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醫師，我的腳都很冰冷，走一點路就會痠痛，得停下來休息。」老太太捶著腿抱怨著。

聽完描述，黃柏森醫師便為老太太量測腳背的脈搏，因為這些都是下肢血管阻塞的典型表現，屬於心血管的治療範疇，但因為民眾對此疾病的認識不足，誤以為是關節或筋骨的問題而錯失治療的黃金時期。

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align_small=”none” align=”center” margin_top=”” margin_right=”” margin_bottom=”” margin_left=”” lightbox=”no” gallery_id=”” lightbox_image=”” lightbox_image_id=”” alt=”Morbi vitae purus dictum, ultrices tellus in, gravida lectus. ” link=”” linktarget=”_self” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” sticky_display=”normal,sticky” class=”” id=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ filter_opacity_hover=”100″ filter_blur_hover=”0″]https://market.carefoot.club/wp-content/uploads/2021/06/a8caec75abde895cab80c8df14fd59db.jpg[/fusion_imageframe][/fusion_builder_column][/fusion_builder_row][/fusion_builder_container][fusion_builder_container admin_label=”Main Article + Image Gallery” hundred_percent=”no” hundred_percent_height=”no” hundred_percent_height_scroll=”no” hundred_percent_height_center_content=”yes” equal_height_columns=”no” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” status=”published” background_color=”#ffffff” background_position=”center center” background_repeat=”no-repeat” fade=”no” background_parallax=”none” enable_mobile=”no” parallax_speed=”0.3″ video_aspect_ratio=”16:9″ video_loop=”yes” video_mute=”yes” border_style=”solid” padding_top=”4%” padding_bottom=”40px” admin_toggled=”no” type=”flex”][fusion_builder_row][fusion_builder_column type=”1_6″ layout=”1_1″ background_position=”left top” background_color=”” border_color=”” border_style=”solid” border_position=”all” spacing=”yes” background_image=”” background_repeat=”no-repeat” padding_top=”” padding_right=”” padding_bottom=”” padding_left=”” margin_top=”0px” margin_bottom=”0px” class=”” id=”” animation_type=”” animation_speed=”0.3″ animation_direction=”left” hide_on_mobile=”medium-visibility,large-visibility” center_content=”no” last=”false” min_height=”” hover_type=”none” link=”” element_content=”” first=”true” spacing_right=”2%”][/fusion_builder_column][fusion_builder_column type=”2_3″ layout=”2_3″ spacing=”yes” center_content=”no” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” background_image_id=”” background_color=”” background_image=”” background_position=”left top” undefined=”” background_repeat=”no-repeat” hover_type=”none” border_color=”” border_style=”solid” border_position=”all” border_radius_top_left=”” border_radius_top_right=”” border_radius_bottom_left=”” border_radius_bottom_right=”” box_shadow=”no” box_shadow_vertical=”” box_shadow_horizontal=”” box_shadow_blur=”” box_shadow_spread=”” box_shadow_color=”” box_shadow_style=”” padding_top=”” padding_right=”” padding_bottom=”” padding_left=”” margin_top=”” margin_bottom=”25px” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” last=”false” first=”false” spacing_right=”2%” spacing_left=”2%”][fusion_text columns=”” column_min_width=”” column_spacing=”” rule_style=”” rule_size=”” rule_color=”” hue=”” saturation=”” lightness=”” alpha=”” content_alignment_medium=”” content_alignment_small=”” content_alignment=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” sticky_display=”normal,sticky” class=”” id=”” margin_top=”” margin_right=”” margin_bottom=”” margin_left=”” fusion_font_family_text_font=”” fusion_font_variant_text_font=”” font_size=”” line_height=”” letter_spacing=”” text_transform=”” text_color=”” animation_type=”” animation_direction=”left” animation_color=”” animation_speed=”0.3″ animation_delay=”0″ animation_offset=””] [fusion_dropcap boxed=”no” boxed_radius=”” class=”” id=”” color=””]奇[/fusion_dropcap] 美醫院心臟血管內科黃柏森醫師指出，導致下肢血管阻塞的原因主要是動脈粥狀硬化，也就是膽固醇堆積在血管壁，血管管徑愈來愈小，使得組織無法獲得充足的血液供應而產生各種症狀。  

未即時治療，恐怕要截肢

黃柏森醫師解釋，除了足部冰冷、腳麻以外，下肢血管阻塞進展到中度時會以「間歇性跛行」來表現，也就是在行走一段距離後便感到腿部痠麻、疼痛、無力，必須停下來休息才能繼續行走。隨著疾病惡化，行走距離將愈來愈短。尤其是天氣較冷的時候，血管收縮，這些症狀會更加明顯。

隨著血管阻塞程度變高，腿部缺乏養分供應將會導致持續性的疼痛，且一旦受傷，即使是很小的傷口也會難以癒合；若未即時治療，皮膚將缺血壞死，而變成紫黑色，甚至併發感染而需要截肢處理。

