国产覆膜支架腔内修复术治疗主动脉病变(附30例临床分析)

目的 探讨国产覆膜支架腔内修复术治疗主动脉夹层、主动脉创伤和动脉瘤的安全性、有效性.方法 应用国产覆膜支架腔内修复术治疗胸主动脉夹层动脉瘤23例(均属Stanford B型);胸主动脉峡部外伤后裂口伴假性动脉瘤形成1例;肾下腹主动脉瘤6例,其中1例选择应用连体带膜支架移植系统,另1例选择单臂带膜支架释放系统和对侧髂总动脉封堵系统,联合股-股动脉人工血管旁路转流术.结果 手术治疗均获得成功.死亡2例,1例Stanford B型,术后24小时内死于夹层破裂;另1例主动脉夹层术后第3天死于心肌梗死.28例病人随访疗效满意.结论 国产覆膜支架腔内修复术治疗主动脉夹层、主动脉创伤和动脉瘤安全、成功率高、创伤小.     

国产覆膜支架腔内修复术治疗主动脉病变的疗效

目的探讨国产覆膜支架腔内修复术治疗主动脉夹层、主动脉创伤和动脉瘤的可行性.方法13例患者术前均行CTA、MRA或彩超特殊检查,测定和了解主动脉弓部、重要分支的直径和受累情况;应用国产覆膜支架腔内修复术,治疗胸主动脉夹层动脉瘤10例(均属Stanford B型)、胸主动脉峡部外伤后裂口伴假性动脉瘤形成1例、肾下腹主动脉瘤2例.结果手术治疗均获成功.1例主动脉夹层术后第3 d发生心肌梗死,经抢救无效死亡;另1例腹主动脉瘤应用连体带膜支架植入腔内修复术者,术后出现左下肢供血不足现象,1周后又行股一股动脉人工血管旁路转流术,术后恢复良好.12例患者随访1～10个月,平均4.5月,疗效满意,生活状态良好,有的已恢复工作.结论国产覆膜支架腔内修复术治疗主动脉夹层、主动脉创伤和动脉瘤成功率高,创伤小,疗效好.     

腹主动脉瘤腔内修复术血管入路并发症的处理

目的 回顾性分析腹主动脉瘤腔内修复术(endovascular aneurysm repair,EVAR)中血管人路相关早期并发症的原因及处理措施.方法 分析我院2015年5月至2017年5月57例EVAR患者的血管人路及其并发症的处理,并发症包括髂动脉破裂、股动脉内膜损伤、血管内支架闭塞、下肢动脉血栓形成等,对不同并发症采取覆膜支架置人、人工血管移植、股-股搭桥、Fogarty导管取栓等处理措施,并于术后30 d采用超声多普勒随访术后情况.结果 57例均完成EVAR手术,无中转开腹,其中伴有髂动脉扭曲＞90° 7例,股动脉直径纤细(＜7 mm)3例,一侧髂动脉闭塞4例,合并髂动脉瘤5例(双侧髂动脉瘤2例,单侧髂动脉瘤3例).入路血管并发症7例(12.28％),其中髂动脉破裂1例,血管内支架闭塞2例,股动脉内膜损伤3例,股髂动脉血栓形成1例.术后30 d随访,发生Ⅱ型内漏3例,1例人工血管移植后吻合口狭窄.结论 重视术前入路血管的评估,同时掌握腔内及开放手术技巧,有助于正确认识和及时处理血管入路相关并发症,降低EVAR手术风险.     

