肠系膜上动脉栓塞的导管取栓溶栓治疗

目的 评价导管取栓溶栓治疗肠系膜上动脉栓塞的疗效.资料与方法 急性肠系膜上动脉栓塞11例患者(男7例,女4例,年龄61～81岁,风湿性心脏病并房颤7例,心肌梗死4例,合并小脑梗死1例,下肢动脉栓塞2例)采用6 F导引导管、5 F导管、颈动脉保护伞取栓导管溶栓术.结果 11例患者均成功取出血栓,取栓溶栓后血管复通,2例患者开腹探查,1例切除坏死肠管,1例未见肠管坏死,无治疗相关并发症.结论 导管取栓溶栓治疗肠系膜上动脉栓塞操作简便,能迅速恢复肠管血运,提高了临床治愈率.     

导管溶栓治疗急性下肢动脉缺血的疗效评价

目的 探讨导管溶栓治疗急性下肢动脉缺血的疗效和安全性.方法 收集2008年1月1日至2009年12月31日就诊于我院急性下肢动脉缺血行导管溶栓治疗的病例共56例,采用尿激酶溶栓,观察溶栓治疗的效果和并发症.结果 治愈10例(17.8%),有效38例(67.9%),无效8例(14.3%),总有效率为85.7%.发生并发症11例(19.6%);与导管溶栓直接相关的并发症6例(10.7%),包括穿刺点血肿5例(8.9%)和脑畸形血管破裂出血1例(1.7%).结论 导管溶栓是治疗急性下肢动脉缺血的较为安全、有效的方法.     

急性下肢静脉栓塞的动脉溶栓治疗

急性下肢静脉栓塞是需急诊处理的病症。我们用动脉溶栓治疗４例急性下肢血管栓塞，报告如下。资料和方法一、自１９９０年以来我院对４例下肢动脉栓塞以动脉导管溶栓治疗，其中２例大动脉炎下肢动脉栓塞合并静脉栓塞，２例单纯静脉栓塞（髂股静脉血栓形成１例，静脉血栓...     

下肢动脉血栓栓塞的介入治疗及护理

目的：探讨下肢动脉血栓栓塞的介入治疗及科学护理的重要性。方法：总结8例下肢动脉血栓栓塞患者采用经导管插管至栓塞局部灌注脲激酶溶栓，并采用细致、周密的护理措施。结果：8例患者经置留导管缓慢滴注脲激酶，1-5天后溶栓均获成功。结论：及时、正确的个入治疗及严格、科学的护理措施是提高溶栓成功率、预防并发症的重要因素?     

动脉性上消化道出血的急症介入诊疗价值和影响因素

目的 分析急症介人在动脉性上消化道出血诊断中的影响因素,探讨其治疗价值.方法 回顾性分析56例动脉性上消化道出血资料.分析导管在2级动脉和3-4级动脉开口造影时出血阳性率差异:经导管灌注缩血管药、止血剂和经导管栓塞治疗的技术成功率、临床成功率.结果 导管在2级和3-4级动脉开口处出血的阳性诊断率分别为21.4%(12/56)和100%(56/56),两者差异有统计学意义(P＜0.05).介入治疗前、后(24 h内)平均收缩压分别为(93.14±18.63)mmHg和(116.84 ±13.61)mmHg,两者差异有统计学意义(P=0.023).经导管灌注垂体后叶素和血凝酶20例,技术成功率80%(16/20),临床成功率55%(11/20).再出血9例行微导管超选择栓塞,7例成功,2例失败,接受手术治疗.经导管灌注血凝酶和明胶海绵条栓塞共45例(36例+9例灌注后再出血),技术成功率93%(42/45),临床成功率89%(40/45).2种介入治疗方法比较,止血的技术成功率无显著差异(P=0.058),临床成功率差异有统计学意义(P=0.001).2例患者栓塞后因酗酒再出血,血管造影显示原出血动脉闭塞:1例患者仅行胃、十二指肠动脉灌注和栓塞,死于动脉性门脉高压所致食管胃底静脉曲张大出血(肝动脉.门静脉瘘).结论 急症介入能快速发现出血部位并有效控制出血,是急性上消化道动脉性出血的有效诊疗手段;出血的诊断率、止血的技术成功率和临床成功率受多重因素影响.     

