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糖尿病下肢血管病變介入治療的療效觀察
【摘要】目的 評價糖尿病下肢血管病變的介入治療臨床效果。方法 對術(shù)前經(jīng)保守治療無效的糖尿病下肢血管病變患者18例行介入治療。其中41支病變血管行血管內(nèi)球囊擴張, 15支血管行腔內(nèi)支架植入術(shù)。術(shù)后常規(guī)抗凝治療1周。結(jié)果 介入治療后患者的臨床癥狀、體征均明顯緩解，踝肱指數(shù)明顯提高,差異有統(tǒng)計學(xué)意義(P＜0.05或＜0.01)。結(jié)論 糖尿病下肢血管病變的血管內(nèi)介入治療安全、有效,具有推廣應(yīng)用價值。
【關(guān)鍵詞】 糖尿病下肢血管病變 介入治療
Therapeutic effect of interventional treatment on diabetic patients with vascular lesions in lower limbs QI Huiqing,TIAN Huiyu, WANG Fujun. Department of Endocrinology, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011,China
【Abstract】 Objective To assess the therapeutic effect on diabetic patients with vascular lesions in lower limbs.Methods Eighteen diabetic patients with chronic incurable vascular lesions in lower limbs were treated by interventional treatment. Among them fortyone vessels with irregular stenosis and obstruction were treated by intravascular angioplasty through balloon dilation and fifteen vessels were treated by intravascular stenting. Regular anticoagulant therapy was given for 1 week after interventional treatment.Results The patients’ symptoms and physical signs were obviously relieved and ABI raised obviously after interventional treatment. There was a significant difference in symptoms,physical signs and ABI of patients between pretherapy and posttherapy.Conclusion Intravascular interventional treatment is safe, effective and valuable for diabetic patients with vascular lesions in lower limbs.
【Key words】 diabetes with vascular lesions in lower limbs; interventional treatment
WHO將糖尿病足(diabetic foot,DF)定義為糖尿病(diabetes mellitus,DM)患者發(fā)生的與下肢遠(yuǎn)端神經(jīng)異常和不同程度的周圍血管病變相關(guān)的足部感染、潰瘍和(或)深層組織破壞［1］。DF常常是下肢血管病變、神經(jīng)病變和感染共同作用的結(jié)果,嚴(yán)重者常需截肢甚致死亡。其傳統(tǒng)治療方法包括控制血糖、抗炎、改善循環(huán)、營養(yǎng)神經(jīng)、局部減壓、局部換藥等綜合對癥治療,但治療效果常不理想，發(fā)生潰瘍者愈合緩慢。經(jīng)保守治療無效的糖尿病下肢血管病變患者采用介入治療改善下肢血供，觀察其療效，報告如下。
1 資料與方法醫(yī)學(xué)全.在.線gydjdsj.org.cn
1.1 一般資料 收集2007年6月至2008年8月我科住院的糖尿病性下肢血管病變患者18例,其中男9例,女9例；年齡47～84歲，平均年齡(71±12)歲；糖尿病病程3～15年。其臨床表現(xiàn)均有患肢明顯缺血癥狀：如冷感、間歇性跛行、缺血性靜息痛等癥狀中的一種或幾種；體征有下肢動脈搏動減弱或消失、皮溫低, 甚至足部潰瘍、壞疽等。術(shù)前均經(jīng)多種傳統(tǒng)治療方法綜合治療4周以上且療效不佳。
