Dittrich J, Spaan G, Stein U, Wagner E, Frese J H
Med Klin. 1979 Sep 28;74(39):1396-403.
Two thirds of the patients with peripheral arterial occlusive disease have to be treated conservatively, for only up to 30% can be revascularized by operative methods. Using the pharmacological differential treatment the grade of compensation and localization of the obliterative process has to be considered. Ignoring the usual basic therapy (elimination of heart failure and pathological bradycardia, systemic walking-exercise, anticoagulation etc.) intrafemoral long-term application of energetic phosphate (i.e. nucleotid-nucleosid-mixtures) leads to a positive result in nearly two thirds (n = 97 legs) with a degree of II to IV of Fontaine. Whereas the snakes' encyme Ancrod with the effect of defibrination was successful in almost 70% of the patients with arterial insufficiency (n = 45) including the degree II B (painless walking-distance under 100 meters). Energetic phosphates, applied to the arteria femoralis, are most successful in degree II with claudication intermittens. Ancrod should be used respectively for patients with pain during rest. These results are discussed with respect to compensation and localization of arterial occlusive disease, acute and chronic measurements of the hemodynamics by use of Doppler ultrasound and strain gauge plethysmography and with respect to variation of the concentration of the metabolic parameters lactate and pyruvate--the latter when defibrination was performed.
三分之二的外周动脉闭塞性疾病患者必须接受保守治疗，因为只有高达30%的患者可通过手术方法实现血管再通。采用药物差异治疗时，必须考虑闭塞过程的代偿程度和部位。若忽视常规基础治疗（消除心力衰竭和病理性心动过缓、全身步行锻炼、抗凝等），在股动脉内长期应用高能磷酸盐（即核苷酸 - 核苷混合物），对于近三分之二（n = 97条腿）Fontaine分级为II至IV级的患者会产生阳性结果。而具有去纤维蛋白作用的蛇酶安克洛，在几乎70%的动脉供血不足患者（n = 45）中取得成功，其中包括II B级患者（无痛步行距离不足100米）。应用于股动脉的高能磷酸盐，在间歇性跛行的II级患者中最为成功。安克洛应分别用于休息时疼痛的患者。结合动脉闭塞性疾病的代偿和部位、使用多普勒超声和应变计体积描记法对血流动力学进行的急性和慢性测量，以及在进行去纤维蛋白治疗时代谢参数乳酸和丙酮酸浓度的变化，对这些结果进行了讨论。
