急性下肢动脉栓塞并发代谢性肌肾综合征的诊治体会

    Experience in management of acute arterial embolism of the lower extremity complicated with myonephropathic-metabolic syndrome

    • 摘要: 目的: 探讨急性下肢动脉栓塞并发代谢性肌肾综合征的确诊和治疗方法。方法: 密切监测肢体的缺血情况及肿胀程度,检测血肌酸磷酸激酶(CPK)、谷草转氨酶(SGOT)、乳酸脱氢酶(LDH)及血钾的变化,反复查血肌酐、血尿素氮及血pH值的变化情况,一旦确诊,应及时作小腿骨筋膜室切开,动脉取栓术前、中、后应用碱化尿液和清除氧自由基药物。结果: 46例患者中有18例并发代谢性肌肾综合征,经处理后,有2例病死,病死率为11.1%;1例膝上截肢,截肢率为5.6%。结论: 尽快取栓,配以术前、术中、术后碱化尿液及清除氧自由基的药物,及时有效的筋膜室切开,可以明显降低病死率和截肢率。

       

      Abstract: Objective: To investigate the effective means for the diagnosis and treatment of acute arterial embolism of the lower extremity complicated with myonephropathic metabolic syndrome(MMS).Methods: The extent of the welling and ischemia of the lower extremity,the change of creatine phosphokinase(CPK),serum glutamic-oxaloacetic transaminase(SGOT),lactat dehydrogeneise(LDH) and blood potassium were monitored.Creatinine BUN and pH of the blood were checked repeatedly.Once diagnosed,fasciotomy should be performed.In addition,alkalinization of the urine,oxygen-derived free radical scavengers should be administered.Results: Of the 48 patients with acute arterial embolism of the lower extremity,18 were complicated with MMS.One died,and the mortality rate was 11.1%;one case was amputated up the knee,and the rate of amputation was 5.6%.Conclusions: The rate of death or amputation might be reduced by embolectomy combined with the administration of vigorous hydration,alkalinization of the urine,oxygen-derived free radical scavengers and effective fasciotomy.

       

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