Jones N F
Division of Plastic and Reconstructive Surgery, University of Pittsburgh, PA.
J Hand Surg Am. 1991 Nov;16(6):1074-83. doi: 10.1016/s0363-5023(10)80072-3.
Fifty consecutive patients with acute and chronic ischemia of the hand were investigated by Allen testing, Doppler ultrasound, digital plethysmography, and angiography over a 4-year period. The pathophysiologic mechanism responsible for the ischemia was determined to be emboli in 6%, vasospasm in 10%, thrombosis or "sludging" in 28%, occlusive disease in 26%, and occlusive disease associated with either vasospasm or external compression in 30%. Ten patients required emergency medical treatment with intraarterial streptokinase, intravenous heparin, or dextran 40 and continuous stellate ganglion blocks, and three patients required emergency microsurgical revascularization because of radial artery thrombosis. Patients with chronic ischemia of the hand were maintained on nifedipine, 30 to 60 mg daily, and pentoxifylline, 1200 mg daily. Seven patients underwent digital sympathectomy and 14 patients underwent microsurgical revascularization as prophylactic procedures for chronic digital ischemia. Amputations were required in 18 patients because of end-stage gangrene. Long-term follow-up revealed a 20% incidence of recurrent digital ulcerations. There have been six deaths during follow-up, five of them due to myocardial infarction; this reflects the underlying systemic arteriopathy in many of these patients.
在4年期间，对50例连续性急慢性手部缺血患者进行了艾伦试验、多普勒超声、数字体积描记法和血管造影检查。确定导致缺血的病理生理机制为：栓塞占6%，血管痉挛占10%，血栓形成或“淤滞”占28%，闭塞性疾病占26%，闭塞性疾病合并血管痉挛或外部压迫占30%。10例患者需要采用动脉内链激酶、静脉肝素或右旋糖酐40进行紧急药物治疗，并持续进行星状神经节阻滞，3例因桡动脉血栓形成需要紧急显微外科血管重建术。慢性手部缺血患者每日服用硝苯地平30至60毫克和己酮可可碱1200毫克。7例患者接受了手指交感神经切除术，14例患者接受了显微外科血管重建术作为慢性手指缺血的预防性手术。18例患者因晚期坏疽需要截肢。长期随访显示复发性手指溃疡的发生率为20%。随访期间有6例死亡，其中5例死于心肌梗死；这反映了这些患者中许多人存在潜在的全身性动脉病变。
