溶栓并腔内介入治疗2型糖尿病合并下肢动脉血栓形成的临床分析

目的回顾性分析2型糖尿病合并下肢动脉血栓形成患者的临床特点与溶栓并腔内治疗的效果。方法选取2008年1月至2012年12月在解放军第三○六医院采用腔内介入治疗的糖尿病合并急性下肢动脉血栓形成患者46例为研究对象，其中男8例，女38例，平均年龄（68±16）岁，急性下肢缺血病程平均（7±4）d，平均糖尿病病程（8±6）年。根据下肢动脉血栓部位与腹股沟韧带关系，将患者分为中央型（8例）、周围型（22例）及混合型（16例）共3组，分析患者相关临床资料，比较组间导管溶栓治疗的差异，并观察治疗前后踝肱指数（ABI）的变化。多组问比较采用单因素方差分析，两两比较采用Student．Newman—Keuls检验。结果周围型血栓患者导管溶栓尿激酶用量明显小于中央型和混合型患者分别为（280±40）、（350±60）、（360±40）万U，F=184．47，P〈0．05]，周围型血栓患者溶栓持续时间明显小于中央型和混合型患者分别为（52±12）、（76±20）、（72±14）h，F=1203．39，P〈0．05]；而中央型与混合型患者之间上述指标均无明显差异（均P〉0．05）。所有患者溶栓后的残余狭窄均予以腔内介入治疗。治疗完成后踝肱指数（ABI）较术前明显升高分别为（0．31±0．15）、（0．95±0．31），t=15．312，P〈0．05]。结论对于2型糖尿病合并急性下肢动脉血栓形成患者，血栓范围越广，导管溶栓药量越大，溶栓周期越长；导管溶栓结合腔内治疗的疗效满意。

Clinical analysis of catheter directed thrombolysis combined with endovascular intervention for lower extremity artery thrombosis in type 2 diabetes patients

Objective To investigate the clinical features of the lower extremity artery thrombosis in the type 2 diabetes patients and to evaluate the effect of the catheter directed thrombolysis combined with endovascular intervention. Method A total of 46 type 2 diabetes patients with acute lower extremity artery thrombosis who were performed the catheter directed thrombolysis and the endovascular intervention in the PLA 306th Hospital during the period from January, 2008 to December, 2012 were enrolled in the study. The subjects consisted of 8 males and 38 females aged （68 ± 16） years old with the diabetes duration of （8 ±6） years and the acute limb ischemia duration of （7 ± 4 ） days. The subjects were divided into three groups according to the location of the lower extremity artery thrombosis relative to the inguinal ligament. , which were the central group （8 cases）, the peripheral group （22 cases） and the mixed group （16 cases）. The treatment process of the catheter directed thrombolysis was compared among the groups and the anke brachial index （ABI） was monitored before and after the treatment. Single factor variance analysis was used for multi-group comparison, and Student-Newman-Keuls test was used for comparison between two groups. Results The needed dosage of urokinase was less in the peripheral group than those in the central and mixed groups （ （280 ± 40）, （350 ± 60）, （360 ± 40） x 104 U, respectively, F = 184.47, P 〈 0.05 ）. The required time for thrombolysis treatment was also less in the peripheral group than in the central and mixed groups （ （52 ± 12）, （76 ± 20）, （ 72 ± 14 ） h, respectively, F = 1203.39, P 〈 0.05 ）. Between the central group and the mixed group, no statistical difference was observed in the needed urokinase dosage or the required thrombolysis time （ P 〉 0.05 ）. After the catheter directed thrombolysis, all residual stenoses were treated with the endovascular intervention. The ABI was significantly increased by the endovaseular intervention from （0.31-± 0.15） to （0.95± 0.31 ）. Conclusions More extensive the thrombosis, much higher dosage of catheter thrombolytic drug and longer treatment time are required. The catheter directedthrombolysis combined with endovascular intervention is a safe and effective treatment to acute lower extremity artery thrombosis in type 2 diabetes patients.