CAJ | 학술논문

目的：探讨急性下肢缺血（ALLI）的临床特点及治疗方法。方法回顾性分析2003年1月至2009年12月收治的ALLI患者的临床资料，根据病因将其分为急性动脉栓塞组（AE组）和急性血栓形成组（AT组），比较两组起病特点和治疗方法的异同，分析影响保肢的因素。结果共收治130例ALLI，其中AE组82例，发病率略高，合并冠心病、风湿性心脏病、房颤者多，起病情况急，症状重，就诊时间多较短；AT组48例，冬季发病率较高，男性较多，平均年龄大，多有吸烟史，就诊时间相对较迟，并且多数有肢体慢性缺血病史。AE组脉搏消失、运动障碍症状出现率较AT组为高（P 值分别为0.001和0.031），其他症状发生率两组之间差别无统计学意义。死亡9例，死亡率6.9%。一期截肢13例，二期截肢8例，总体保肢率为80.70%（88/109），AT组的总体截肢率、一期截肢率和二期截肢率均高于AE组（P值分别为1.0×10-4,4.2×10-3,0.051）。吸烟史、合并糖尿病和起病时间超过24 h是影响保肢的独立危险因素。结论ALLI应当尽早治疗，动脉切开导管取栓是治疗急性动脉栓塞的有效方法，而治疗急性血栓形成应尽可能地完善术前评估，选择合适的综合治疗方案，必要时联合置管溶栓和（或）旁路治疗。
목적：탐토급성하지결혈（ALLI）적림상특점급치료방법。방법회고성분석2003년1월지2009년12월수치적ALLI환자적림상자료，근거병인장기분위급성동맥전새조（AE조）화급성혈전형성조（AT조），비교량조기병특점화치료방법적이동，분석영향보지적인소。결과공수치130례ALLI，기중AE조82례，발병솔략고，합병관심병、풍습성심장병、방전자다，기병정황급，증상중，취진시간다교단；AT조48례，동계발병솔교고，남성교다，평균년령대，다유흡연사，취진시간상대교지，병차다수유지체만성결혈병사。AE조맥박소실、운동장애증상출현솔교AT조위고（P 치분별위0.001화0.031），기타증상발생솔량조지간차별무통계학의의。사망9례，사망솔6.9%。일기절지13례，이기절지8례，총체보지솔위80.70%（88/109），AT조적총체절지솔、일기절지솔화이기절지솔균고우AE조（P치분별위1.0×10-4,4.2×10-3,0.051）。흡연사、합병당뇨병화기병시간초과24 h시영향보지적독립위험인소。결론ALLI응당진조치료，동맥절개도관취전시치료급성동맥전새적유효방법，이치료급성혈전형성응진가능지완선술전평고，선택합괄적종합치료방안，필요시연합치관용전화（혹）방로치료。
Objective To investigate the clinical features and treatment of acute lower limb ischemia. Methods A retrospective analysis was carried out of patients who were admitted and treated for ALLI from January 2003 to December 2009. Results 82 cases of acute arterial embolism and 48 cases of acute thrombosis were studied. Clinical features:The overall incidence and co-incidence of CHD and AF was higher in the embolization group, and the patients in this group were treated earlier. In the acute thrombosis group:winter incidence was higher;men and smoking history were majority, older in average, and later for treatment. A systemic thrombolysis and anticoagulation therapy was taken in 12 cases and 9 patients undertook catheter thrombolysis. Fogarty catheter embolectomy procedures were performed in 81 cases, and 15 patients received immediate graft by-pass after the removal of thrombosis. An amputation was the first choice in 13 patients, and 8 patients underwent amputation of the second phase. A total of 27 patients underwent open decompression of compartment. Overall amputation rate was 16.15%; hospital mortality rate was 6.9%. Smoking, diabetes and onset time were independent risk factors for limb preservation. Conclusions ALLI should be treated as early as possible. Fogarty catheter embolectomy is effective for the acute arterial embolism. Preoperative assessment is important for acute arterial thrombosis and thrombolysis and/or graft by-pass should be used if necessary.