下肢pad的治疗心血管危险矫正治疗对跛行症状的效果.ppt

PAD is highly associated with critical coronary and carotid artery disease that predispose these patients to a marked increase risk of myocardial infarction, ischemic stroke, and vascular death. Primary Goal Aggressive management of cardiovascular risk factors to prevent the progression of leg arterial disease and also to reduce the risk of ischemic events. ? Antiplatelet therapy, angiotensin-converting enzyme (ACE) inhibitor drugs, Statin Secondary Goal Severity of limb symptoms should be assessed ? Structured exercise program, Pletaal PAD is a major manifestation of systemic atherothrombosis that affects a large segment of the adult population. The major treatment goals for this population are to address the marked increase risk in cardiovascular events and then secondarily to treat the disability and reduced exercise tolerance. Once patients have had a complete assessment and management of their risk factor, the second major of consideration is to address their limb symptoms. An important observation is that treatments that reduce cardiovascular risks generally do not improve their claudication symptoms. This claudication must be treated on its own merits. * * 周围动脉疾病（PAD） 定义、 PAD是动脉粥样硬化的一种类型,脂肪沿动脉管壁沉积,导致管腔的狭窄和阻塞性病变，主要损伤下肢和足部的动脉。 流行病学 有症状的PAD患者占55-74岁年龄段人群的4.5%，大约20%的老年人患有症状的或无症状的PAD。 ——德国血管学协会和血管医学协会 周围动脉疾病（PAD） 糖尿病 高血压 高脂血症 危险因素 溃疡和坏死 功能降低 血流减少 溃疡 坏死 静息痛 间歇性 跛行 无症状 麻木冷感 雷诺氏综合征 Level IV Level III Level II Level I PAD 颈动脉 主动脉 肠系膜上动脉腹动脉 肾动脉 髂总动脉 缺血： 血供减少引起疼痛和功能障碍 动脉狭窄 血小板 50%的直径狭窄 75%的面积狭窄 60%的直径狭窄 84%的面积狭窄 主要动脉狭窄 狭窄进展 闭塞 疼痛或静息疼 间歇性跛行 肢冷 皮肤颜色改变 下肢PAD的主要临床表现 间歇性跛行(IC) 行走痛疼，休息后消失 最大行走速度 最大行走距离 血氧峰值 正常 = 3 - 4 mph(英里/小时) PAD = 1 - 2 mph 正常= 无限制 PAD, 31% 家中行走困难 PAD, 66% 难以行走半个街区 PAD, 减少50% Otsuka data set. WR Hiatt et al. J Appl Physiol. 1992;73:346-353 PAD与间歇性跛行 PAD的分级 PAD的分类: Fontaine’s 分期和Rutherford’s 分类 Rutherford Fontaine IIb III III II I I I 0 分级 6 5 4 3 2 1 0 分类 大块组织缺损 小块组织缺损 缺血性静息痛 重度跛行 中度跛行 轻度跛行 无症状 临床特点 溃疡或坏疽 缺血性静息痛 中重度跛