

目的:评价周围动脉栓塞的预后.方法:回顾分析我院从1990年1月～2002年6月收治的117例149次动脉栓塞的分布情况,以及因栓塞所致的死亡率和截肢率.采用Logistic回归分析栓塞的部位,肢体缺血时间,缺血的程度和范围,手术的方式和手术后的抗凝治疗,是否伴有动脉硬化,是否反复发作等因素对截肢的影响.结果:117例149次急性周围动脉栓塞以下肢发生的频率最高,约占87%,内脏动脉栓塞约占2%,上肢约占10%.全组病例死亡率为11.9%.截肢率为7.8%,肢体救治率92.2%.Logistic回归分析表明,肢体的缺血程度和范围回归系数为3.3412(P＜0.05),说明缺血的程度愈重,截肢的可能性愈大;及时治疗的回归系数为-4.0165(P＜0.05),可降低截肢率.结论:潜在的心脏疾病和栓塞重要脏器是导致死亡的主要原因.单纯的导管取栓术和抗凝治疗是急性动脉栓塞的主要措施.肢体的缺血程度和范围以及栓塞后的及时处理决定肢体动脉栓塞预后.

Multifactorial analysis on prognosis of acute peripheral arterial embolization

Objective:To evaluate the prognosis of acute peripheral arterial embolization.Methods:From Jan 1990 to Jun 2002,117 cases with 149 times of embolization were analyzed retrospectively to determine the distribution,amputation rate and mortality of arterial embolization.Logistic regression was employed to define the role of site,the extent and range of ischemia,ischemic time,treatment modality,with or without atherosclerosis,and recurrent onset on amputation rate of extremities.Results:Approximately 87% of embolization occurred in lower limbs,that occuring in internal organ was about 2% and upper extremities 10%.Among 117 cases,the mortality was 11.9%,amputation rate 7.8% and limb salvage 92.2%.Conclusion:Underlying heart disease and embolization of internal principal organ are the leading causes of death.Single embolectomy and anti-coagulation therapy are the mainstay of treatment for acute embolization.The major prognosis of limbs depended on the extent and range of ischemia and secondary treatment.