【摘要】 目的观察血管灌注区段(angiosome)理念指导下精准腔内膝下动脉血运重建联合通冠胶囊治疗对重症下肢缺血(CLI)患者的临床效果。方法选取CLI患者110例,其中74例经皮腔内血管成形术(PTA)中精准建立angiosome区域直通血流患者纳入直接血运重建组(DR组),36例开通邻近angiosome区域血管血流患者为间接血运重建组(IR组),两组再分别随机分为通冠胶囊治疗组、安慰剂对照组。对比DR、IR组治疗组、对照组术前及术后1周、1个月、3个月疗效指标及术后6个月终点指标。结果 DR、IR组治疗、对照组患者跛行距离、踝-肱指数(ABI)、趾-肱指数(TBI)、皮肤温度和经皮氧分压随术前术后时间变化(P<0.05),术后各指标参数均值较术前升高;两组治疗、对照组间各参数均值差别随时间变化(P<0.05),各参数均值组间差异有统计学意义(P<0.05)。术后6个月血管通畅率、溃疡愈合率、保肢率,DR组对照组均优于IR组对照组(P<0.05),DR组治疗组与其对照组间差异无统计学意义(P>0.05),而IR组治疗组均优于其对照组(P<0.05)。结论 Angiosome理念下精准膝下动脉腔内治疗,可重建CLI患者病变区直通血流,改善缺血症状,联合通冠胶囊可进一步改善缺血症状,改善跛行距离、ABI、 TBI、皮肤温度和经皮氧分压,也可用于未能获得直通血运重建患者,从而提高术后靶血管通畅率、溃疡愈合率和保肢率。更多还原

【Abstract】 Objective To investigate the clinical therapeutic efficacy of precise endovascular infrapopliteal revascularization combined with Tongguan capsule based on the concept of vascular perfusion area(angiosome) in treating patients with critical limb ischemia(CLI). Methods A total of 110 patients with CLI were enrolled in this study. The patients were divided into two groups: direct revascularization(DR) group(n=74) and indirect revascularization(IR) group(n=36). Patients of DR group received percutaneous transluminal angioplasty(PTA) to accurately establish linear blood flow in angiosome area, and in patients of IR group the blood flow in the vessels of adjacent angiosome area was reopened. The patients of each group were randomly subdivided into Tongguan capsule treatment subgroup and placebo control subgroup. The preoperative as well as one-week, one-month and 3-month postoperative indexes of curative effect and endpoint criteria were compared between Tongguan capsule treatment group and placebo control group of DR group as well as of IR group. Results The claudication distance, ankle-brachial index(ABI), toe-brachial index(TBI), skin temperature and transcutaneous partial pressure of oxygen in Tongguan capsule treatment subgroup and placebo control subgroup of both DR group and IR group changed with time passing(P<0.05), and after treatment the mean values of all above items became higher than preoperative ones. The mean value difference of each parameter in Tongguan capsule treatment subgroup and placebo control subgroup of both DR group and IR group changed with time passing(P<0.05). Six months after treatment, the vascular patency rate, ulcer healing rate and limb preservation rate in the placebo control subgroup of DR group were better than those in the placebo control subgroup of IR group(P<0.05). There were no statistically significant differences in the above items between Tongguan capsule treatment subgroup and placebo control subgroup in DR group(P>0.05), while in IR group the differences in the above items between Tongguan capsule treatment subgroup and placebo control subgroup were statistically significant(P<0.05). Conclusion The precise endovascular infrapopliteal revascularization based on the concept of angiosome can reconstruct linear blood flow in lesion area and, thus, to improve the ischemic symptoms of CLI patients. Additional use of Tongguan capsule can further improve the ischemic symptoms, claudication distance, ABI, TBI, skin temperature and transcutaneous partial pressure of oxygen. This combination therapy can also be used in treating CLI patients who failed to achieve linear revascularization so as to improve the vascular patency rate, ulcer healing rate and limb preservation rate.(J Intervent Radiol, 2020, 29: 283-287)更多还原