补片扩大成型术构建猪腹主动脉瘤腔内治疗模型

目的 探索使用补片扩大成型技术建立猪腹主动脉瘤模型,验证其作为动脉瘤腔内修复动物模型的可行性。方法 实验猪在全身麻醉下接受腹人工血管补片扩大成型术构建腹主动脉瘤模型,随即进行动脉造影,并实施覆膜支架动脉瘤腔内修复术,术后随访3个月复查造影。结果 完成腹主动脉瘤模型建立及腔内修复10例,所有模型建立均获得成功,术中测量肾下腹主动脉直径平均为(10.5±0.4)mm;动脉瘤模型最大直径平均为(26.3±3.1)mm,直径平均增加(15.7±3.1)mm;动脉瘤模型建立前、后的动脉直径差异有统计学意义(P＜0.001)。除1例因腔内修复时支架遮盖肾动脉于术后24 h死亡,其余实验猪手术过程平稳,术后恢复良好,随访3个月未发生意外死亡,围手术期1个月及术后3个月生存率均为90%。腔内修复发生Ⅱ型内漏1例(10%),随访3个月造影均无内漏。结论 全身麻醉下开腹人工血管补片扩大成型技术构建猪腹主动脉瘤模型安全有效,该模型可作为腹主动脉瘤腔内修复的动物模型。     

血管内介入治疗颈内动脉眼动脉段动脉瘤的临床效果分析

目的探究血管内介入治疗颈内动脉眼动脉段动脉瘤的临床效果。方法选择济源市人民医院收治的31例颈内动脉眼动脉段动脉瘤患者,均实施血管内介入治疗,并依据肿瘤直径选择行单纯弹簧圈栓塞术或支架辅助弹簧圈栓塞术,观察术中情况,并随访12个月统计患者视力恢复、并发症、动脉瘤闭塞情况。结果 31例患者通过造影检查共发现36枚动脉瘤,其中瘤颈直径<2 mm 3枚,≥2 mm 33枚,视术中情况使用25枚支架,支架均成功释放至动脉瘤内,其中3枚出现支架移位,术中产生动脉瘤再次破裂出血1例,经及时发现并行栓塞治疗后无脑疝等并发症发生;经12个月随访,视力恢复正常者29例、视野缺损者1例、单纯偏盲者1例;动脉瘤完全闭塞30枚,大部分闭塞4枚,小部分闭塞2枚,且支架辅助弹簧圈栓塞术治疗者动脉瘤完全闭塞比例高于单纯弹簧圈栓塞术,差异具有统计学意义(P<0.05);动脉瘤复发1例,均为单纯弹簧圈栓塞术治疗者。结论对颈内动脉眼动脉段动脉瘤患者应用血管内介入治疗效果显著。     

国产覆膜支架腔内修复术治疗主动脉病变的疗效

目的探讨国产覆膜支架腔内修复术治疗主动脉夹层、主动脉创伤和动脉瘤的可行性。方法13例患者术前均行CTA、MRA或彩超特殊检查,测定和了解主动脉弓部、重要分支的直径和受累情况;应用国产覆膜支架腔内修复术,治疗胸主动脉夹层动脉瘤10例（均属Stanford B型）、胸主动脉峡部外伤后裂口伴假性动脉瘤形成1例、肾下腹主动脉瘤2例。结果手术治疗均获成功。1例主动脉夹层术后第3d发生心肌梗死,经抢救无效死亡;另1例腹主动脉瘤应用连体带膜支架植入腔内修复术者,术后出现左下肢供血不足现象,1周后又行股一股动脉人工血管旁路转流术,术后恢复良好。12例患者随访1～10个月,平均4．5月,疗效满意,生活状态良好,有的已恢复工作。结论国产覆膜支架腔内修复术治疗主动脉夹层、主动脉创伤和动脉瘤成功率高,创伤小,疗效好。     

前交通微小动脉瘤破裂出血急性期介入治疗临床随访(附35例分析)

