Application Of Thrombolytic Drugs In The Lower Extremity Atherosclerotic Occlusive Disease Surgery

Objective：This study aims to lower extremity atherosclerotic occlusive disease patientshow to reduce the time for elective surgery PTA thrombosis阿occurs secondarycomplications. Were randomly divided into group A, group B and group C。A groupof not using urokinase in group B received0.9%saline250ml compatibility200,000units of urokinase was half an hour before surgery peripheral vein, group Cintraoperative arterial catheter sheath or sheath crosses inject50ml of0.9%salinecompatibility200,000units of urokinase。A comparative study of group B and groupC after lower extremity arterial thrombosis during surgery, the incidence of falseaneurysm, hematoma or without statistical difference。 Discussion urokinase inlower extremity arterial occlusive atherosclerotic disease in patients with surgicalapplications PTA efficacy and safety。The significance of this study is that the resultscan provide guidance to improve clinical results PTA surgery for improving lowerextremity atherosclerotic occlusive disease prognosis after PTA, PTA reduce the riskof lower extremity vascular surgery, such as clogged again has a very importantsignificance。Methods：Select January1,2013to December31,2013Check Vascular Surgery, the FirstAffiliated Hospital of Nanchang University, patients diagnosed with lower extremityatherosclerotic occlusive disease。Exclusion of liver function and blood coagulationabnormalities; rule system of blood diseases such as leukemia, leukocytosispsychosis; rule out malignancy; rule out the use of urokinase contraindications,Include：①recent (within14days) with active bleeding (gastric and duodenalulcers, coughing up blood, hemorrhoids, bleeding, etc.), had surgery, biopsy,cardiopulmonary resuscitation (external cardiac massage, intracardiac injection,intubation), can not be implemented as well as a history of trauma oppressionvascular puncture site；②Control dissatisfied hypertension (blood pressure> 21.3/14.7kPa) or who can not be excluded aortic dissection；③hemorrhagic stroke(including temporary ischemic attack) history;④for expansion and vasopressorunresponsive shock;⑤bacterial endocarditis, mitral valve disease and atrialfibrillation and left ventricular cavity highly suspected thrombosis;⑥bleedingdisorders or bleeding tendency, severe liver and kidney dysfunction and progressivedisease;⑦consciousness disorders. Interventional intraoperative angiographyconfirmed damage contrast extravasation were xenophobic. Select the58patients,including34males and24females, mean age was70.59±5.19years follow-up rateof100%during the observation period. Group A of18patients were randomlydivided into male10cases,8females, mean age71.61±5.14years; group B20cases,14males and6females, mean age69.95±5.36years, group C20cases, male10cases,10females, mean age70.3±5.20years old. Improve the relevant checksbefore surgery, interventional treatment underwent PTA. PTA involvement surgerysuccess criteria: PTA after lower extremity vascular blood flow, residual stenosis≤20%; interventional surgery with no serious complications. Postoperative were givenenoxaparin sodium (Clexane) Q8H use3d, oral Aspirin and clopidogrel100mgtablets (Plavix)75mg QD. Observe whether intraoperative angiography lowerextremity vascular arterial thrombosis, vascular ultrasound after one day if there isarterial thrombosis, postoperative changes in skin temperature, whether oral mucosalbleeding and hematuria, skin ecchymosis size and incidence of pseudoaneurysm.Complete collection of cases and observation data for statistical analysis.Results：A, B, C three groups of patients between the age, sex, hypertension, diabetes,hyperlipidemia proportion of the statistical analysis showed no significant statisticaldifference (P>0.05Table I)；Three groups of patients with lower extremity surgeryafter PTA preoperative lower limb skin temperature and skin temperature analysisthere was a significant difference (P <0.05, Table II); Three groups of patients beforeand after surgery PTA comparative analysis of prothrombin time was no significantstatistical difference (P>0.05, Table3); Fibrinogen compare three groups of patientsbefore and after surgery PTA analyzed statistically significant difference (P <0.05,Table4); Group A1patients after stenting intraoperative angiography showed stent thrombosis, two cases of postoperative ultrasound confirmed stent thrombosis,femoral artery catheter thrombolysis or peripheral intravenous thrombolyticrecanalization angiography showed no significant stenosis; puncture site hematomaand pseudoaneurysm does not appear; Group B1postoperative ultrasonographyconfirmed thrombosis, peripheral intravenous thrombolytic drugs after thrombolysisultrasound confirmed stent patency; puncture site hematoma and pseudoaneurysmdoes not appear; Group C intraoperative and postoperative thrombosis did not occur;puncture site hematoma and pseudoaneurysm does not appear. Lower limb skintemperature after three groups showed significant improvement, with preoperativeskin temperature contrast P <0.05, statistically significant, indicating that PTAsurgery for the treatment of lower extremity atherosclerosis obliterans obvious;Urokinase were significantly reduced compared with nonusers postoperativecomplications secondary to thrombosis, the three groups were not there mouthbleeding and hematuria nasal mucosa; After peripheral intravenous thrombolyticdrugs given partial puncture skin ecchymosis; lower limbs showed significantimprovement in skin color, pain improved significantly, compared with preoperativealleviate most, some complained of increased pain, but the pain changing nature ofant-like acupuncture pain.Conclusion:Arteriosclerosis obliterans in the intervention process should pay attention to thissecondary arterial thrombosis complications, preoperative or intraoperative use ofthrombolytic drugs can effectively reduce or avoid secondary arterial thrombosis,intraoperative administration more safe, non-invasive again, fewer side effects, lessrisk of bleeding.