Allen R C, Schneider J, Longenecker L, Kosinski A S, Smith R B, Lumsden A B
Department of Surgery, Emory University Hospital, Atlanta, Georgia.
Am J Surg. 1993 Aug;166(2):124-9; discussion 129. doi: 10.1016/s0002-9610(05)81042-6.
A retrospective review during a 5-year period (1987 to 1992) was conducted of all patients manifesting leg ischemia after major cardiac surgery. There were 7,620 procedures performed, and 65 (0.85%) patients (mean age: 65 years) were identified with acute ischemia. Diagnosis was made by physical examination, during which a cool pulseless extremity without pedal Doppler signals was noted in 63 of 65 patients (97%). An intra-aortic balloon pump (IABP) was inserted in 56 patients (86%). Treatment regimens included medical management (17), IABP removal (4), IABP removal and thromboembolectomy (24), thromboembolectomy and endarterectomy with patch angioplasty (10), femoral-femoral bypass (17), other bypasses (6), fasciotomy (10), and amputation (16). Morbidity was 92% and mortality was 46%. Mortality was 11% in those patients developing ischemia without an IABP. Acute leg ischemia after cardiac surgery is predictive of high morbidity and mortality. This reflects the compromised cardiac status and multi-system disease. Treatment alternatives are based on the overall clinical status, degree of arterial insufficiency, and distribution of pre-existing peripheral vascular disease. However, ultimate limb salvage had no influence on overall patient survival in our study.
对1987年至1992年这5年期间所有在心脏大手术后出现腿部缺血的患者进行了回顾性研究。共进行了7620例手术，其中65例（0.85%）患者（平均年龄65岁）被确诊为急性缺血。诊断通过体格检查做出，65例患者中有63例（97%）在检查时发现肢体发凉、无脉搏且无足背多普勒信号。56例患者（86%）插入了主动脉内球囊反搏（IABP）。治疗方案包括药物治疗（17例）、移除IABP（4例）、移除IABP并进行血栓切除术（24例）、血栓切除术及带补片血管成形术的动脉内膜切除术（10例）、股-股旁路移植术（17例）、其他旁路移植术（6例）、筋膜切开术（10例）和截肢术（16例）。发病率为92%，死亡率为46%。未使用IABP而发生缺血的患者死亡率为11%。心脏手术后的急性腿部缺血预示着高发病率和高死亡率。这反映了心脏功能受损和多系统疾病。治疗方案的选择基于总体临床状况、动脉供血不足的程度以及原有周围血管疾病的分布情况。然而，在我们的研究中，最终的肢体挽救对患者的总体生存率没有影响。