目的 探讨介入弹簧圈栓塞治疗在前交通微小动脉瘤破裂出血急性期的意义及弹簧圈栓塞程度对预后的影响.方法 回顾性分析2004年至2009年因前交通微小动脉瘤破裂引起蛛网膜下腔出血,急性期行介入弹簧圈栓塞治疗的35例患者治疗方式、术中栓塞程度、随访结果及临床意义.35例患者病变均为单发,均于术中成功释放弹簧圈,其中27例单纯弹簧圈栓塞,8例支架辅助弹簧圈栓塞.术后随访至2年.结果 27例单纯弹簧圈栓塞中11例致密填塞,16例部分填塞;8例支架辅助弹簧圈栓塞中6例致密填塞,2例部分填塞.单纯弹簧圈栓塞者中有5例部分填塞的瘤腔仍有血流,予2次介入治疗.随访至2年时,30例中(5例2次治疗者未列入随访统计)27例致密填塞,3例部分填塞.均无再出血发生.结论 前交通微小动脉瘤破裂出血急性期介入弹簧圈栓塞治疗主要目的 是瘤腔内减压止血,安全有效.术后动脉瘤残留一般不会引起再出血,未达到致密填塞者亦能起到瘤内减压止血效果.     

主动脉疾病腔内介入治疗15例体会

目的: 总结腔内修复术治疗主动脉疾病的经验、体会,探讨主动脉疾病介入治疗的适应证及操作要点。方法: 在气管插管全麻下进行,8例主动脉夹层患者采用直径34~42 mm覆膜支架封堵降主动脉近端破裂口,其中1例支架覆盖左锁骨下动脉;6例腹主动脉瘤中1例采用直型支架腔内隔绝,其余均采用分叉型支架经双股动脉置放成功;1例早期主髂动脉硬化性闭塞症患者采用预先扩张主髂动脉狭窄段,置入分叉型人工血管支架。结果: 全组无手术死亡,腔内隔绝术后造影显示假腔及瘤腔均消失;2例I型内漏,随访半年后消失,假腔内部分血栓形成。1例主动脉夹层患者手术后1年突然死亡。结论: 腔内隔绝术治疗主动脉疾病安全、可行、有效,适应证不断扩展。     

支架辅助治疗在颅内宽颈动脉瘤治疗中的价值

目的:观察支架辅助治疗在颅内宽颈动脉瘤治疗中的价值。方法:78例宽颈动脉瘤患者行颅内支架联合弹簧圈血管内介入栓塞治疗。结果:支架植入后显示动脉瘤腔内造影剂滞留。完全栓塞62例,近全栓塞9例,部位栓塞5例;动脉瘤破裂2例,均死亡。38例病例术后3～6个月血管造影随访,32例致密栓塞的动脉瘤均未显影;6例瘤颈残留者,无再次蛛网膜下腔出血及血栓栓塞症状。结论:颅内支架联合弹簧圈血管内介入栓塞在宽颈动脉瘤治疗中具有重要的价值。     

髂股动脉区域非创伤性动脉瘤患者的外科治疗

目的 探讨髂股动脉区域非创伤性动脉瘤的诊治经验.方法 回顾性分析中国医科大学附属第一医院1985年1月至2010年11月61例髂股动脉区域非创伤性动脉瘤患者的临床资料.结果 本组髂动脉瘤29例,股动脉瘤32例,共有髂股动脉区域动脉瘤76个,其中43个髂动脉瘤和33个股动脉瘤;17例(27.9％)为多发性动脉瘤,8例(13.1％)发生髂动脉瘤或股动脉瘤破裂,4例(6.6％)合并动脉硬化闭塞症.本组中50例择期行动脉瘤切除、人工血管或自体血管移植;7例破裂性动脉瘤急诊行动脉瘤切除、血运重建术,另1例抢救无效死亡;1例髂动脉瘤行腔内修复和1例髂内动脉瘤行栓塞术;1例髂动脉瘤保守治疗.1例股动脉瘤术后因急性动脉血栓形成导致下肢缺血、坏死而截肢,其余未发生围手术期下肢及盆腔脏器缺血等并发症.随访期间7例死亡,存活患者移植血管通畅,无新生动脉瘤形成.结论 髂股动脉区域的非创伤性动脉瘤重在早期诊断和治疗,并注意多发性动脉瘤.动脉瘤切除及血运重建可获得良好疗效,术后应长期随访,观察有否新生动脉瘤.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.