目的 探讨鉴别急性下肢动脉栓塞与急性血栓形成的临床因素的异同点.方法 2005年5月至2010年6月收治73例急性下肢动脉缺血患者,根据DSA表现将患者分为动脉栓塞组(52例)和动脉血栓形成组(21例).回顾性分析两组患者的一般临床资料以及发病时间、梗阻部位、发病肢体性质、临床表现、缺血程度等,并进行统计学分析.结果 急性动脉栓塞部位好发于髂股动脉(χ2 ＝ 5.44,P ＜ 0.05),急性动脉血栓形成血管病变可累及多个部位(P ＝ 0.02).急性动脉栓塞患者感觉异常(χ2 ＝ 4.15,P ＜ 0.05)和运动障碍(χ2 ＝ 9.42,P ＜ 0.05) 较急性动脉血栓形成患者更明显,而对侧动脉搏动相对正常 (χ2 ＝ 18.10,P ＜ 0.05);急性动脉血栓形成患者则更常伴有间歇性跛行病史(χ2 ＝ 10.01,P ＜ 0.05);急性动脉血栓形成缺血程度倾向于Ⅱa级(χ2 ＝ 9.11,P ＜ 0.05),急性动脉栓塞缺血程度更为严重,更趋向于Ⅱb级(χ2 ＝ 5.44,P ＜ 0.05).急性血栓形成患者合并糖尿病(χ2 ＝ 12.37,P ＜ 0.05)、高血压(χ2 ＝ 7.96,P ＜ 0.05)及吸烟(χ2 ＝ 8.18,P ＜ 0.05)病史的比例明显高于急性动脉栓塞患者,房颤者(χ2 ＝ 14.00,P ＜ 0.05)更好发急性动脉栓塞,既往有栓塞病史(χ2 ＝ 4.24,P ＜ 0.05)仅见于急性动脉栓塞患者中.结论 有助于鉴别两者的临床因素包括临床表现(运动障碍、感觉异常及对侧动脉搏动情况),梗阻的部位,既往有无间歇性跛行及栓塞史,缺血程度及外周血管疾病的高危因素(房颤、高血压、糖尿病、吸烟).%Objective To assess the clinical factors useful for the differentiation of acute arterial embolism from acute arterial thrombosis in patients with acute lower extremity ischemia. Methods A total of 73 patients with acute arterial embolism or acute arterial thrombosis of lower extremity, who were admitted to the hospital during the period from May 2005 to June 2010, were enrolled in the study. Depending on the DSA findings, the patients were divided into arterial embolism group (n = 52) and arterial thrombosis group (n = 21). The clinical data, including general information, the onset of the disease, the obstructed sites, the condition of the diseased limb, the clinical manifestations and the severity of ischemia, were retrospectively analyzed and compared between the two groups. Results The acute arterial embolism occurred usually on the iliofemoral artery (x2 = 5.44, P < 0.05), while the vascular disorders caused by acute arterial thrombosis often involved many sites (P = 0.02). Patients with acute arterial embolism presented more severe clinical manifestations such as impaired sensation (x2 = 4.15, P<0.05) and dyskinesia (x2 = 9.42, P < 0.05), and showed normal peripheral pulse on the healthy limb (x2 = 18.10, P < 0.05). The patients with acute arterial thrombosis were accompanied with intermittent claudication more often than the patients with acute arterial embolism (x2 = 10.01, P < 0.05). The severity of ischemia in patients with acute arterial embolism tended to become immediately threatened II b grade (x2 =5.44, P < 0.05), while marginally threatened ischemia was more often observed in patients with acute arterial thrombosis. Diabetes mellitus (x2 = 12.37 , P < 0.05), hypertension (x2 = 7.96, P < 0.05 )and smoking habit (x2 = 8.18, P < 0.05)were more commonly detected in patients with acute arterial thrombosis than in patients with acute arterial embolism. Atrial fibrillation had a strong predilection for patients with acute arterial embolism (x2 = 14.00, P < 0.05). Previous arterial embolism history (x2 = 4.24, P < 0.05) was only seen in patients with acute arterial embolism. Conclusion The clinical factors helpful for differentiating acute arterial embolism from acute arterial thrombosis include:clinical manifestations (dyskinesia, impaired sensation and peripheral pulse condition of the healthy limb), the obstructed sites,the history of intermittent claudication and previous arterial embolism , the severity of ischemia, and the high-risk factors of the peripheral vascular disease (atrial fibrillation, hypertension, diabetes mellitus and smoking habit).(J Intervent Radiol, 2012, 21: 369-373)
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