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1、中西医结合治疗 下肢动脉硬化闭塞症 Integrative Medicine arteriosclerosis obliterans作者：郑焕金、艾发元、王丽娟 苗志勃、贾岩 author ： Huan Jin Zheng, Ai- fa yuan, Wang Lijuan ，Miao Zhi Bo, Jia Yan 一、概述n 随着社会整体生活水 平的提高和人口的老 龄化，下肢动脉硬化 闭塞症的发病和下肢 动脉硬化闭塞症就诊 的患者将越来越多， 最新一项统计结果显 示全美国下肢动脉硬 化闭塞症共有一千两 百万患者。nWith the improvement of living standar
2、ds of society as a whole and the aging of the population, The incidence of arteriosclerosis obliterans and arteriosclerosis obliterans patients will seek treatment for more and more. The latest findings of a survey throughout the United States a total of arteriosclerosis obliterans in patients with
3、twelve million。一、概述nMeijer W等研究结果显示， 下肢动脉硬化闭塞症若以 踝肱指数(ankle-brachial pressure index，ABPI)小于 0.9%为诊断标准，55岁以 上人群的下肢动脉硬化闭 塞症患病率是10-25， 但以间歇性跛行等临床表 现来诊断下肢动脉硬化闭 塞症患病率仅为前者下肢 动脉硬化闭塞症的10%- 20%。n Meijer W, etc. The results show ankle-brachial pressure index Criteria for the diagnosis of less than 0.9%.People
4、 over the age of 55 lower extremity arteriosclerosis obliterans prevalence rate is 10% -25%, but the clinical manifestations of intermittent claudication to diagnose the disease rate lower extremity arteriosclerosis obliterans arteriosclerosis obliterans of the former 10% -20%.。n在中国，年龄50岁 以上的心血管高危 人
5、群中，四分之一 存在下肢动脉疾病 。北京60以上的老 年人中，下肢动脉 疾病患者约为五分 之一。一、概述nIn China, the age of 50 years of age in cardiovascular high-risk groups, there is a quarter of lower extremity arterial disease. Beijing 60 or older, the lower extremity arterial disease is about one-fifth of patients。n1.1 年龄是下肢动脉硬化 闭塞症的首要危险致病因 素，
6、随着年龄的增长其发 病率升高。n1.2 有糖尿病史患者具有 下肢动脉硬化闭塞症患病 率较高、患病年龄小、病 程 进展快等特点。n1.3 吸烟对外周血管的危 害极大，是心、脑血管的 两倍。高血压、高脂血症 、肥胖等也是下肢动脉硬 化闭塞症下肢动脉硬化闭 塞症的致病因素。 二、致病因素二、致病因素：n1.1 Age is the primary arteriosclerosis obliterans disease risk factors, with age the incidence rate increasedn1.2 History of diabetes patients with lo
7、wer extremity arterial occlusive disease prevalence of high prevalence of young age, rapid progression and so on.n1.3 The harm of smoking on peripheral vascular great is the heart, cerebrovascular twice.Hypertension, hyperlipidemia, and obesity is lower limb arteriosclerosis obliterans arteriosclero
8、sis obliterans factor.。n该病是多种因素长期综合性 作用的过程。动脉壁内皮细 胞受损、功能改变、渗透性 增高，血液中的单核细胞粘 附、侵润、进入内皮下，吞 噬脂质成为泡沫细胞，形成 脂肪斑，血小板聚集也在局 部粘附、活化，吞噬细胞、 内皮细胞及粘附于内皮细胞 损伤处的血小板释放生长因 子刺激平滑肌细胞进入内膜 并增殖，脂肪斑变成纤维斑 块，最终导致动脉粥样硬化 下肢动脉硬化闭塞症。三三. .发病机理发病机理nThe disease is a comprehensive long-term effect of many factors in the process.Arte
9、rial wall endothelial cell damage, functional changes, increased permeability of the blood mononuclear cell adhesion, invasion into the endothelium, the phagocytosis of lipid to become foam cells, the formation of fatty plaques, platelet aggregation also in focal adhesion, activation , phagocytic ce
10、lls, endothelial cells and adhesion to endothelial cell damage at the stimulation of platelet release of growth factors and proliferation of smooth muscle cells into the intima, fatty plaque into fibrous plaque, eventually leading to atherosclerosis arteriosclerosis obliterans。三.发病机理n下肢动脉硬化闭塞症动脉 粥样硬
11、化主要累及体循环 系统的大型弹力型动脉和 中型肌弹力型动脉，外周 血管以下肢动脉病变多见 ，髂、股、腘动脉均可受 累，后期可延及其远端大 的分支。糖尿病下肢动脉 硬化闭塞的病变相对特殊 ，胫前、胫后和腓动脉受 累多见，血管壁粥样硬化 改变不明显，下肢动脉硬 化闭塞症临床症状多由血 栓形成而引起。nLower extremity arterial occlusive atherosclerotic disease mainly involving large-scale circulation systems and medium-sized muscular arteries elastic
12、arteries elastic, peripheral arterial disease in lower limbs more common iliac, femoral, popliteal artery can be involved, and the latter can be extended far end of large branches. Diabetic lower extremity arterial occlusive lesions relatively specific, anterior tibial, posterior tibial and common p
13、eroneal artery involvement, atherosclerotic changes in vessel wall was not obvious, lower extremity arterial occlusive disease clinical symptoms caused by the thrombosis。四、临床分期n第期-局部缺血期：n疾病初期阶段，动脉 硬化闭塞较轻，有慢 性肢体缺血表现，以 间歇性跛行为主，患 肢远端怕冷、发凉、 麻木、或轻度胀痛。 患足皮色苍白或萎黄 ，皮肤温度低，动脉 搏动多减弱。nStage - ischemic periodn T
14、he early stages of disease, arteriosclerosis obliterans light, the performance of chronic limb ischemia, intermittent claudication mainly distal limb cold, cold, numbness, or mild pain. The affected foot or skin color pale complexion, the skin temperature is low, arterial pulse weakened and more.。四、
15、临床分期n第期-营养障碍期：n 此期患者肢体缺血加重， 开始出现营养障碍表现， 如皮肤变薄而光亮，皮下 脂肪垫萎缩，汗毛脱落， 趾甲增厚，肌肉萎缩，小 腿变瘦，间歇性跛行，且 有静息痛，夜间加重。患 足皮肤明显苍白或紫红， 趾端发绀，或有瘀斑瘀点 ，动脉搏动明显减弱或消 失。nStage - Nutrition disorders periodn The increase in patients with limb ischemia, the performance began to nutritional disorders, such as skin thinning and bright
16、, subcutaneous fat pad atrophy, fine hair loss, thickened nails, muscle atrophy, thin legs, intermittent claudication, rest pain and there, increased at night. The affected foot was pale or purple skin, toe cyanosis, petechia or ecchymosis, arterial pulse was reduced or lost。四、临床分期第期-坏死期：n此期为疾病晚期阶段，动脉 硬化闭塞严重，侧枝循环不 良，肢体严重缺血而导致溃 疡、坏疽，动脉搏动消失。 患者除有间歇性跛行，静息 痛等症状外，发生肢体溃疡 坏疽， 根据坏死范围可
