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目的探讨经皮血管腔内成形术(PTA)对不同程度下肢慢性缺血病变患者生存质量的影响。方法选择2007年6月至2010年6月在该院行PTA治疗的下肢慢性缺血患者68例,按卢瑟福-贝克分级量表分为跛行组(30例)和缺血组(38例),所有患者均于术前、出院前1 d及出院后6个月以SF-36量表评价生存质量,测量踝肱指数(ABI),统计疼痛缓解率、截肢率及死亡率。结果缺血组下肢完全血运重建率明显低于跛行组(P<0.05)。跛行组的患者出院前1 d及出院后6个月ABI及疼痛缓解率明显高于缺血组(P<0.05)。跛行组无死亡和截肢患者,缺血组6个月截肢率为10.2%(5条/49条),死亡2例,组间无统计学差异(P>0.05)。跛行组出院前1 d及出院后6个月SF-36量表中的8个维度均较术前高(P<0.05),但在出院前1 d及出院后6个月间无显著差异(P>0.05);缺血组在出院前1 d生理功能(PF)、躯体疼痛(BP)及活力(VT)等维度较术前高(P<0.05),出院后6个月高于术前的维度只有BP和VT(P<0.05),且维度在出院前1 d至出院后6个月间有下降趋势,但未发现显著差异(P>0.05)。除情感职能(RE)和精神健康(MH)外出院前1 d的其他维度在两组间存在显著差异(P<0.05),出院后6个月除总体健康(GH)、RE及MH外的维度在两组间存在显著差异(P<0.05)。结论 PTA可改善下肢慢性缺血病变患者血供,缓解症状,减少截肢率,提高其生存质量,尤其对于间歇跛行的患者。但对于严重下肢慢性缺血的患者,PTA完全血运重建率低,即使完全血运重建,也不一定能减低截肢概率,改善生存质量,故选择适当的适应证尤为重要。
Objective To investigate the effect of percutaneous transluminal angioplasty (PTA) on the quality of life of patients with different degrees of lower extremity chronic ischemic lesions. Methods Sixty-eight patients with lower extremity chronic ischemia treated with PTA from June 2007 to June 2010 were divided into limp group (n = 30) and ischemia group (n = 38) according to Rutherford-Baker grading scale ). All patients were evaluated on the quality of life, the ankle brachial index (ABI), the rate of pain relief, the rate of amputation and the rate of death by the SF-36 scale 1 d before surgery and 6 months after discharge. Results The complete revascularization rate of lower extremity in ischemic group was significantly lower than that of limp-like group (P <0.05). Patients in the claudication group had better ABI and pain relief at 1 d before discharge and at 6 months after discharge than those in the ischemic group (P <0.05). There was no death or amputation in the claudication group. The amputation rate in the ischemic group was 10.2% (5/49) at 6 months, and 2 patients died. There was no significant difference between the two groups (P> 0.05). Eight dimensions of the SF-36 scale at 1 d before discharge and 6 months after discharge in the claudication group were significantly higher than those before operation (P <0.05), but there was no significant difference between the 1 d before discharge and the 6 months after discharge P> 0.05). The ischemic group had higher dimensions of physical function (PF), body pain (BP) and activity (VT) than those before operation 1 d before discharge (P <0.05) Only BP and VT (P <0.05), and the dimension decreased from 1 d before discharge to 6 months after discharge, but no significant difference was found (P> 0.05). There was a significant difference (P <0.05) between the two groups on other dimensions except for emotional function (RE) and mental health (MH) on the first day before discharge. After 6 months of discharge, except for general health (GH), RE and MH There was a significant difference in dimensions between the two groups (P <0.05). Conclusions PTA can improve blood supply, relieve symptoms, reduce amputation rate and improve quality of life in patients with chronic ischemia of lower extremities, especially in patients with intermittent claudication. However, for patients with severe chronic ischemia of the lower extremities, the complete revascularization rate of PTA is low. Even if complete revascularization does not necessarily reduce the probability of amputation and improve the quality of life, it is especially important to choose appropriate indications.