血管灌注分区理论在糖尿病足腔内治疗的应用

发布时间：2018-05-12 07:21

本文选题：angiosome理念 + 糖尿病足　；参考：《新疆医科大学》2017年硕士论文

【摘要】：目的:探讨angiosome理念在糖尿病足和下肢重度肢体缺血的临床治疗应用。方法:回顾性分析我院自2015.01-2016.06收治入院的糖尿病足(wagner 1-4级)患者42例48条肢体和CLI患者40例42条肢体,分别为DF组和CLI组,两组病人均按angiosome理念打通下肢病变血管,术后予抗血小板、稳定斑块、控制血糖及辅助超声清创等处理,随访6个月。比较两组病人的一般资料、术前术后ABI值及ABI改善值、足溃疡分布情况、下肢受累血管分布情况,以及技术成功率、临床成功率、大截肢率和死亡率。两组病人的人口学特征无明显差异,DF组术后ABI改善值为0.20±0.16,CLI组为0.39± 0.11,p0.001;两组病人的足溃疡位置无显著性差别(χ2=0.143,p=0.706);受累血管的分布差异有统计学意义(χ2=15.115,p=0.004),CLI组中受累的股浅动脉(χ2=7.981,p=0.005)及乆动脉(χ2=5.026,p=0.025)显著多于DF组;两组病人技术成功率(DF组75%,CLI组76.19%,p=0.896)、临床成功率(DF 组 70.83%,CLI 组 83.33%,p=0.162)、大截肢率(DF 组 8.33%,CLI 组 7.14%,p=0.833)、死亡率(DF 组 7.14%,CLI组5.00%,p=0.523)均无显著差别。DF组的wagner分级级别越高,足溃疡转归愈差(Spearman相关系数0.515,kendall相关系数0.448)。结论:糖尿病足和CLI下肢受累血管的分布存在显著差异,但两组病人的临床结局无明显差别。以angiosome理念为基础的腔内治疗能改善糖尿病足和CLI治疗的临床成功率,需要更多的前瞻性随机对照试验来支angiosome理念的临床应用。
[Abstract]:Objective: to explore the clinical application of angiosome in the treatment of diabetic foot and limb ischemia. Methods: a retrospective analysis of 48 limbs of 42 patients with diabetic foot and 42 limbs of 40 CLI patients (DF group and CLI group) admitted to our hospital from January to June 2016.The patients in both groups were treated with angiosome. Postoperative antiplatelet, plaque stabilization, blood glucose control and ultrasonic debridement were followed up for 6 months. The general data of the two groups were compared, including the preoperative and postoperative ABI values and ABI improvement values, the distribution of foot ulcers, the distribution of the involved vessels of the lower extremities, the success rate of technique, the clinical success rate, the rate of large amputation and the death rate. There was no significant difference in demographic characteristics between the two groups. The improvement value of postoperative ABI in DF group was 0.39 卤0.11p 0.001, there was no significant difference in the location of foot ulcer between the two groups (蠂 ~ 2 = 0.143) and the distribution of involved vessels was significantly different (蠂 ~ 215.115p 0.004). The blood vessels (蠂 2 + 7.981) and the male and female arteries (蠂 2 + 5.026) were significantly higher than those in DF (P < 0.05). There was no significant difference in clinical success rate between DF group (70.833), DF group (83.33%), large amputation rate (8.33%), DF group (7.14%) and mortality group (7.14%). There was no significant difference between DF group (7.14%) and DF group (5.00%, 0.523). The wagner grade of DF group was higher than that of DF group. Spearman correlation coefficient 0.515 kendall correlation coefficient 0.448%. Conclusion: there is a significant difference in the distribution of the involved vessels between diabetic foot and CLI, but there is no significant difference in the clinical outcome between the two groups. Endovascular therapy based on angiosome concept can improve the clinical success rate of diabetic foot and CLI treatment. More prospective randomized controlled trials are needed to support the clinical application of angiosome concept.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.2;R658.3

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