Amery A, Deloof W, Vermylen J, Verstraete M
Br Med J. 1970 Dec 12;4(5736):639-44. doi: 10.1136/bmj.4.5736.639.
All our patients with a recent thromboembolic occlusion of limb arteries treated with streptokinase have been reviewed retrospectively. Clearing of the main artery, as judged by arteriography or reappearance of arterial pulsations, occurred more often when treatment was started early. If only patients with an iliac, femoral, or popliteal artery occlusion are considered, those who received a lower initial dose had a significantly higher clearing rate and a significantly lower mortality than those who received a high initial dose (500,000 units of streptokinase or more). Therefore an initial standard dose of 1,200,000 units of streptokinase is no longer recommended in these conditions, and even an individually titrated initial dose of more than half a million units could be hazardous. If no neurological abnormalities were present on admission amputation was never necessary, even if clearing of the main artery did not occur. If there was sensory loss of at least part of a limb, amputation was avoided only if the pulsations returned in at least one artery of hand or foot.
我们对所有近期接受链激酶治疗的肢体动脉血栓栓塞性闭塞患者进行了回顾性研究。根据动脉造影或动脉搏动再次出现判断，主要动脉通畅情况在早期开始治疗时更常出现。如果仅考虑髂动脉、股动脉或腘动脉闭塞的患者，接受较低初始剂量的患者与接受高初始剂量（500,000单位或更多链激酶）的患者相比，通畅率显著更高，死亡率显著更低。因此，在这些情况下不再推荐1,200,000单位链激酶的初始标准剂量，即使是超过50万单位的个体化滴定初始剂量也可能有风险。如果入院时无神经功能异常，即使主要动脉未通畅，截肢也绝非必要。如果肢体至少有部分感觉丧失，仅当手部或足部至少一条动脉恢复搏动时才可避免截肢。
