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中华危重症医学杂志(电子版) ›› 2022, Vol. 15 ›› Issue (05) : 399 -404. doi: 10.3877/cma.j.issn.1674-6880.2022.05.009

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急性缺血性脑卒中合并上肢动脉栓塞三例救治分析
王瑶1, 张劲松1, 姜丽丽1, 万芬1, 陈旭锋1, 蒋雷1,()   
  1. 1. 210029 南京,南京医科大学第一附属医院 江苏省人民医院急诊科
  • 收稿日期:2022-03-11 出版日期:2022-10-31
  • 通信作者: 蒋雷
  • 基金资助:
    国家自然科学基金青年基金项目(81701872); 江苏省"六大人才高峰"资助项目(WSN-005); 江苏省"六个一工程"拔尖人才科研项目(LGY2019068)
  • Received:2022-03-11 Published:2022-10-31
引用本文:

王瑶, 张劲松, 姜丽丽, 万芬, 陈旭锋, 蒋雷. 急性缺血性脑卒中合并上肢动脉栓塞三例救治分析[J]. 中华危重症医学杂志(电子版), 2022, 15(05): 399-404.

卒中的临床表现多样,肢体功能活动障碍为重要的发病表现之一。肢体动脉栓塞的症状与卒中部分相似,既往临床上经常容易误诊、漏诊及延误治疗,导致患者肢体残疾甚至危及生命[1,2]。心房纤颤是引起动脉栓塞最主要的病因,约占80%[3,4,5,6,7,8,9]。研究表明心房纤颤大多引起单一器官的动脉栓塞,其中以脑栓塞最常见,2个及以上部位的器官栓塞少见[9,10,11,12,13,14]。本研究收集江苏省人民医院自2020年1月至2021年12月急诊卒中绿色通道中的3例急性缺血性脑卒中合并上肢动脉栓塞患者资料并结合文献进行分析,对此类患者的临床特点及治疗预后进行总结,希望为临床诊治提供借鉴。

图1 急性缺血性脑卒中合并上肢动脉栓塞病例1影像资料注:a图为CT提示右侧颈内动脉及右侧大脑中动脉栓塞(箭头所示);b图为B超提示左侧肱动脉闭塞(箭头所示);c图为头颅CT提示右侧额颞顶部脑出血,蛛网膜下腔出血,侧脑室及第三四脑室积血
图2 急性缺血性脑卒中合并上肢动脉栓塞病例2影像资料注:a图为数字减影血管造影提示右侧腋动脉栓塞(箭头所示);b图、c图为头颅磁共振提示左侧小脑、双侧额叶及顶叶急性脑梗死
图3 急性缺血性脑卒中合并上肢动脉栓塞病例3影像资料注:a图为数字减影血管造影提示左侧肱动脉栓塞(箭头所示);b图、c图为头颅磁共振提示左侧小脑、脑干急性脑梗死
表1 急性脑栓塞合并急性上肢动脉栓塞15例患者的基本情况
作者 发表时间 年龄(岁) 性别 病因 发病时间(h) 栓塞部位 处理 预后
吴良平等[17] 2005 64 AF 4.0 脑栓塞,右侧肱动脉栓塞,左侧腋动脉栓塞 静脉溶栓(具体药物不详)同时双侧肱动脉切开及取栓术 动脉恢复血流,但mRS 5分
陈欣欣[18] 2011 17 左心房黏液瘤 16.0 脑栓塞,右上肢动脉栓塞 介入治疗,抗凝 病情好转,具体血流及mRS不详
张沁丽等[19] 2014 42 卵圆孔未闭 24.0 脑栓塞,左侧锁骨下动脉及腋动脉栓塞 抗凝 病情好转,具体血流及mRS不详
杨宁等[20] 2015 75 风湿性心脏病,AF 48.0 脑栓塞,右侧肱动脉及尺桡动脉栓塞,右肾动脉栓塞 尿激酶静脉溶栓,抗凝 远端动脉部残余灌注不足,mRS 0分
Lee等[21] 2015 73 AF,缺血性心脏病 5.0 脑栓塞,右侧肱动脉栓塞 右上肢探查和右臂动脉取栓术,抗凝 右肱动脉完全再灌注,mRS 0分
焦莉等[22] 2017 45 左心房黏液瘤 0.5 脑栓塞,右侧尺动脉栓塞 静脉溶栓(具体药物不详) -
Nakano等[23] 2017 82 AF,心脏瓣膜病 - 脑栓塞,左侧锁骨下动脉、腹主动脉栓塞,双侧股动脉栓塞,肾梗死,脾梗死 肝素抗凝 血管条件差,由于多发栓塞于24 h内死亡
Khilchuk等[24] 2017 80 AF,缺血性心脏病 - 脑栓塞,右侧腋动脉栓塞 静脉溶栓(rt-PA)同时介入治疗 右腋动脉再灌注,mRS 0分
Vollherbst等[25] 2021 85 - - 脑栓塞,右侧肱动脉栓塞 静脉溶栓(rt-PA)同时介入治疗 远端动脉部残余灌注不足,mRS 5分
    71 AF - 脑栓塞,右侧肱动脉栓塞 静脉溶栓(rt-PA)同时介入治疗 远端动脉部残余灌注不足,mRS 5分
