老年人重症肢体缺血治疗经验总结.docVIP

老年人重症肢体缺血治疗经验总结【摘要】目的 探讨不同治疗方法对老年人重症肢体缺血(CLI)的疗效。方法 回顾性分析2003年1月至2006年12月采用不同方法治疗的141例65岁以上病人CLI的临床资料。结果 113例得到随访,平均62个月,动脉旁路术75例,其1、3、5年通畅率及保肢率分别为67%、51%、49%及84.1%、76.1%、73.8%;介入治疗15例,其1、3、5年通畅率及保肢率分别是73.3%、60%、53.3%及86.6%,73.3%、66.7%;联合治疗7例,其1、3、5年分别有5、4、4例保持通畅;自体骨髓干细胞移植有效率81.3%(13/16)。结论 老年人周围动脉病变复杂,合并症多,针对老年人CLI的临床特征综合制定治疗方案是理想选择 【关键词】老年人动脉闭塞性疾病重症肢体缺血回顾性研究 【中图分类号】R246.5 【文献标识码】A 【文章编号】1004-7484(2010)09-00-02 Overview of the Treatment for Critical Limb Ischemia in the Aged 【Abstract】Objective:To explore the efficacy of different treatment for Critical Limb Ischemia(CLI) in the aged. Methods: The data of 141 cases aged≥65ys,underwent different therapeutics from January 2003 to december 2006, were retrospectively reviewed. Results: 113 cases were followed up,averaged 62 months. Patency rate and limb salvage rate of bypass were 67%、51%、49% and 84.1%,76.1%,73.8% at 1-, 3- and five-year respectively;Patency rate and limb salvage rate of intervention were 73.3%、60%、53.3% and 86.6%、73.3%、66.7% at 1-, 3- and five-year respectively; Therapeutic alliance of 7 cases have 5 cases at one year, 4 cases at three years and five years keeping patent respectively. Effective power of autologous bone marrow stem cells transplantation is 81.3%.Conclusion: The aged have more complications and complex peripheral arterial disease. Comprehensive Therapeutics should be made according to different clinical characters of the aged with CLI. 【Keywords】The aged; Arterial occlusive disease; Critical limb ischemia;Retrospective study 动脉硬化闭塞症(arteriosclerosis obliterans,ASO)是全身性动脉硬化在肢体局部的表现,是重症肢体缺血(critical limb ischemia ,CLI)的主要原因。ASO是老年性疾病,发病率随年龄增大而增加,65岁以上男性约10%,75岁以上约20%,且截肢率及病死率高,故如何提高CLI的疗效已成研究重点。本文收集了自2003年1月至2006年12月65岁以上老年病人141例154条患肢的临床资料,报告如下 1 临床资料及方法 1.1一般资料 本组141例病人中男110例、女31例,男女比例3.5:1,年龄65～98岁,平均73±11岁;病程9个月～20年,平均(7.5±3)年。左下肢68例,右下肢53例,双下肢13例,左上肢4例,右上肢3例。Fontaine分期: Ⅱ期9例(6.4%),Ⅲ期98例(69.5%),Ⅳ期34例(24.1%)。吸烟史76例,糖尿病47例,高血压病89例,冠心病37例,脑梗塞43例,高脂血症37例。术前经患肢动脉彩色