Singh S, Ackroyd R, Lees T, Morris-Jones W, Gaines P, Beard J D
Vascular Unit, Royal Hallamshire Hospital, Sheffield, U K.
Int Angiol. 1996 Mar;15(1):6-8.
Between 1988 and 1993, 82 patients with a median age (iq range) of 81 (73-87) years underwent thrombo-embolectomy (TE) and thrombolysis for acute lower limb ischaemia at the Royal Hallamshire Hospital, Sheffield. 28 patients (Group 1) underwent TE prior to the introduction of thrombolysis in 1991. TE with intraoperative thrombolysis (IT) as an adjunct was performed in 34 patients (Group 2) and 20 patients (Group 3) were treated using percutaneous thrombolysis (PT) in the first instance. 41 of these patients were in AF at presentation. Although 24 were on digoxin, only 4 were on warfarin. Group 3 patients were younger (p < 0.05; ANOVA) with a longer duration of ischaemia (p < 0.05; ANOVA) and had less limbs suffering a sensorimotor deficit (p = 0.007; chi 2) compared with Groups 1 and 2 which were similar in these respects. Overall mortality was 17%. Successful revascularisation was achieved in 18 (64%), 28 (82%) and 15 (75%) patients in Groups 1, 2 and 3 respectively. 14 of the 15 patients successfully treated initially by PT required further intervention in order to maintain revascularisation. Revascularisation failure was associated with the presence of a sensorimotor deficit but not associated with patient age or duration of ischaemia.
1988年至1993年间，82例年龄中位数（四分位间距）为81（73 - 87）岁的患者在谢菲尔德皇家哈勒姆郡医院接受了急性下肢缺血的血栓清除术（TE）和溶栓治疗。1991年在溶栓治疗引入之前，28例患者（第1组）接受了TE治疗。34例患者（第2组）接受了术中溶栓（IT）辅助的TE治疗，20例患者（第3组）首先采用经皮溶栓（PT）治疗。这些患者中有41例在就诊时处于房颤状态。虽然24例患者服用地高辛，但只有4例服用华法林。与第1组和第2组在这些方面相似相比，第3组患者更年轻（p < 0.05；方差分析），缺血持续时间更长（p < 0.05；方差分析），且感觉运动功能障碍的肢体较少（p = 0.007；卡方检验）。总体死亡率为17%。第1组、第2组和第3组分别有18例（64%）、28例（82%）和15例（75%）患者成功实现血管再通。最初通过PT成功治疗的15例患者中有14例需要进一步干预以维持血管再通。血管再通失败与感觉运动功能障碍有关，但与患者年龄或缺血持续时间无关。
