Kennedy Gem, McGarry K, Bradley G, Harkin D W
The Vascular Centre, Royal Victoria Hospital Belfast. Royal Victoria Hospital, Belfast Health and Social Care Trust, 274 Grosvenor Rd, Belfast BT12 6BA. N. Ireland.
Department of Paleontology. Faculty of Earth and Atmospheric Science. University of Alberta 1-26 Earth Sciences Building. Edmonton, Alberta T6G 2E3 Canada.
Ulster Med J. 2019 Jan;88(1):30-35. Epub 2019 Jan 22.
Major lower limb amputation remains a common treatment for patients with peripheral vascular disease (PVD) in whom other measures have failed. It has been associated with high morbidity and mortality, including risks from venous thromboembolism (VTE).
A two-year retrospective cohort study was conducted involving 79 patients who underwent major lower limb amputation (below- or above-knee amputation) between January 2014 and December 2015 in a single tertiary referral centre. Amputation procedures were performed for reasons relating to complications of PVD and/or diabetes mellitus. Patients were followed-up to investigate all-cause mortality rates and VTE events using the Northern Ireland Electronic Care Record database (mean follow-up time 17 months).
Of the 79 patients, there were 52 male and 27 female. Mean age at time of surgery was 72 years (range 34-99 years). Forty-six patients (58%) suffered from diabetes mellitus, 29 (35%) heart failure, 31 (39%) chronic kidney disease (CKD) and 10 (13%) chronic obstructive pulmonary disease (COPD). Twenty patients (25%) were on anticoagulant therapy, and 53 (67%) were on antiplatelet therapy.Thirty-five patients (44%) died during follow-up; mean age at death was 74 years. No statistically significant association was found between mortality rate and the level of amputation (p=0.3702), gender (p=0.3507), or comorbid diabetic mellitus (p=0.1127), heart failure (p=0.1028), CKD (p=0.0643) or COPD (p=0.4987).Two patients experienced radiologically-confirmed non-fatal pulmonary emboli and two patients developed radiologically-confirmed deep vein thrombosis.
The results are in agreement with current literature that amputation is associated with significant mortality, with almost half of the study population dying during follow-up. Further work should explore measures by which mortality rates may be reduced.
对于其他治疗措施无效的外周血管疾病（PVD）患者，大下肢截肢仍是一种常见的治疗方法。它与高发病率和死亡率相关，包括静脉血栓栓塞（VTE）风险。
进行了一项为期两年的回顾性队列研究，纳入了2014年1月至2015年12月期间在一家三级转诊中心接受大下肢截肢（膝下或膝上截肢）的79例患者。截肢手术是因PVD和/或糖尿病的并发症而进行的。利用北爱尔兰电子护理记录数据库对患者进行随访，以调查全因死亡率和VTE事件（平均随访时间17个月）。
79例患者中，男性52例，女性27例。手术时的平均年龄为72岁（范围34 - 99岁）。46例（58%）患有糖尿病，29例（35%）患有心力衰竭，31例（39%）患有慢性肾脏病（CKD），10例（13%）患有慢性阻塞性肺疾病（COPD）。20例（25%）接受抗凝治疗，53例（67%）接受抗血小板治疗。35例（44%）患者在随访期间死亡；死亡时的平均年龄为74岁。未发现死亡率与截肢水平（p = 0.3702）、性别（p = 0.3507）或合并糖尿病（p = 0.1127）、心力衰竭（p = 0.1028）、CKD（p = 0.0643）或COPD（p = 0.4987）之间存在统计学显著关联。2例患者经影像学证实发生非致命性肺栓塞，2例患者经影像学证实发生深静脉血栓形成。
研究结果与当前文献一致，即截肢与显著的死亡率相关，几乎一半的研究人群在随访期间死亡。应进一步开展工作探索降低死亡率的措施。