身為醫師，最不樂見的就是截肢，因為截肢不僅影響患者外觀、行走功能、工作能力，此外，截肢後死亡率在一年內高達34%，對家屬的心理與經濟皆是很大的負擔。

[/fusion_text][fusion_imageframe image_id=”20855|full” max_width=”” sticky_max_width=”” skip_lazy_load=”” style_type=”” blur=”” stylecolor=”” hover_type=”none” bordersize=”” bordercolor=”” borderradius=”” align_medium=”none” align_small=”none” align=”none” margin_top=”” margin_right=”” margin_bottom=”” margin_left=”” lightbox=”no” gallery_id=”” lightbox_image=”” lightbox_image_id=”” alt=”” link=”” linktarget=”_self” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” sticky_display=”normal,sticky” class=”” id=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ filter_opacity_hover=”100″ filter_blur_hover=”0″]https://market.carefoot.club/wp-content/uploads/2021/06/34341146a3615ae0a5203ac8f8b5854a.jpg[/fusion_imageframe][fusion_text columns=”” column_min_width=”” column_spacing=”” rule_style=”” rule_size=”” rule_color=”” hue=”” saturation=”” lightness=”” alpha=”” content_alignment_medium=”” content_alignment_small=”” content_alignment=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” sticky_display=”normal,sticky” class=”” id=”” margin_top=”” margin_right=”” margin_bottom=”” margin_left=”” fusion_font_family_text_font=”” fusion_font_variant_text_font=”” font_size=”” line_height=”” letter_spacing=”” text_transform=”” text_color=”” animation_type=”” animation_direction=”left” animation_color=”” animation_speed=”0.3″ animation_delay=”0″ animation_offset=””]  

治療下肢周邊動脈阻塞，三高務必控制達標

黃柏森醫師說明，下肢血管阻塞、冠狀動脈阻塞、中風皆屬於血管阻塞的疾病，面對各種血管阻塞，務必將糖尿病、高血壓、高血脂嚴格控制，並視情況搭配使用預防血栓形成的藥物，並且定期回診追蹤調整用藥。

而針對民眾常詢問的促進血液循環的健康食品，不論是國際治療指引或是臨床經驗都覺得治療反應不一，只能當作附加治療，民眾務必還是需要找尋專業醫師並配合醫師處方用藥。

  下肢血管阻塞的治療方式

黃柏森醫師說，當血管阻塞程度已經太高，單靠藥物不足以治療時，進一步下肢血管阻塞的治療可分為外科繞道手術或導管介入手術。外科繞道手術是取下一段病患的靜脈或是用人工血管嫁接於血管上游和血管下游健康的部位，讓血流可以繞道跨過狹窄阻塞的地方恢復遠端的血流供應，手術需要全身麻醉，侵入性及麻醉風險較高，但目前研究認為長期維持血流暢通的機會較高。

[/fusion_text][fusion_imageframe image_id=”23403|full” max_width=”” sticky_max_width=”” skip_lazy_load=”” style_type=”” blur=”” stylecolor=”” hover_type=”none” bordersize=”” bordercolor=”” borderradius=”” align_medium=”none” align_small=”none” align=”none” margin_top=”” margin_right=”” margin_bottom=”” margin_left=”” lightbox=”no” gallery_id=”” lightbox_image=”” lightbox_image_id=”” alt=”” link=”” linktarget=”_self” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” sticky_display=”normal,sticky” class=”” id=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ filter_opacity_hover=”100″ filter_blur_hover=”0″]https://market.carefoot.club/wp-content/uploads/2020/11/0062-peripheral-artery-disease-3.jpg[/fusion_imageframe][/fusion_builder_column][fusion_builder_column type=”1_6″ layout=”1_1″ background_position=”left top” background_color=”” border_color=”” border_style=”solid” border_position=”all” spacing=”yes” background_image=”” background_repeat=”no-repeat” padding_top=”” padding_right=”” padding_bottom=”” padding_left=”” margin_top=”0px” margin_bottom=”0px” class=”” id=”” animation_type=”” animation_speed=”0.3″ animation_direction=”left” hide_on_mobile=”medium-visibility,large-visibility” center_content=”no” last=”true” min_height=”” hover_type=”none” link=”” element_content=”” first=”false” spacing_left=”2%”][/fusion_builder_column][fusion_builder_column type=”1_6″ layout=”1_1″ background_position=”left top” background_color=”” border_color=”” border_style=”solid” border_position=”all” spacing=”yes” background_image=”” background_repeat=”no-repeat” padding_top=”” padding_right=”” padding_bottom=”” padding_left=”” margin_top=”0px” margin_bottom=”0px” class=”” id=”” animation_type=”” animation_speed=”0.3″ animation_direction=”left” hide_on_mobile=”medium-visibility,large-visibility” center_content=”no” last=”false” min_height=”” hover_type=”none” link=”” element_content=”” first=”true” spacing_right=”2%”][/fusion_builder_column][fusion_builder_column type=”2_3″ layout=”1_1″ spacing=”yes” center_content=”no” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” background_image_id=”” background_color=”” background_image=”” background_position=”left top” undefined=”” background_repeat=”no-repeat” hover_type=”none” border_color=”” border_style=”solid” border_position=”all” padding_top=”” padding_right=”” padding_bottom=”” padding_left=”” margin_top=”0px” margin_bottom=”0px” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” last=”false” first=”false” spacing_right=”2%” spacing_left=”2%”][fusion_text columns=”” column_min_width=”” column_spacing=”” rule_style=”” rule_size=”” rule_color=”” hue=”” saturation=”” lightness=”” alpha=”” content_alignment_medium=”” content_alignment_small=”” content_alignment=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” sticky_display=”normal,sticky” class=”” id=”” margin_top=”” margin_right=”” margin_bottom=”” margin_left=”” fusion_font_family_text_font=”” fusion_font_variant_text_font=”” font_size=”” line_height=”” letter_spacing=”” text_transform=”” text_color=”” animation_type=”” animation_direction=”left” animation_color=”” animation_speed=”0.3″ animation_delay=”0″ animation_offset=””]  