大管径导管抽吸血栓治疗急性下肢动脉栓塞的疗效分析

目的探讨使用大管径导管进行血栓抽吸治疗急性下肢动脉栓塞的疗效。方法对16例患者,共18段栓塞段动脉采用6F或8FGuiding导管抽吸血栓,根据血栓抽吸情况,继续给与溶栓或动脉成形术重建血流。结果导管抽栓有效率为81.25%,介入综合治疗有效率100%,其中痊愈(10/16)62.5%,良好(5/16)31.25%,一般(1/16)6.25%,疗效差(0)0.00%,无严重并发症。结论使用大管径导管血栓抽吸的方法治疗急性下肢动脉栓塞安全、有效,是介入放射科医生的好选择。     

急性胰腺炎出血的血管造影诊断及经导管栓塞治疗

目的探讨急性胰腺炎出血的血管造影诊断及经导管栓塞治疗的方法选择及疗效。方法回顾性分析19例急性胰腺炎并发腹腔或胃肠道出血患者行血管介入诊疗的临床资料及治疗结果。结果19例患者共行血管造影检查23次,发现胰及胰周血管破裂出血者9例次(9/23,39.1%),假性动脉瘤破裂出血者10例次(10/23,43.5%),脾静脉血栓形成1例次(1/23,4.3%),不能明确出血部位者4例次(4/23,17.4%)。其中13例患者行经导管栓塞治疗。随访1～7个月,5例再发出血,其中4例再次血管造影均发现新的出血病灶,3例患者再次行栓塞治疗,其中2例患者最终因合并严重感染和多器官功能衰竭而死亡,另1例患者经过2次栓塞后无再出血。结论血管造影诊断和经动脉栓塞治疗是急性胰腺炎并出血时首选的紧急治疗方法。     

动脉灌注替罗非班在处理颅内动脉瘤栓塞术中急性血栓栓塞的研究

目的 探讨动脉灌注盐酸替罗非班在处理颅内动脉瘤栓塞术中急性血栓栓塞的有效性及安全性.方法 收集2010年1月至2012年4月10例行颅内动脉瘤栓塞术中发生血栓栓塞患者,其中9例采用盐酸替罗非班动脉内靶向灌注处理,作为研究对象,另1例采用尿激酶动脉溶栓处理.9例均在完成动脉瘤腔致密填塞后,经微导管行盐酸替罗非班0.5 ～ 1.0 mg靶向灌注,并配合使用微导管、微导丝机械碎栓.术后进行DSA或CT追踪随访,观察有无脑梗死或脑出血发生.结果 9例术中造影血管均完全再通,且术中CT均未发现颅内新增出血征象;术后3～7d复查CT发现不同程度脑梗死4例;术后1个月后复查,遗留不同程度神经功能缺损2例,余均恢复良好.结论 颅内动脉瘤栓塞术中处理急性血栓栓塞并发症时,经动脉靶向灌注盐酸替罗非班是一种安全、有效的方法.     

介入取栓术治疗急性肠系膜上动脉栓塞临床研究

目的评价经皮肠系膜上动脉吸栓和(或)溶栓治疗急性肠系膜上动脉栓塞的疗效。方法34例急性肠系膜上动脉栓塞的患者(房颤14例;左房黏液瘤2例;血栓形成15例;慢性缺血性肠病急性发作3例),行经皮动脉长鞘吸栓术和(或)溶栓术。结果34例患者均成功的去除栓子,动脉开通。31例痊愈;2例行开腹探查;1例24h后死亡。结论经皮介入取栓术对于治疗急性肠系膜上动脉栓塞,是一种简便有效的方法。准确地判断病因是提高疗效,避免合并症的关键。     

rt-PA动脉内溶栓治疗急性脑梗死的临床研究

目的观察重组组织型纤溶酶原激活剂(rt-PA)动脉内溶栓(IAT)治疗急性脑梗死的疗效及并发症,分析预后相关因素。方法对12例发病后20h内的急性缺血性脑梗死患者行IAT治疗。血管再通程度根据“急性心肌梗死溶栓标准”(TIMI)分类。临床结果评价在溶栓后20d进行,根据改良的Rank分数(MRS)分为良好(MRS0～3)、不良(MRS4～6)两类。结果溶栓前1例为TIMI1,11例为TIMI0。溶栓后9例闭塞血管部分／完全再通,3例未再通。8例患者结果良好;4例不良结果;其中2例死亡。发生症状性脑出血1例,经治疗恢复良好。结论rt-PA用于急性脑梗死动脉溶栓,是安全可行的。     

Sudden death caused by hydatid embolism

Summary An 18-year-old man died on the spot during a foot race. Previously, he had been in a healthy condition. Since the cause of his sudden death was unknown, a forensic autopsy was carried out. The autopsy revealed hydatid cysts in the right ventricle of the heart some of which had embolized the pulmonary arteries. In case of sudden death in endemic areas the possibility of a hydatid disease should be taken into consideration.     

