持续血管腔内肝素灌注治疗老年急性下肢缺血的效果分析

Efficacy of continuous intravascular heparin infusion for acute lower extremity ischemia in the elderly patients

摘要:

目的 评价持续血管腔内肝素灌注疗法对老年急性下肢缺血(ALI)患者的安全性及效果。方法 入选2015年7月至2017年2月陆军总医院血管外科ALI接受腔内治疗的老年患者67例。按手术方式将患者分为标准导管溶栓组(对照组,n=35)和持续腔内肝素输注组(肝素组,n=32)。对照组患者应用尿激酶以100万IU/d持续导管内泵入,且皮下应用低分子肝素100 IU/(kg·12 h),肝素组患者应用肝素以18 U/(kg·h)泵入。术后随访患者30 d、3个月及1年。记录2组患者一般资料、缺血严重程度分级、踝肱指数(ABI)、术中持续治疗时间、完全血栓溶解例数、并发症,并进行组间比较。采用SPSS 23.0软件对数据进行统计分析。根据数据类型,组间比较采用t检验或χ²检验。结果 2组患者一般资料及缺血严重程度分级差异均无统计学意义(P＞0.05)。与对照组比较,肝素组患者持续治疗时间显著增加[(53.24±10.49) vs(35.67±9.25)min,P=0.010],大出血率[0.0%(0/32) vs 11.4%(4/35),P=0.001]显著下降。治疗后,2组完全血栓溶解率、ABI增加值、心血管事件发生率、30 d截肢率、30 d死亡率、随访1年免于截肢率比较,差异无统计学意义(P＞0.05)。结论 持续血管腔内肝素输注治疗可以获得良好的近期效果,大出血率明显降低,是高出血风险ALI老年患者微创治疗的一种安全、有效的方法。

Abstract:

Objective To evaluate the safety and efficacy of continuous intravascular heparin infusion for acute lower extremity ischemia (ALI) in the elderly patients. Methods Sixty-seven elderly patients with ALI were enrolled in the study, who received endovascular treatment from July 2015 to February 2017 in PLA Army General Hospital. They were divided into 2 groups, one treated with standard catheter-directed thrombolysis (control group, n=35) and the other with continuous intraventricular heparin perfusion (heparin group, n=32). In the former, urokinase 1 million IU/day was administered via continuous infusion and low molecular heparin with 100 IU/(kg·12 h) hypodermically. In the latter, a continuous infusion heparin was administered at 18 U/(kg·h). Patients were followed up for 30 d, 3 months, and 1 year. Data of the general information, severity of ischemia, ankle brachial index (ABI), duration of the treatment, number of clots dissolved by thrombolysis and complications were recorded, and comparison was made between the 2 groups. SPSS statistics 23.0 was used for data analysis, and t test or Chi-square test for comparison, depending on data type. Results No significant difference was observed in general information and ischemic severity between the 2 groups (P>0.05). Compared with the control group, heparin group had significantly longer duration of continuous treatment [(53.24±10.49) vs (35.67±9.25)min, P=0.010] and lower hemorrhage rate [0.0%(0/32) vs 11.4%(4/35), P=0.001]. There was no significant differences in total thrombolysis rate, improvement in ABI, incidence of cardiovascular events, rate of amputation and mortality within 30 days, and rate of free-amputation at 1 year of follow-up (P＞0.05). Conclusion Continuous intravascular heparin infusion can achieve good short-term effects with significantly reduced hemorrhage rate. It serves as a safe and effective minimally invasive treatment for ALI in the elderly patients with high risk of hemorrhage.