Oesterling Christine, Kalia Amun, Chetcuti Thomas, Walker Steven
Eastmead Surgery, Ealing CCG . Greenford , UK.
Kingston Hospital NHS Trust , Kingston upon Thames , UK.
London J Prim Care (Abingdon). 2015 Sep 3;7(5):97-102. doi: 10.1080/17571472.2015.1082345. Epub 2015 Sep 28.
: Managing patients with atypical leg symptoms in primary care can be problematic. Determining the ankle brachial pressure index (ABPI) may be readily performed to help diagnose peripheral arterial disease, but is often omitted where signs and symptoms are unclear. Does routine measurement of ABPI in patients with atypical leg symptoms aid management increase satisfaction and safely reduce hospital referral? Patients with atypical leg symptoms but no skin changes or neurological symptoms underwent clinical review and Doppler ABPI measurement (suspicious finding ≤ 1.0). Testing was performed by the same doctor (study period: 30 months). Patient outcomes were determined from practice records, hospital letters and a telephone survey. : The study comprised 35 consecutive patients (males: = 15), mean age 64 years (range: 39-88). Presentation included pain, cold feet, cramps, irritation and concerns regarding circulation. Prior to ABPI measurement, referral was considered necessary in 10, not required in 22 and unclear in 3. ABPI changed the referral decision in 10 (29%) and confirmed the decision in 25 (71%). During the study, 10 (29%) patients were referred (9 vascular, 1 neurology). Amongst the vascular referrals, significant peripheral arterial disease has been confirmed in six patients. A further two patients are under review and one did not attend. To date, lack of referral in patients with atypical leg symptoms but a normal ABPI has not increased morbidity. Current status was assessed by telephone review in 16/35 (46% contact rate; mean 18 months, range 2-28). Fifteen patients (94%) appreciated that their symptoms had been quickly and conveniently assessed, 8/11 (73%) with a normal ABPI were reassured by their result and in 8/11 symptoms have resolved. APBI conveniently aids management of atypical leg symptoms by detecting unexpected peripheral arterial disease, avoids /confirms the need for referral, reassures patients and guides reassessment. This study suggests ABPI should be used more widely.
在基层医疗中管理有非典型腿部症状的患者可能存在问题。测定踝臂压力指数（ABPI）有助于诊断外周动脉疾病，操作简便，但在体征和症状不明确时往往被省略。对有非典型腿部症状的患者常规测量ABPI是否有助于管理、提高满意度并安全减少医院转诊？对有非典型腿部症状但无皮肤改变或神经症状的患者进行临床检查和多普勒ABPI测量（可疑结果≤1.0）。检测由同一位医生进行（研究期：30个月）。根据实践记录、医院信件和电话调查确定患者的结局。该研究纳入了35例连续患者（男性15例），平均年龄64岁（范围：39 - 88岁）。症状包括疼痛、足部发冷、抽筋、刺激感以及对血液循环的担忧。在测量ABPI之前，10例患者被认为需要转诊，22例不需要转诊，3例情况不明。ABPI改变了10例（29%）患者的转诊决定，确认了25例（71%）患者的转诊决定。在研究期间，10例（29%）患者被转诊（9例血管科，1例神经科）。在血管科转诊患者中，6例已确诊为严重外周动脉疾病。另外2例患者正在接受检查，1例未就诊。迄今为止，有非典型腿部症状但ABPI正常的患者未转诊并未增加发病率。通过电话回访对16/35例（46%的回访率；平均18个月，范围2 - 28个月）患者的当前状况进行了评估。15例患者（94%）对其症状得到快速便捷的评估表示满意，11例ABPI正常的患者中有8例（73%）因结果而安心，且11例中有8例症状已缓解。ABPI通过检测意外的外周动脉疾病方便地辅助管理非典型腿部症状，避免/确认转诊需求，使患者安心并指导重新评估。本研究表明ABPI应更广泛地应用。
