摘要
目的:观察自体外周血干细胞移植对下肢缺血性疾病截肢率及截肢平面的影响。方法:选择2003-11/2004-07解放军第四六三医院30例下肢缺血性疾病患者,已行单侧下肢截脚术3侧,均经药物治疗疼痛及创面无改善,经彩色超声多普勒和血管造影检查显示有不同程度的下肢血管闭塞,临床已诊断以闭塞部位确定截肢平面。施行自体外周血干细胞移植治疗,观察移植治疗后截肢率和截肢平面的降低情况,以及经自体外周血干细胞移植治疗后足部皮温,踝脓比、经皮氧分压、疼痛的改善及创面愈合情况。结果:按实际处理分析,30例患者均进入结果分析。①降低截肢率情况:27例患者移植后截肢8例,截肢率为30%(8/27),截肢率降低了70%。②截肢患者降低截肢平面情况:3例已截肢患者行再次截肢,8例移植后截肢,移植术后截肢患者11例中拟截肢平面为大腿6例、小腿2例、足3例,实际截肢平面为大腿3例、小腿4例、足趾3例、趾1例。降低截肢平面者8例。③移植前后患足皮温和经皮氧分压变化情况:移植后患者皮温较移植前明显升高[(325±1.3],(28.1±1.5)℃,P<0.011,移植后经皮氧分压测定较移植前明显增高[(4.0±0.80),(3.2±0.53)kPa,P<0.01]。④移植后3个月局部疼痛及创面愈合情况随访;疼痛消失、剖面愈合11例;疼痛减轻,创面面积减少5例;疼痛减轻,创面面积无明显变化7例;无效7例。结论:外周血干细胞移植治疗下肢缺血性血管病,可促进剖面愈合,降低截肢率和降低截肢平面,无明显副作用及并发症,可望成为一种简单的、有效的治疗下肢动脉缺血性疾病的方法。
AIM: To observe the effect of autologous peripheral blood stem cell transplantation(PBSCT) on amputation rate and amputation level in ischemic diseases of lower extremity. METHODS: Thirty patients with ischemic diseases of lower extremity were selected from the 463 Hospital of Chinese PLA between November 2003 and July 2004. including 3 having their single foot amputated. No relief of pain ami no healing of wound were found in all patients after drup treatment. All blood vessels of lower extremities were obstructed at different degrees diagnosed by color Doppler ultrasound and angiography. It was clinically verified that the amputation level should be judged by amputation position. Autulogous PBSCT was performed is all the patients to detect the decrease of amputation rate and amputation level, the improvement of fool skin temperature, ankle/brachial index(ABI), transcutaneous oxygen partial pressure (TcPO2), relief of pain and wound healing. RESULTS: According to the actual management analysis, all the 30 puiients were involved in the result analysis. (1)The decreasing ampu tation rale after translpantation: Eight patients were amputated in 27 patients at the amputation rate of 30% (8/27), which was deceased by 70%. (2) The decreasing amputation level after transplantation: Eleven patients were amputated, including 3 patients amputated for the second time after transplantation and 8 amputated after transplantation. The planned amputation level was 6 thighs. 2 legs and 3 feet, and the actual one was 3 thighs, 4 legs. 3 feet and 1 toe. Amputation level was decreased in 8 of 11 amputated patients. (3) The skin temperature was significantly higher in the affected feet after transplantation than before transplantation [ (32. 5±1. 3)℃. vs (28. 1±1.5)℃, P < 0. 01 ]. The TcPO2 after transplantation was significantly higher than that before transplantation[(4.0±0. 80) kPa vs (3. 2±0. 53 ) kPa. P < 0. 01 ]. (4)The condition of patients 3 months after transplantation in local pain and wound healing: pain vanished and wound healed in 11 palienis, pain released ami partial wound healed in 5 patients, pain released and wound was unchanged in 7 patients and ineffectiveness was in 7 patients. CONCLUSION: Autologous PBSCT for ischemic diseases of lower extremity can promote wound healing and decrease amputation rate and amputation level without obvious side effects and complication, so autologous PBSCT is expected to be a simple and effective method for the treatment of ischemic diseases of lower extremity.
出处
《中国临床康复》
CSCD
北大核心
2005年第18期44-45,共2页
Chinese Journal of Clinical Rehabilitation
