严重肢体缺血：管理与结局。一项全国性调查的报告。英国和爱尔兰血管外科学会
Critical limb ischaemia: management and outcome. Report of a national survey. The Vascular Surgical Society of Great Britain and Ireland.
出版信息
Eur J Vasc Endovasc Surg. 1995 Jul;10(1):108-13. doi: 10.1016/s1078-5884(05)80206-0.
AIM
A prospective national survey of patients with critical lower limb ischaemia was carried out to estimate the prevalence of critical lower limb ischaemia in Britain and Ireland; and to assess the average national outcome following treatment.
METHOD
The surgeons were selected randomly but stratified according to the number of vascular surgical operations performed annually to match the profile of the vascular surgical population of the country as a whole.
OUTCOME MEASURES
The main outcome measures were the primary treatment intention; final treatment undertaken; duration of hospital stay; final outcome in terms of mortality and limb salvage rates and destination on discharge.
RESULTS
The data reveal that the extrapolated incidence of critical lower limb ischaemia in Great Britain and Ireland was 21,450 limbs in 20,000 patients, equating to a prevalence of 1 in 2500 of the population annually. Thirty per cent of the patients were diabetic. The overall mortality and amputation rates were 13.5% and 21.5% respectively. The mean duration of hospital stay was 25 days. Nearly 70% of patients were offered some form of revascularisation as the primary treatment option with a 75% chance of successful limb salvage. Amputation was associated with a significantly higher mortality (Chi square = 10.79, p = 0.001), longer hospital stay (t = 4.589, p < 0.0001) and a greater proportion of patients requiring long-term institutional support, than revascularisation. The ratio of revascularisation to amputation was 4:1. Surgeons with a lower annual experience of patients with vascular disease tended to undertake fewer revascularisations (Chi square = 6.737, p = 0.0094) and more amputations (Chi square = 10.445, p = 0.0012) than those treating larger numbers. The mean limb salvage rate achieved by surgeons with a lower throughput of vascular operations was significantly lower that achieved by other groups of surgeons (Chi square = 7.544, p = 0.0045).
目的
开展一项针对严重下肢缺血患者的全国性前瞻性调查，以估计英国和爱尔兰严重下肢缺血的患病率；并评估全国范围内治疗后的平均结果。
方法
外科医生通过随机选择，但根据每年进行的血管外科手术数量进行分层，以匹配整个国家血管外科患者群体的特征。
结果指标
主要结果指标包括主要治疗意向；最终进行的治疗；住院时间；死亡率、肢体挽救率方面的最终结果以及出院去向。
结果
数据显示，英国和爱尔兰严重下肢缺血的外推发病率为20000例患者中有21450条肢体，相当于每年每2500人中就有1例患病率。30%的患者患有糖尿病。总体死亡率和截肢率分别为13.5%和21.5%。平均住院时间为25天。近70%的患者被提供某种形式的血运重建作为主要治疗选择，肢体挽救成功的几率为75%。与血运重建相比，截肢与显著更高的死亡率（卡方 = 10.79，p = 0.001）、更长的住院时间（t = 4.589，p < 0.0001）以及更多需要长期机构支持的患者比例相关。血运重建与截肢的比例为4:1。每年治疗血管疾病患者经验较少的外科医生与治疗患者数量较多的外科医生相比，进行的血运重建手术较少（卡方 = 6.737，p = 0.0094），截肢手术较多（卡方 = 10.445，p = 0.0012）。血管手术量较低的外科医生实现的平均肢体挽救率显著低于其他外科医生组（卡方 = 7.544，p = 0.0045）。
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