Eliason Jonathan L, Wainess Reid M, Proctor Mary C, Dimick Justin B, Cowan John A, Upchurch Gilbert R, Stanley James C, Henke Peter K
Department of Surgery, Section of Vascular Surgery, University of Michigan Medical Center, Ann Arbor, Michigan, USA.
Ann Surg. 2003 Sep;238(3):382-9; discussion 389-90. doi: 10.1097/01.sla.0000086663.49670.d1.
To determine the contemporary clinical relevance of acute lower extremity ischemia and the factors associated with amputation and in-hospital mortality.
Acute lower extremity ischemia is considered limb- and life-threatening and usually requires therapy within 24 hours. The equivalency of thrombolytic therapy and surgery for the treatment of subacute limb ischemia up to 14 days duration is accepted fact. However, little information exists with regards to the long-term clinical course and therapeutic outcomes in these patients.
Two databases formed the basis for this study. The first was the National Inpatient Sample (NIS) from 1992 to 2000 of all patients (N = 23,268) with a primary discharge diagnosis of acute embolism and thrombosis of the lower extremities. The second was a retrospective University of Michigan experience from 1995 to 2002 of matched ICD-9-CM coded patients (N = 105). Demographic factors, atherosclerotic risk factors, the need for amputation, and in-hospital mortality were assessed by univariate and multivariate logistic regression analysis.
In the NIS, the mean patient age was 71 years, and 54% were female. The average length of stay (LOS) was 9.4 days, and inflation-adjusted cost per admission was $25,916. The amputation rate was 12.7%, and mortality was 9%. Decreased amputation rates accompanied: female sex (0.90, 0.81-0.99), age less than 63 years (0.47, 0.41-0.54), angioplasty (0.46, 0.38-0.55), and embolectomy (0.39, 0.35-0.44). Decreased mortality accompanied: angioplasty (0.79, 0.64-0.96), heparin administration (0.50, 0.29-0.86), and age less than 63 years(0.27, 0.23-0.33). The University of Michigan patients' mean age was 62 years, and 57% were men. The LOS was 11 days, with a 14% amputation rate and a mortality of 12%. Prior vascular bypasses existed in 23% of patients, and heparin use was documented in 16%. Embolectomy was associated with decreased amputation rates (0.054, 0.01-0.27) and mortality (0.07, 0.01-0.57).
In patients with acute limb ischemia, the more widespread use of heparin anticoagulation and, in select patients, performance of embolectomy rather than pursuing thrombolysis may improve patient outcomes.
确定急性下肢缺血的当代临床相关性以及与截肢和住院死亡率相关的因素。
急性下肢缺血被认为会危及肢体和生命，通常需要在24小时内进行治疗。溶栓治疗和手术治疗持续时间长达14天的亚急性肢体缺血的等效性是公认的事实。然而，关于这些患者的长期临床病程和治疗结果的信息很少。
两个数据库构成了本研究的基础。第一个是1992年至2000年全国住院患者样本（NIS），其中所有患者（N = 23268）的主要出院诊断为下肢急性栓塞和血栓形成。第二个是密歇根大学1995年至2002年对匹配的国际疾病分类第九版临床修订本（ICD-9-CM）编码患者（N = 105）的回顾性研究。通过单因素和多因素逻辑回归分析评估人口统计学因素、动脉粥样硬化危险因素、截肢需求和住院死亡率。
在全国住院患者样本中，患者平均年龄为71岁，54%为女性。平均住院时间（LOS）为9.4天，每次住院经通胀调整后的费用为25916美元。截肢率为12.7%，死亡率为9%。截肢率降低伴随着：女性（0.90，0.81 - 0.99）、年龄小于63岁（0.47，0.41 - 0.54）、血管成形术（0.46，0.38 - 0.55）和栓子切除术（0.39，0.35 - 0.44）。死亡率降低伴随着：血管成形术（0.79，0.64 - 0.96）、肝素给药（0.50，0.29 - 0.86）和年龄小于63岁（0.27，0.23 - 0.33）。密歇根大学患者的平均年龄为62岁，57%为男性。住院时间为11天，截肢率为14%，死亡率为12%。23%的患者曾行血管搭桥术，16%的患者有肝素使用记录。栓子切除术与较低的截肢率（0.054，0.01 - 0.27）和死亡率（0.07，0.01 - 0.57）相关。
在急性肢体缺血患者中，更广泛地使用肝素抗凝，以及在特定患者中进行栓子切除术而非溶栓治疗，可能会改善患者的预后。
