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JACC：美发布汇编版外周动脉疾病治疗指南

2013-04-10 伊文 医师报

外周动脉治疗指南
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　　近日，美国心脏病学会基金会(ACCF)和美国心脏协会(AHA) 对2005 年和2011年外周动脉疾病(PAD)治疗指南进行了汇编，内容涵盖下肢PAD、肾动脉疾病、肠系膜动脉疾病、腹主动脉及其分支动脉瘤等方面，对2011 年更新的建议进行了重点推荐。（J Am CollCardiol. 2013 年3 月5&nbs

　　近日，美国心脏病学会基金会(ACCF)和美国心脏协会(AHA) 对2005 年和2011年外周动脉疾病(PAD)治疗指南进行了汇编，内容涵盖下肢PAD、肾动脉疾病、肠系膜动脉疾病、腹主动脉及其分支动脉瘤等方面，对2011 年更新的建议进行了重点推荐。（J Am CollCardiol. 2013 年3 月5 日在线版）

　　下肢动脉疾病 在诊断上，2011 版指南建议，所有疑为下肢动脉疾病者均应接受静息踝臂指数（ABI） 检查， 包括劳力性腿部不适、伤口不愈合、年龄≥ 65 岁、年龄≥ 50 岁但伴吸烟或糖尿病的个体。ABI正常值为1.00~1.40，临界值为0.91~0.99，≤ 0.9 则提示异常。除了ABI 检查，脉冲量记录、连续波多普勒超声检查、平板运动试验和6 min 步行试验、下肢双功能超声、CT 血管造影、磁共振血管造影和对比剂血管造影也可用来诊断下肢动脉疾病。

　　在治疗方面，2011 版指南着重对戒烟和抗栓治疗进行了更新。指南建议，接诊医生应询问吸烟者或既往吸烟者的吸烟情况，并为吸烟者提供咨询和戒烟计划，包括行为和药物戒烟治疗，若无禁忌，建议选用伐尼克兰、安非他酮和尼古丁替代治疗中一种或多种药物进行治疗。

　　指南指出，有症状的动脉粥样硬化性下肢动脉疾病患者应接受抗血小板治疗，建议应用小剂量阿司匹林（75~325mg/d）或氯吡格雷（75 mg/d）；ABI ≤ 0.9 的无症状患者也可考虑抗血小板治疗；然而，在抗血小板治疗的基础上加用华法林不仅不能降低不良心血管缺血事件风险，反而增加大出血风险。

　　肾动脉狭窄 指南建议，血管紧张素转换酶抑制剂、血管紧张素Ⅱ受体拮抗剂和钙拮抗剂均可用来控制单侧肾动脉狭窄导致的高血压，β 受体阻滞剂治疗肾动脉狭窄相关高血压也有效。肾动脉狭窄患者若血液动力学明显异常、血压迅速升高、合并顽固性高血压、恶性高血压、高血压伴原因不明的单侧肾脏缩小及不能耐受药物治疗的高血压时，可考虑经皮血运重建。

　　腹主动脉瘤 2011 版指南建议，如腹主动脉瘤或髂总动脉瘤患者具备较好手术条件，可行开腹或血管内修复术。腹主动脉瘤或髂总动脉瘤患者接受血管内修复术后应定期进行影像学检查，以监测有无内漏、记录动脉瘤囊的稳定性以及明确患者是否需要进一步干预。

与心脏病相关的拓展阅读：


    

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    2013-08-25 w984445tii

    #治疗指南#

    0

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    2013-07-12 qindq

    #疾病治疗#

    0

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    2014-03-19 hbwxf

    #JACC#

    0

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    2013-04-12 仁心济世

    #ACC#

    0

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    2013-04-12 wujh_7312825

    #外周动脉#

    0