When Li Jiaoyu, an 82-year-old who lives in Changsha, walks on weekdays, her left leg will be painful and numb, which can be relieved by resting for a while, and then there will be pain and numbness after walking for a while. It was only recently when I felt numbness and weakness in my left leg, and I obviously felt that my left foot was colder than my right foot, that I came to the Department of Neurology of the Second People's Hospital of Hunan Province (Hunan Brain Hospital).
After the doctor and nurse's physical examination, it was found that Li Jiao's left thigh circumference was 3 cm longer than the right thigh circumference, the skin temperature of the left foot was significantly lower than that of the right foot, and the left foot in the dorsal artery could not be touched, and it was blue-purple, and it was impossible to complete the leg lifting action. Color ultrasound results show that the artery of the left lower extremity is occluded and acutely ischemic.
Li Jiao's left lower extremity arterial vessels were severely blocked, and immediate local anesthesia descended on the left lower extremity angiography + balloon angioplasty + thrombosectomy + indwelling left lower extremity vascular sheath and thrombolytic catheterization. The operation went smoothly, and no complications such as compartment syndrome occurred after the operation. After the blood vessels were opened, Li Jiaoyu breathed a long sigh of relief: "This left leg is finally not numb or painful, and it feels very relaxed." "A few days later he recovered and was discharged from the hospital.
Zhou Gaogao, director of the Intensive Care Unit of Neurology, introduced that arterial embolism in the lower extremities refers to the blockage of blood vessels caused by cardiac embolus or atherosclerotic plaques, causing sudden interruption of blood flow, resulting in pathological and physiological changes in limbs. Often accompanied by the clinical manifestations of the "6P": pain, pale skin, no pulse, skin paresthesias, limb paralysis, limb chills. Worsening vascular occlusion can easily lead to ischemic necrosis of the lower extremities, and there is a risk of amputation. With the progress of modern medicine and the rapid development of minimally invasive surgery, the limb preservation rate of arterial embolism in the lower limbs has increased significantly, and early prevention, early detection and early treatment are very important.
As the preferred examination method, vascular ultrasound is low cost, no radiation and trauma, convenient and fast. The "gold standard" for diagnosing arterial embolism in the lower extremities is digital subtraction angiography, or "DSA," but is not indicative for patients with contrast allergies and poor renal function. Compared with angiography, ctnography angiography, or "CTA," has more advantages in definitively assessing atherosclerotic plaques, forming three-dimensional images that show circulation and the degree of patency of distal arterial vessels.
Responsible nurse Yuan Haiyan introduced that the affected limbs of patients with arterial embolism in the lower limbs should pay attention to the following points:
1. Keep warm, so as not to cause arterial contractions or spasms, but can not do hot compresses, because heating or hyperthermia will strengthen local oxygen consumption and aggravate the hypoxia of the affected limb.
2. After surgery, the drug should be taken on time to achieve the purpose of anticoagulation and antiplatelet aggregation.
3. Arterial embolism is closely related to hyperlipidemia, hypertension, diabetes, smoking, obesity, etc. Pay attention to a low-salt, low-fat, light diet on weekdays, and choose foods that are beneficial to blood vessels: such as onions that lower blood lipids, tomatoes that protect the elasticity of blood vessels, and garlic, the "consumbrator" of blood clots.
4. It is necessary to do a good job of exercise and control the "three highs".
Contributed by: Zhu E, Department of Neurology Intensive Care Unit, Second People's Hospital of Hunan Province (Hunan Brain Hospital).
Editor: Liu Yuchen
Image: From the Internet, intrusion and deletion