摘要
目的:已经证明新的药物治疗对间歇性跛行患者有效,且近年来外周血管的介入技术发展迅速,促进了外周动脉疾病的治疗。综述外周动脉疾病治疗的临床进展,为最佳的药物治疗配合适当的介入治疗提供参考,使外周动脉疾病患者取得最好的长期预后。资料来源:应用计算机检索Medline数据库1991/2006-04期间的相关文章,检索词“peripheralarterialdisease,catheterization,peripheral,genetics”,限定文章语言种类为English;同时计算机检索中国期刊全文数据库、万方数据库1994/2006-04期间的相关文章,检索词“外周动脉疾病/周围动脉疾病、间歇性跛行、治疗”,限定文章语言种类为中文。资料选择:对资料进行初审,选取包括外周动脉疾病治疗的相关文献,开始查找全文。纳入标准:外周动脉疾病与药物治疗、支架、血管成行术、基因治疗、外科手术。寻找有关外周动脉疾病治疗方面的基础研究、临床研究、正式组织发表的科学标准。排除标准:重复研究、综述文献、Meta分析类文献。资料提炼:共收集到60篇关于外周动脉疾病治疗的相关文章,纳入30篇包括外周动脉疾病治疗的相关文献进行综述,排除30篇为重复研究、综述文献、Meta分析类文献。资料综合:①外周动脉疾病的患病率取决于如何诊断。以检查足部动脉搏动为标准的方法会过高估计患病率。相反,询问间歇性跛行病史又会过低估计患病率。血管造影已经证实外周动脉疾病患者踝/肱指数测定是有效的,其敏感性为95%,特异性为100%。②外周动脉疾病的危险因素与心脑血管疾病相似。外周动脉疾病患者治疗的主要目的是预防全身动脉粥样硬化疾病的进展和临床心血管事件,预防截肢和改善间歇性跛行患者的功能状态。③外周动脉疾病的治疗必须包括冠状动脉粥样硬化性心脏病二级预防策略中对危险因素的控制,包括戒烟、减轻体质量、控制血糖、控制血压、降低高胆固醇血症等;有指导的运动疗法是非介入性治疗策略中最有效的方法;药物治疗主要包括抗血小板治疗、血管扩张药物治疗、抗凝治疗。如患者有明显的临床缺血性症状而内科治疗无效则需行经皮介入治疗或外科手术治疗。结论:有指导的运动疗法、最佳的药物治疗配合适当的介入治疗,可以使外周动脉疾病患者取得最好的长期预后。
OBJECTIVE： Newer medicine therapies have been proved efficacy in patients with intermittent claudication. With rapid advances of intervention devices and techniques for peripheral vessels in recent years, which has improved the therapy of peripheral artery disease （PAD）. To review the clinical developments in treatment of PAD so as to provide references for optimal integrated therapy of medicine with proper interventional treatment, which enable PAD patients to achieve the greatest long-term prognosis . DATA SOURCES： A computer-based search for literatures related to PAD from 1991 to April 2006 was conducted in Medline databasewith the keywords of ＂peripheral arterial disease, catheterization, peripheral, genetics＂, and the language was limited to English. Meanwhile, Chinese relevant literatures between 1994 and April 2006 were searched in Journal Full-text Database and Wanfang Database by computer with the keywords of ＂peripheral arterial disease, intermittent claudication, management＂. STUDY SELECTION： Primary selection was performed by following inclusive criteria： PDA and drug treatment, stent, angioplasty, genetic therapy, surgery, and articles related to PDA were selected. Scientific criteria of treatment for PDA were looked for in basic researches, clinical studies and those published in formal organizations. Exclusive criteria： Repetitive studies, reviews and Meta analytical literatures were excluded. DATA EXTRACTION： A total of 60 literatures about the treatment for PDA were collected, 30 enrolled articles in which were reviewed. Thirty repetitive studies, reviews and Meta analytical literatures were excluded. DATA SYNTHESIS：①The prevalence of PAD depends on the diagnosis. Given the inaccuracy of physical examination, use of pulse examination as the sole criterion would grossly overestimate the prevalence. In contrast, a historical query for intermittent claudication would underestimate the prevalence of PAD. The ankle-brachial index （ABI） has been validated by angiography with the sensitivity of 95% and the specificity of 100%.②The risk factors of PAD were similar to those in patients with cardiovascular disease and cerebrovascular disease. The goals of therapy for patients with PAD are to prevent systemic atherosclerotic disease progression and clinical cardiovascular events as well as prevent limb loss and improve the functional status of patients with intermittent caludication. ③Medical therapy of PAD should include manipulations of risk factors for atherosclerotic heart disease, including smoke-stopping; body mass reducing, blood glucose controlling, blood pressure controlling and hypercholestermia reducing etc. Instructive exercise therapy is the most effective way in non-interventional therapy, while medicine therapy mainly included antiplatelet therapy, angiotenic therapy and anticoagulation therapy. If the patients has obvious clinical ischemla symptoms and cannot be relieved by medical treatment, then interventional therapy or surgery is necessary. CONCLUSION： Patients with PAD can achieve the best long-term prognosis by an instructive exercise treatment integrated with optimal medicine therapy and proper interventional therapy.
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2007年第4期733-736,共4页
Journal of Clinical Rehabilitative Tissue Engineering Research
