周邊動脈阻塞

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周邊動脈阻塞
Arterial ulcer peripheral vascular disease.jpg
嚴重周邊動脈阻塞出現的動脈供血不足潰瘍英语arterial insufficiency ulcer
分类和外部资源
醫學專科 心臟內科
ICD-10 I73.9
ICD-9-CM 443.9
DiseasesDB 31142
MedlinePlus 000170
eMedicine med/391 emerg/862
MeSH D016491

周邊動脈疾病Peripheral artery disease, PAD),可以稱為周邊血管疾病(Peripheral vascular disease, PVD)、周邊動脈阻塞性疾病(Peripheral artery occlusive disease, PAOD),或是周邊閉塞性動脈病變(Peripheral obliterative arteriopathy, POA),是一種供應大腦和心臟以外之動脈的窄化現象[1],多數情況會影響患者的雙腿[2]。典型的症狀是走路時腳痛英语Claudication,但這種症狀在休息時便可改善[3]。其他症狀包括:皮膚潰瘍英语Arterial insufficiency ulcer、皮膚偏藍、冰冷,或是患肢的指甲和毛髮生長較差[4]。併發症可能包括感染或壞疽,可能會導致截肢冠狀動脈疾病中風[2],不過有將近一半的病患是沒有症狀的[3]

周邊動脈阻塞最主要的危險因子是吸菸[2]。其他危險因子包括糖尿病高血壓高膽固醇英语Hypercholesterolemia[5]。其潛在的致病機轉通常是動脈粥樣硬化,如果硬化的斑塊脫落將會導致動脈的完全阻塞[6],其他原因包含動脈痙攣英语Vasospasm[1]。周邊動脈阻塞通常藉由發現踝肱指數(Ankle-brachial index, ABI)低於0.90而確診,踝肱指數的公式是腳踝的收縮壓除以手臂的收縮壓[7]血管攝影是更準確的診斷方法,不過它具有一定的風險[7]

目前篩檢的效果仍待進一步研究[8][9],對於周邊動脈阻塞的病患,戒菸和運動療法英语Exercise_therapy能夠改善[10][11]。藥物治療包括HMG-CoA還原酶抑制劑(Statin)、ACE抑制劑西洛他唑 都會有幫助[11][12]阿司匹林對於輕症患者沒有顯著幫助,但通常會建議較嚴重的患者使用[13][14]华法林並沒有特別效益[15]。一些用來治療周邊動脈阻塞的手術包括冠状动脉旁路移植血管再成形術旋切術英语atherectomy[16]

2010年全世界有將近2.02億人有周邊動脈阻塞的疾病[5]。在已開發國家,周邊動脈阻塞在45至50歲的民眾中佔了5.3%,85至90歲中佔了18.6%[5];而在開發中國家,45至50歲的民眾中佔了4.6%,85至90歲中佔了15%[5]。在已開發國家,男女罹病的比例相當;但在開發中國家則是女性較容易罹病[5]。 在1990年,周邊動脈阻塞造成近16,000的死亡;在2013年,周邊動脈阻塞造成的死亡數更高達近41,000人[17]

參考資料[编辑]

  1. ^ 1.0 1.1 What Is Peripheral Vascular Disease? (PDF). https://www.heart.org. 2012 [26 February 2015].  外部链接存在于|website= (帮助)
  2. ^ 2.0 2.1 2.2 What Is Peripheral Arterial Disease?. http://www.nhlbi.nih.gov/. August 2, 2011 [25 February 2015]. 
  3. ^ 3.0 3.1 Violi, F; Basili, S; Berger, JS; Hiatt, WR. Antiplatelet therapy in peripheral artery disease.. Handbook of experimental pharmacology. 2012, (210): 547–63. PMID 22918746. doi:10.1007/978-3-642-29423-5_22. 
  4. ^ What Are the Signs and Symptoms of Peripheral Arterial Disease?. http://www.nhlbi.nih.gov/. August 2, 2011 [26 February 2015]. 
  5. ^ 5.0 5.1 5.2 5.3 5.4 Fowkes, FG; Rudan, D; Rudan, I; Aboyans, V; Denenberg, JO; McDermott, MM; Norman, PE; Sampson, UK; Williams, LJ; Mensah, GA; Criqui, MH. Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis.. Lancet. 19 October 2013, 382 (9901): 1329–40. PMID 23915883. doi:10.1016/s0140-6736(13)61249-0. 
  6. ^ What Causes Peripheral Arterial Disease?. http://www.nhlbi.nih.gov/. August 2, 2011 [26 February 2015]. 
  7. ^ 7.0 7.1 Ruiz-Canela, M; Martínez-González, MA. Lifestyle and dietary risk factors for peripheral artery disease.. Circulation journal : official journal of the Japanese Circulation Society. 2014, 78 (3): 553–9. PMID 24492064. doi:10.1253/circj.cj-14-0062. 
  8. ^ Andras, A; Ferket, B. Screening for peripheral arterial disease. The Cochrane database of systematic reviews. Apr 7, 2014, 4: CD010835. PMID 24711093. doi:10.1002/14651858.CD010835.pub2. 
  9. ^ U.S. Preventive Services Task Force. Peripheral artery disease screening and cardiovascular disease risk assessment with the ankle-brachial index in adults: recommendation statement.. Am Fam Physician. Dec 15, 2014, 90 (12): 858A–858D. PMID 25591190. 
  10. ^ Fokkenrood, HJ; Bendermacher, BL; Lauret, GJ; Willigendael, EM; Prins, MH; Teijink, JA. Supervised exercise therapy versus non-supervised exercise therapy for intermittent claudication.. The Cochrane database of systematic reviews. 23 August 2013, 8: CD005263. PMID 23970372. doi:10.1002/14651858.CD005263.pub3. 
  11. ^ 11.0 11.1 Hankey, GJ; Norman, PE; Eikelboom, JW. Medical treatment of peripheral arterial disease.. JAMA. 1 February 2006, 295 (5): 547–53. PMID 16449620. doi:10.1001/jama.295.5.547. 
  12. ^ Bedenis, R; Stewart, M; Cleanthis, M; Robless, P; Mikhailidis, DP; Stansby, G. Cilostazol for intermittent claudication.. The Cochrane database of systematic reviews. 31 October 2014, 10: CD003748. PMID 25358850. doi:10.1002/14651858.CD003748.pub4. 
  13. ^ Lin, JS; Olson, CM; Johnson, ES; Whitlock, EP. The ankle-brachial index for peripheral artery disease screening and cardiovascular disease prediction among asymptomatic adults: a systematic evidence review for the U.S. Preventive Services Task Force.. Annals of internal medicine. 3 September 2013, 159 (5): 333–41. PMID 24026319. doi:10.7326/0003-4819-159-5-201309030-00007. 
  14. ^ Poredos, P; Jezovnik, MK. Is aspirin still the drug of choice for management of patients with peripheral arterial disease?. VASA. Zeitschrift fur Gefasskrankheiten. March 2013, 42 (2): 88–95. PMID 23485835. doi:10.1024/0301-1526/a000251. 
  15. ^ Hauk, L. ACCF/AHA update peripheral artery disease management guideline.. American family physician. 15 May 2012, 85 (10): 1000–1. PMID 22612053. 
  16. ^ How Is Peripheral Arterial Disease Treated?. http://www.nhlbi.nih.gov. August 2, 2011 [26 February 2015].  外部链接存在于|website= (帮助)
  17. ^ GBD 2013 Mortality and Causes of Death, Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.. Lancet. 17 December 2014, 385 (9963): 117–71. PMID 25530442. doi:10.1016/S0140-6736(14)61682-2.