Intravenous Infusion of Prostaglandin E1 and Urokinase for Critical Limb

前列腺素E1及尿激酶靜脈灌注對危急肢體的治療

10.6200/TCMJ.2013.10.4.03

盧崇弘(Lucifer Lu)

深層靜脈栓塞 ； 週邊動脈阻塞缺血症狀 ； 糖尿病足部潰爛傷口 ； 前列腺素E1及尿激酶 ； DVT ； PAOD ； Diabetic foot ； PGE1 and Urokinase

北市醫學雜誌

10卷4期（2013 / 12 / 30）

317 - 324

英文

目的：在臨床上，我們治療患者所遭受到危急的肢體病變，這些病變包括深層靜脈栓塞，週邊動脈阻塞缺血症，糖尿病足潰爛傷口，我們的治療措施是合併前列腺素E1及尿激酶給予靜脈灌注數日直到肢體病變緩解。方法：在排除不適接受用藥的患者及患者在治療前所評估的數據都在正常範圍，我們所採用的初始劑量是前列腺素E1及尿激酶各三劑溶合在100 cc生理食鹽水再經由靜脈灌注一小時以提升血液內治療劑量，接著，維持劑量則採用前列腺素E1及尿激酶各六劑溶合在500 cc生理食鹽水，同樣經由靜脈灌注二十四小時，持續數日（五至七日），如果治療療程中有不適的藥物反應，靜脈灌注立即停止。結果：接受治療的患者，除症狀明顯改善，偶有發冷、嘔吐外，並無嚴重的併發症，在深層靜脈栓塞的患肢，在五到七天的療程，即有患肢浮腫消退的改善，週邊動脈阻塞缺血症狀的患者，在三到五天的療程，患肢發紺部位逐漸恢復正常血色，至於糖尿病足的患者，潰爛的傷口經過五到七天的療程加上清創手術也能逐漸乾燥結痂。結論：臨床上，我們合併前列腺素E1及尿激酶經由靜脈灌注，用於治療深層靜脈栓塞，週邊動脈阻塞缺血症，糖尿病足潰爛傷口的患者，雖然是保守治療，但是，均有明顯的症狀改善，對於不適合接受手術（包括繞道，支架，氣球擃擴張等）的患者，提供另類的療效選擇。

Objectives: To present the results of our clinical study that used prostaglandin E1 (PGE1) and urokinase (UK) intravenous infusions in patients with critical limb. The underlying cause for critical limb included deep vein thrombosis (DVT), peripheral arterial disease (PAD), and diabetic foot ulcer (DF). Methods: We excluded patients with a high risk of peptic ulcer, bleeding tendency, and a history of strokes. Laboratory tests, including complete blood count, platelet count, prothrombin time (PT), thrombin time (TT), and activated partial thromboplastin time (aPTT) were performed and indicated normal values before the initiation of therapy. Patients received an initial loading dose of PGE1 (3 vials) and UK (3 vials) (1 vial=250,000 IU) was administered in 100 ml normal saline (NS) in an intravenous (IV) drip for 30 min, and the maintenance dose of PGE1 and UK (6 vials each) was then administered in 500 ml NS in an IV drip for 24 hrs, at least 5 to 12 days. The aPTT and platelet count were monitored during the course of the intravenous infusion, and if the PT and aPTT values were prolonged, PGE1 and UK administration were terminated. Results: Clinical improvement of the critical limb was evaluated based on the subsidence of swelling in DVT patients, reperfusion and recovery from cyanosis in PAD patients, or changes in the dry gangrene in the diabetic foot ulcers of DF patients. In most cases, patients experienced relief of the critical limb status after the intravenous infusion of PGE1 and UK. Conclusion: In conclusion, intravenous infusion of PGE1 and UK is a feasible clinical strategy to improve the critical limb by creating significant peripheral reperfusion without complications, and it establishes a solid basis for therapy in this special patient population.