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在慢性肢体威胁性缺血症的重血管化后伤口管理策略的影响
Tsunehiro Shintani1, Hideaki Obara2, Kentaro Matsubara2
1Department of Vascular Surgery, Shizuoka Red Cross Hospital, Shizuoka, Japan.
Journal of vascular surgery
|November 8, 2023
概括
在慢性四肢威胁性缺血症 (CLTI) 患者中,怀疑骨质炎的早期脚截肢显著改善了伤口愈合和四肢挽救率,相比于在重新血管化后的警等待.
科学领域:
- 血管外科 血管外科
- 伤口愈合 伤口愈合
- 肢体的救援工作
背景情况:
- 慢性四肢威胁性缺血症 (CLTI) 缺乏标准化的伤口管理指南.
- 在重血管化手术后的CLTI患者中,脚伤口是一个挑战.
研究的目的:
- 评估不同伤口管理策略在CLTI患者重血管化后对脚伤口的临床影响.
- 为了比较早期的脚截肢与对疑似骨髓炎的警等待.
主要方法:
- 在8个日本机构进行的回顾性队列研究 (2019年4月至2021年7月).
- 包括132名患有脚伤的CLTI患者,并恢复了血液流动.
- 使用倾向分数匹配,比较早期截肢 (A组) 和警等待 (B组) 之间的结果.
主要成果:
- 匹配分析 (33名患者/组) 显示,A组 (90.0%) 与B组 (68.2%) (P <.001) 的1年伤口愈合显著改善.
- 在A组 (65天) 和B组 (258天) 中,中位愈合时间更快 (P < .01).
- 组A的肢体恢复率为100%,而B组的这一比例为90.5% (P = .02),而A组没有需要进行重大截肢,而B组则需要5次截肢.
结论:
- 在CLTI患者中,在疑似骨髓炎的脚的早期截肢加快了脚伤口的愈合,并减少了主要截肢率.
- 这种策略可能会改善与警等待相比,四肢救援的结果.
- 伤口管理方法对于接受再血管化治疗的CLTI患者的成功结果至关重要.
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