介入性導管手術的侵入性則較低，過程類似於大家熟悉的「心導管手術」，醫師會在X光輔助下，將導管放入狹窄的動脈中，利用醫療器材來拓寬血管管徑。由於下肢血管管徑較大，而且血管會隨著腿部動作伸縮、扭曲或彎折，如果置放堅硬的金屬支架，可能有支架變形折斷的風險，因此目前國際上的共識是「leave nothing behind」，盡量不要在體內放入金屬支架。

進行導管手術，最常見的有氣球導管擴張術，利用氣球導管將硬化的膽固醇斑塊壓扁而擴大血管管徑，然而當斑塊太硬或阻塞程度太高時，其效果有限。假使氣球導管撐過之後，管徑依舊狹小，必要時會再放入金屬支架以維持血流。

除了氣球導管與支架以外，為了防止日後血管壁發炎、纖維化導致血管再度狹窄，可考慮使用塗藥球囊將紫杉醇藥物塗至血管壁內，抑制血管壁細胞增生，避免或是延緩血管再次阻塞，目前研究指出，使用一般氣球擴張術，2年內血管暢通率約5成，若是使用塗藥球囊，2年內血管暢通率則可提高到約8成左右。

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黃柏森醫師解釋，部分患者的鈣化斑塊在氣球擴張術之後不易壓扁，而鈣化如同牆壁的斑塊也會影響塗藥球囊的效果，為了解決這個問題，可考慮採用斑塊旋切術，也就是一種去除血管內斑塊的裝置，透過刮除或旋磨的方式去除粥狀硬化斑塊，恢復血管管徑，讓血管更持久地暢通、不阻塞。

由於治療的方式很多，醫師會根據患者的狀況選用合適的做法，並非每個病灶都需要使用斑塊旋切裝置這樣的治療方式，但在某些特別的病灶就得多花點精力來處理，例如阻塞長度較長、鈣化嚴重的病灶等，尤其是位於關節處的血管，因為比較不適合放置支架，因此比較建議使用斑塊旋切搭配塗藥球囊來治療。

黃柏森醫師回憶，曾經有位90歲的老太太，右腳跛行已經兩、三年之久，漸漸嚴重到走10公尺去上廁所都會痠痛到無法行走。檢查發現右鼠蹊部的血管有嚴重鈣化的斑塊導致血管幾乎完全阻塞，當時花了30分鐘才終於穿過病灶，使用氣球導管擴張仍無法打開血管管徑，於是決定進行斑塊旋切術，經過多次刮除終於將塞滿血管的斑塊刮除，再搭配塗藥球囊完成治療。後續經過一年半的追蹤，沒有發生再狹窄，病人也沒有跛行症狀，能夠自行上廁所或走到隔壁跟鄰居串門子，讓老太太十分開心。

  如何預防下肢周邊動脈阻塞？

黃柏森醫師再次強調，患者務必按時服藥，好好控制糖尿病、高血壓、高血脂，可以有效降低下肢血管阻塞的風險。適度的行走復健能夠改善下肢血液循環，也能刺激側枝循環血管增生。

此外，氣溫較低時，血管容易收縮使症狀惡化，因此要多多注意保暖。由於糖尿病患者大多合併神經病變導致感覺遲鈍，平日須留意足底及腳指頭皮膚的狀況，若有傷口便需謹慎照顧或就醫，以免感染惡化，甚至截肢。

黃柏森醫師提醒，因為民眾對於下肢血管阻塞較不熟悉，容易延誤就醫，甚至拖到腳趾發黑，此時治療難度很高效果也較差，因此呼籲民眾要對腿部冰冷、痠麻、疼痛提高警覺，及早就醫、及早治療。

血液循環不佳的組織容易出現不易癒合的傷口，若發現足部傷口超過兩周仍未有癒合跡象，便須檢查是否有動脈阻塞或靜脈疾病的問題。

【本文由「照護線上」授權轉載，原文出處：走10公尺都很困難！嚴重恐截肢的下肢周邊動脈阻塞。】

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