    83 - - 脑栓塞,左侧腋动脉栓塞 静脉溶栓(rt-PA)同时介入治疗 远端动脉部残余灌注不足,mRS 5分
    81 AF - 脑栓塞,右侧肱动脉栓塞 介入治疗 远端动脉部残余灌注不足,mRS 2分
    68 AF - 脑栓塞,右尺动脉栓塞 介入治疗后血管未开通,药物继续治疗后4 d行手术治疗 远端动脉部残余灌注不足,mRS 5分
    60 AF - 脑栓塞,右侧肱动脉栓塞 介入治疗 远端动脉部残余灌注不足,mRS 0分
    87 AF - 脑栓塞,右侧腋动脉栓塞 介入治疗 远端动脉部残余灌注不足,mRS 4分
1
Holmstedt C, Chimowitz M. E-Pearl: brachial artery embolus mimicking acute stroke[J]. Neurology, 2011, 76 (18): e86-e87.
2
谭必瞻,曾宪筠.急性肢体动脉栓塞误诊为脑梗死15例分析[J].实用医学杂志201026(14):2644-2645.
3
Haimovici H. Cardiogenic embolism of the upper extremity[J]. J Cardiovasc Surg (Torino), 1982, 23 (3): 209-213.
4
Freedman B, Hindricks G, Banerjee A, et al. World Heart Federation roadmap on atrial fibrillation — a 2020 update[J]. Glob Heart, 2021, 16 (1): 41.
5
Zaidel EJ, Leng X, Adeoye AM, et al. Inclusion in the World Health Organization model list of essential medicines of non-vitamin K anticoagulants for treatment of non-valvular atrial fibrillation: a step towards reducing the burden of cardiovascular morbidity and mortality[J]. Glob Heart, 2020, 15 (1): 52.
6
Chao TF, Joung B, Takahashi Y, et al. 2021 focused update of the 2017 consensus guidelines of the Asia Pacific Heart Rhythm Society (APHRS) on stroke prevention in atrial fibrillation[J]. J Arrhythm, 2021, 37 (6): 1389-1426.
7
Freeman JV, Wang Y, Akar J, et al. National trends in atrial fibrillation hospitalization, readmission, and mortality for Medicare beneficiaries, 1999-2013[J]. Circulation, 2017, 135 (13): 1227-1239.
8
王娟,杨艳敏,朱俊,等. ≥ 75岁急诊心房颤动患者的预后分析——中国急诊心房颤动研究的亚组分析[J].中华急诊医学杂志202130(12):1459-1464.
9
Staerk L, Sherer JA, Ko D, et al. Atrial fibrillation: epidemiology, pathophysiology, and clinical outcomes[J]. Circ Res, 2017, 120 (9): 1501-1517.
10
Kodani E, Akao M. Atrial fibrillation and stroke prevention: state of the art—epidemiology and pathophysiology: new risk factors, concepts and controversies[J]. Eur Heart J Suppl, 2020, 22 (Suppl O): O1-O13.
11
常三帅,常栋,邱接,等.非瓣膜病心房颤动患者发生外周动脉栓塞的单中心病例对照研究[J].中华心血管病杂志2014(7):577-581.
