急慢性下肢缺血患者围手术期死亡原因分析

发布时间：2018-02-14 08:43

本文关键词： 下肢缺血动脉硬化闭塞性腔内治疗切开取栓术后死亡　出处：《安徽医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的通过分析患者的临床资料(包括手术方式、伴随疾病、病史、相关检查结果),探讨影响急慢性下肢缺血患者缺血再通治疗的围手术期死亡相关因素。方法收集安徽医科大学第一附属医院血管外科2011年1月至2016年9月住院手术治疗的249例下肢急慢性缺血患者中11例死亡患者的临床资料,内容包括病案号、性别、年龄、发病到就诊时间、并存疾病、血液检查指标、踝肱指数、Rutherford缺血分级、手术治疗方式。将上述资料与同期接受手术治疗的生存组相比较,采用单因素分析,分析影响围手术期死亡的相关因素。结果249例术后病例中11例死亡患者,动脉硬化闭塞症(Arteriosclerosis occlusion,ASO)行血管腔内治疗5例,包括支架置入后置管溶栓6小时1例,动脉切开取栓6例,其中行双侧股动脉切开取栓2例,单侧股动脉切开取栓4例;死亡原因:心功能衰竭4例;多脏器功能衰竭3例;急性心肌梗塞2例;脑梗塞1例;肾功能衰竭1例;心功能衰竭与多脏器功能衰竭死亡占63.6%(7/11)。手术死亡率4.4%(11/249),其中急性肢体缺血行动脉切开取栓死亡率8.9%(6/67),慢性肢体缺血行血管腔内治疗死亡率2.8%(5/180)。死亡的单因素统计分析结果显示:严重下肢缺血(Critical Limb Ischemia CLI)、合并心脏疾病、合并慢性肾功能不全、高血压、贫血、低蛋白血症死亡率分别较无上述合并症的死亡率高,单因素分析显示差异均有统计学意义(P0.05),是围手术其死亡的的相关危险因素。缺血再灌注损伤对下肢缺血再通患者的围手术期死亡有一定的影响。结论1.影响下肢缺血患者围手术期死亡的独立危险因素是CLI、CK、LDH、贫血、COPD、高血压病、低白蛋白血症及心脏疾病,死亡原因与影响因素及重要脏器功能密切相关;2.3.缺血再灌注损伤对下肢缺血手术患者的围手术期死亡有一定的影响;
[Abstract]:Objective to analyze the clinical data of the patients (including surgical methods, concomitant diseases, medical history, etc.). To explore the factors related to perioperative death in patients with acute and chronic ischemia of lower extremity. Methods the hospital hands were collected from January 2011 to September 2016 in the vascular surgery department of the first affiliated hospital of Anhui Medical University. Clinical data of 11 cases of death in 249 patients with acute and chronic ischemia of lower extremities treated by surgery. The contents included medical record number, sex, age, time from onset to visit, co-existing diseases, blood examination, ankle brachial index Rutherford ischemic grading, and surgical treatment. The above data were compared with the survival group undergoing surgical treatment at the same time. Results among the 249 postoperative patients, 11 patients died, 5 patients with Arteriosclerosis occlusion ASO were treated with endovascular therapy, including 1 patient who received stent placement for 6 hours after placement of the stent for thrombolytic therapy, and 11 patients who died after the operation, and 5 patients with arteriosclerosis obliterans (Arteriosclerosis obliterans) received endovascular treatment, including 6 hours of thrombolytic therapy with stent implantation. Among them, 2 cases received bilateral femoral artery thrombectomy and 4 cases unilateral femoral artery thrombectomy. The causes of death were heart failure in 4 cases, multiple organ failure in 3 cases, acute myocardial infarction in 2 cases, cerebral infarction in 1 case, acute myocardial infarction in 2 cases, cerebral infarction in 1 case, cardiac failure in 4 cases, multiple organ failure in 3 cases, acute myocardial infarction in 2 cases, cerebral infarction in 1 case. Renal failure in 1 case; Death rate of cardiac function failure and multiple organ failure accounted for 63.6% / 110.Surgical mortality was 4.4%. Among them, the mortality rate of acute limb ischemia with arterial thrombectomy was 8.9%, and that of chronic limb ischemia with endovascular therapy was 2.8% 5180%. The single factor statistical analysis of death was concluded. The results showed that severe lower extremity ischemia, critical Limb Ischemia CLI, combined with heart disease, The mortality rates of chronic renal insufficiency, hypertension, anemia and hypoproteinemia were higher than those without these complications. Univariate analysis showed that the difference was statistically significant (P 0.05), which was the risk factor of perioperative death. Ischemia-reperfusion injury had a certain effect on perioperative mortality of patients with lower extremity ischemia reperfusion. Conclusion 1. The independent risk factors for perioperative death in ischemic patients were CLI CKD LDH, anemia, and hypertension. Hypoalbuminemia and heart disease, the cause of death is closely related to the influencing factors and important organ function. Ischemia-reperfusion injury has a certain effect on perioperative death of patients with lower extremity ischemia surgery.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R654.4

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