超声引导下Fogarty球囊导管在动脉危象中的临床应用

发布时间：2018-04-26 21:00

本文选题：彩色多普勒超声 + Fogarty球囊导管　；参考：《中国修复重建外科杂志》2017年10期

【摘要】：目的观察超声引导下Fogarty球囊导管在断肢再植术后动脉危象中应用的临床疗效。方法 2012年1月—2016年7月,应用超声引导下Fogarty球囊导管联合溶栓抗凝药物治疗断肢再植术后动脉危象患者27例。男18例,女9例;年龄19~51岁,平均32岁。膝关节离断3例,小腿离断9例,踝关节离断6例,肘关节离断2例,前臂离断4例,腕关节离断3例。于断肢再植术后2.5~18 h,平均7.5 h出现动脉危象。均采用彩色多普勒超声检查明确诊断,其中吻合口血栓16例,非吻合口血栓7例,联合血栓4例。血栓均存在于动脉内,长度为0.8~3.9 cm。结果术后患者均未发生血管穿孔、破裂、空气栓塞、血栓栓塞、伤口感染及败血症等并发症。术后1.5~13.5 h 3例再次出现动脉危象,行切开探查术,1例治疗成功;2例动脉闭塞,肢体部分坏死,行截肢术。余24例患肢顺利成活,切口均Ⅰ期愈合,其中1例出现急性肌病肾病代谢综合征,予以血液透析后得以纠正;1例出现急性肝功能损害,予以内科综合治疗纠正。24例患者获随访7~38个月,平均11个月。末次随访时肢体血运良好,皮温正常,感觉、活动度及肿胀度均改善。参照中华医学会手外科学会上肢部分功能评定试用标准评价疗效,获优12例、良8例、差4例,优良率83.3%。结论超声引导下应用Fogarty球囊导管处理断肢再植术后动脉危象,血栓定位精准,取栓快捷、微创,避免了盲目、反复取栓,临床疗效肯定。
[Abstract]:Objective to observe the clinical effect of Fogarty balloon catheter guided by ultrasound in patients with arterial crisis after replantation of severed limbs. Methods from January 2012 to July 2016, 27 patients with arterial crisis after replantation were treated with ultrasound guided Fogarty balloon catheter combined with thrombolytic and anticoagulant drugs. There were 18 males and 9 females, aged 19 to 51 years (mean 32 years). The knee joint was broken in 3 cases, the leg in 9 cases, the ankle joint in 6 cases, the elbow joint in 2 cases, the forearm in 4 cases and the wrist joint in 3 cases. After replantation of amputated limbs, arterial crisis appeared at 2.5 h and 18 h on average at 7.5 h. All cases were diagnosed by color Doppler ultrasound, including 16 cases of anastomotic thrombus, 7 cases of non-anastomotic thrombus and 4 cases of combined thrombus. Thrombosis was found in the arteries with a length of 0.810 cm. Results there were no complications such as perforation, rupture, air embolism, thromboembolism, wound infection and septicemia. Arterial crisis occurred again in 3 cases at 1.5h to 13.5 h after operation. One case was successfully treated with open exploration and 2 cases with arterial occlusion, partial necrosis of limbs, and amputation. The remaining 24 patients survived successfully and all the incisions healed in the first stage. Among them, one patient developed acute myopathy nephrotic metabolic syndrome, one patient was corrected after hemodialysis, and 1 patient had acute liver function damage. 24 patients were followed up for 7 ~ 38 months (mean 11 months). At the last follow-up, the limb blood flow was good, the skin temperature was normal, and the sensation, activity and swelling were improved. According to the evaluation criteria of upper limb function of the Chinese Medical Association, 12 cases were excellent, 8 good and 4 poor, and the excellent and good rate was 83.3%. Conclusion under the guidance of ultrasound, Fogarty balloon catheter is used to treat the arterial crisis after replantation of severed limbs. The location of thrombus is accurate, the thrombus removal is quick and minimally invasive, the blind and repeated embolization is avoided, and the clinical curative effect is positive.
【作者单位】：承德医学院附属医院手足外科;承德医学院附属医院重症医学科;承德医学院附属医院血管外科;
【基金】：2016年度河北省卫生厅指令性项目(20160010)~~
【分类号】：R658.1

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