药物涂层球囊联合血栓抽吸治疗亚急性下肢动脉栓塞的效果研究.docx

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1、药物涂层球囊联合血栓抽吸治疗亚急性下肢动脉栓塞的效果研究卫飞鹏I王国壮I惠满靖2*1.中国人民解放军空军军医大学第二附属医院介入疼痛科陕西西安7100382.富平县医院介入科陕西富平711700WeiFeipeng1,WangGuozhaung1,HuiManjin2*第一作者：卫飞鹏(1983-02-24)男，硕士，主治医师，主要从事介入放射学方面，邮箱：通讯作者信息：惠满靖(1977-4-12)男，学士，副主任医师，主要从事外周血管与综合介入方面的工作，邮箱：项目名称：陕西省重点研发计划项目项目编号：S2020-YBSF-0042【摘要】目的探讨药物涂层球囊联合血栓抽吸治疗亚急性下肢动脉栓

2、塞的效果。方法选择2018年1月至2022年1月在本院进行治疗的亚急性下肢动脉栓塞患者78例为研究对象，依据随机数表法，分为对照组与研究组，每组39例。对照组接受血栓抽吸治疗，研究组在对照组的基础上接受药物涂层球囊治疗。比较两组术前与术后即刻静脉通畅评分、静脉通畅率、术前与术后即刻、术后6个月股胭动脉最小管腔直径和踝肱指数(ABI)及术前与术后24h、术后2周血管内皮功能包括内皮素(ET-1)、一氧化氮(NO)。结果治疗前，两组静脉通畅评分相比，差异无统计学意义(PX).05);研究组治疗后即刻静脉通畅评分为(2.060.42)分，明显低于对照组的(2.370.60)分，静脉通畅率为(73.3

3、2土9.61)%,明显高于对照组的(62.4110.85)%,差异有统计学意义(PVO.05)；治疗前，两组最小管腔直径、ABl相比，差异无统计学意义(P0.05);治疗后即刻与治疗6个月后，研究组患者的最小管腔直径、ABl分别为(3.500.79)mm、(0.880.14)与(3.25+0.64)mm、(0.870.15。均明显高于对照组的(3.09+0.73)mm、(0.790.12)与(1.580.42)mm、(0.63+0.10),差异有统计学意义(PcO.05)；治疗前，两组ET-KNO水平相比，差异无统计学意义(P0.05);治疗后24h与治疗2周后，研究组患者的ET-I水平分别为

4、(67.237.08)pgmL(65.796.75)pgmL,明显低于对照组的(71.237.52)pg/mL、(70.566.58)pgmL,NO水平为(32624.23)pg/mL、(33.764.41)pgmL,明显高于对照组的(28.484.21)pg/mL、(30.214.72)pgmL,差异有统计学意义(P0.05)。结论药物涂层球囊联合血栓抽吸治疗亚急性下肢动脉栓塞疗效显著，可扩大血管直径，提高踝肱指数，同时可有效减轻血管内皮损伤，值得推广应用。【关键词】下肢动脉栓塞；亚急性；药物涂层球囊；血栓抽吸；疗效；血管内皮功能Effectofdrugcoatedballooncombin

5、edwiththrombusaspirationonsubacutelowerextremityarterialembolism1 .InterventionalPainDepartment,SecondAffiliatedHospitaloftheChinesePeoplesLiberationArmyAirForceMilitaryMedicalUniversity,Xi,an,Shaanxi,7100382.1IiterventionalDepartmentofFupingCountyHospital,ShaanxiFuping711700AbstractJObjectiveToinve

6、stigatetheeffectofdrugcoatedballooncombinedwiththrombusaspirationonsubacutelowerextremityarterialdsAtotalof78patientswithsubacutelowerextremityarterialembolismtreatedinourhospitalfromJanuary2018toJanuary2022wereselectedastheresearchobjects,andweredividedintocontrolgroupandstudygroupaccordingtorandom

7、numbertablemethod,with39casesineachgroup.Thecontrolgroupreceivedthrombusaspirationtreatment,andthestudygroupreceiveddrug-coatedballoontreatmentonthebasisofthecontrolgroup.Thepreoperativeandpostoperativevenouspatencyscores,venouspatencyrate,minimumlumendiameterandankle-brachialindex(ABI)offemoralpopl

8、itealarterybeforeandimmediatelyaftersurgeryand6monthsaftersurgery,andvascularendothelialfunction(includingendothelin-l(ET-I)andnitricoxide(NO)beforeand24haftersurgeryand2weeksaftersurgerywerecomparedbetweenthetwotsThescoreofvenouspatencyinthestudygroupimmediatelyaftertreatmentwas(2.060.42)points,whi

9、chwassignificantlylowerthanthatinthecontrolgroup(2.370.60)points,andthevenouspatencyratewas(73.32+9.61)%,whichwassignificantlyhigherthanthatinthecontrolgroup(62.4110.85)%,thedifferencewerestatisticallysignificant(P0.05);TheminimumlumendiameterandABIofthestudygroupwere(3.500.79)mm,(0.880.14)and(3.250

10、.64)mm,(0.870.15)immediatelyaftertreatmentand6monthsaftertreatment,whichsignificantlyhigherthanthecontrolgroup(3.090.73)mm,(0.790.12)and(1.580.42)mm,(0.630.10),thedifferencewerestatisticallysignificant(P0.05).24haftertreatmentand2weeksaftertreatment,ET-Ilevelsinthestudygroupwere(67.237.08)pg/mLand(6

11、5.796.75)pgmL,whichweresignificantlylowerthanthoseinthecontrolgroup(71.237.52)pg/mLand(70.566.58)pg/mL,thelevelsofNOwere(32.624.23)pg/mLand(33.764.41)pg/mL,whichweresignificantlyhigherthanthoseinthecontrolgroup(28.484.21)pg/mLand(30.214.72)pg/mL,thedifferencewerestatisticallysignificant(P005）,有可比性。1

12、.2 方法对照组接受血栓抽吸治疗，研究组在对照组的基础上接受药物涂层球囊治疗，具体操作如下:（1）血栓抽吸准备：对照组及研究组患者于导尿、消毒、铺巾之后，经利多卡因2%进行局部麻醉，健侧股动脉逆行穿刺并将血管鞘5F置入，猪尾导管5F在腹主动脉造影，确定腹主动脉、两侧股与骷动脉血流状况。将翻山血管鞘6F置入“翻山”到病肢动脉造影,确定病变的性质及范围，导管导丝交换后，使加硬导丝经闭塞血管到达远端动脉，并利用加硬导丝导入AngioJet吸栓抽吸导管于闭塞部分的血管腔。（2）血栓抽吸具体方式：将电源接通、导管套装取出，并连接及其，选择肝素盐水开展导管冲洗排气;按照屏幕提示选择喷射模式,将溶栓药物（尿激酶25万U溶于100mL氯化钠0.9%溶