12
常三帅,高连君,常栋,等.心房颤动与周围动脉栓塞[J].中华心律失常学杂志201418(4):316-318.
13
陈洁霞,唐海沁,李结华. 3 194例心房颤动患者并发肢体动脉栓塞临床分析[J].安徽医科大学学报201146(12):1316-1317.
14
胡大一,张鹤萍,孙艺红,等.华法林与阿司匹林预防非瓣膜性心房颤动患者血栓栓塞的随机对照研究[J].中华心血管病杂志200634(4):295-298.
15
王伟明,朱俊龙,胥雄飞,等.导管接触性溶栓治疗急性上肢动脉栓塞[J].中国介入影像与治疗学202017(10):585-589.
16
Gerhard-Herman MD, Gornik HL, Barrett C, et al. 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines[J]. Circulation, 2017, 135 (12): e726-e779.
17
吴良平,张玉新,王俊,等.双上肢动脉栓塞合并脑栓塞及出血1例[J].中国普通外科杂志200514(12):921.
18
陈欣欣.左房粘液瘤并发全身血管多发性栓塞1例[J].广东医学院学报201129(6):699-700.
19
张沁丽,王玉芬,武桂花,等.卵圆孔未闭合并贫血致多发动脉栓塞1例报告[J].中风与神经疾病杂志201431(7):654.
20
杨宁,张彩莲.老年房颤并多发动脉栓塞抢救成功1例分析[J].包头医学院学报2015(1):9-9,11.
21
Lee SH, Choi NC, Jang IS, et al. Simultaneous event of brachial artery occlusion and acute embolic stroke[J]. Am J Emerg Med, 2015, 33 (3): 477.e3-477.e4.
22
焦莉,孙钦建.活动中起病的心房粘液瘤致多发栓塞一例[C]. 中国卒中学会第三届学术年会暨天坛国际脑血管病会议2017论文集. 2017:44-44.
23
Nakano H, Yamagami H, Ofuchi H. A case report of systemic embolic events associated with atrial fibrillation[J]. Acute Med Surg, 2017, 4 (1): 127-130.
24
Khilchuk AA, Vlasenko SV, Scherbak SG, et al. Successful carotid thrombus aspiration, middle cerebral mechanical thrombectomy, and axillary artery clot disruption attempt in a patient with acute ischemic stroke and critical upper limb ischemia[J]. Radiol Case Rep, 2017, 13 (1): 183-185.
25
Vollherbst DF, Ulfert C, Maus V, et al. Concomitant acute ischemic stroke and upper extremity arterial occlusion: feasibility of mechanical thrombectomy of the upper limb using neurointerventional devices and techniques[J]. J Clin Med, 2021, 10 (14): 3189.
26
Shi M, Chen LY, Bekwelem W, et al. Association of atrial fibrillation with incidence of extracranial systemic embolic events: the ARIC study[J]. J Am Heart Assoc, 2020, 9 (18): e016724.
27
Bruins Slot KM, Berge E. Factor Xa inhibitors versus vitamin K antagonists for preventing cerebral or systemic embolism in patients with atrial fibrillation[J]. Cochrane Database Syst Rev, 2018, 3 (3): CD008980.
28
Bekwelem W, Connolly SJ, Halperin JL, et al. Extracranial systemic embolic events in patients with nonvalvular atrial fibrillation: incidence, risk factors, and outcomes[J]. Circulation, 2015, 132 (9): 796-803.
29
January CT, Wann LS, Calkins H, et al. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society in collaboration with the Society of Thoracic Surgeons[J]. Circulation, 2019, 140 (2): e125-e151.
30
Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J]. Stroke, 2019, 50 (12): e344-e418.
31
谭颗,钱德才,邓磊,等.静脉溶栓桥接血管内治疗急性缺血性脑卒中患者41例分析[J/CD].中华危重症医学杂志(电子版)201912(6):409-412.
32
Cejna M, Salomonowitz E, Wohlschlager H, et al. rtPA thrombolysis in acute thromboembolic upper-extremity arterial occlusion[J]. Cardiovasc Intervent Radiol, 2001, 24 (4): 218-223.
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