超声检查对肺栓塞的诊断价值探讨

目的:探讨超声对肺栓塞(pulmonary embolism,PE)患者的临床诊断价值。方法:回顾性分析9例经临床确诊的PE患者,其彩色多普勒超声心动图和静脉血管超声的改变。结果:血管超声检查9例患者中有7例发现下肢静脉血栓,l例发现盆底静脉血栓。超声心动图检查6例患者发现右心室扩大,7例患者存在不同程度的肺动脉高压。结论:超声心动图及静脉超声检查的联合应用,可以为PE的临床诊断提供依据。     

Scintigraphic control of pulmonary embolism

Pulmonary embolism was diagnosed by combined perfusion and ventilation scintigraphy in 30 patients. A control examination 6 months later revealed pulmonary embolism or infarction in 8, in spite of conventional treatment. Therefore, patients treated for pulmonary embolism should be reexamined 3 to 6 months after diagnosis.     

Imaging of nonthrombotic pulmonary embolism: Biological materials,nonbiological materials,and foreign bodies

Nonthrombotic pulmonary embolism is defined as embolization to the pulmonary circulation caused by a wide range of substances of endogenous and exogenous biological and nonbiological origin and foreign bodies. It is an underestimated cause of acute and chronic embolism. Symptoms cover the entire spectrum from asymptomatic patients to sudden death.     

Pantopaque pulmonary embolism following myelography

Summary A patient with radiological evidence of Pantopaque embolism in the lungs following myelography is reported.     

创伤后脂肪栓塞综合征

脂肪栓塞综合征是创伤或骨折后的严重并发症,矫形外科及骨科手术中也可发生。本病发病突然、进展迅速、死亡率较高,创伤或手术期间应予警惕。本文对脂肪栓塞综合征的病理生理、诊断及治疗等有关进展作一简要综述。     

Proof of air embolism after exhumation

The detection, storage, and analysis of gas taken from the heart ventricle is necessary to diagnose a fatal air embolism and this requires special precautions during autopsy. When the results of gas analysis correspond to the criteria defined by Pierucci and Gherson [1] the diagnosis “air embolism” is justified. In cases showing putrefaction the diagnostic value of gas analysis was negated [2]. In a series of 15 patients who were assumed to have been killed by air injection in a peripheral vein the corpses were exhumed and a full medico-legal examination was carried out including gas analysis. In 8 cases results could be obtained indicating a mixture of embolised air and gases of putrefaction. In two control groups comprising 10 exhumed bodies and 30 cases showing advanced putrefaction, gas analysis showed putrefaction gases except in 5 cases with gas volumes less than 5 ml in the right ventricle. Therefore gas analysis can be helpful to diagnose fatal air embolism even in cases showing putrefaction while the diagnosis of putrefaction gases only does not exclude this diagnosis. Received: 20 March 1998 / Accepted: 25 April 1998     

A case of sudden death by decidual cell embolism

Summary A 35-year-old multipara died suddenly of a pulmonary embolism about 12h after delivery. The morphological features and the entry site of the emboli into the circulation suggested that they were decidual cells. Intact decidual cells accounted for only a minority of the emboli: the great majority were cells that had lost their nuclei and/or had been fragmented. The presence of embolized areas, accompanied by fibroblasts and newly formed capillaries, suggested that the embolization process had started before the beginning of labor. However, no symptoms suggesting embolism had been recorded on the clinical chart.     

Proof of fatal air embolism

Venous air embolism is a rare cause of death. Entry of gas into the circulation is caused by trauma, mostly surgical or therapeutic, and sometimes resulting from criminal intervention. The detection of air embolisms requires special precautions during autopsy. An aspirometer has to be used for the detection, measurement and storage of gas originating from the heart ventricles. The aspirometer has to be filled completely with distilled water containing two drops of Tween 80 to reduce the surface tension of the water and to prevent adherence of small air bubbles to the wall of the aspirometer. Subsequently the gas has to be analysed by gas chromatography. When the results correspond with the main criteria defined by Pierucci and Gherson [2] the diagnosis “air embolism” is justified. The technique for the detection of air embolism is simple but requires a careful procedure which is described in detail. Received: 29 November 1997 / Accepted: 8 January 1998     

Fatal air embolism during female autoerotic practice

Summary Air embolism has been described in pregnant women and is a classic cause of death during attempted abortion by syringing. Death was caused by the introduction of an amount of air sufficient to cause a substantial air lock in the heart, pulmonary trunk or arteries. If the surface of the placenta has been stripped by the syringe, venous spaces are opened and air can pass into the circulation. Orogenital sex with vaginal insufflation can also cause air embolism during pregnancy. We report a case of air embolism in a 40-year-old non-pregnant woman subsequent to vaginal insertion of a foreign body (carrot) for an autoerotic purpose. The mechanism is roughly similar to syringing, the foreign body acting like a piston to displace a sufficient amount of air. In the present case, the endometrium stripping was probably due to the presence of an intrauterine device. As such risks may often be encountered and as, to our knowledge, no similar case has previously been reported, we may speculate if such air embolisms are underdiagnosed or dissimulated by the partners when questioned by the medical rescue teams.

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Zusammenfassung Verschiedene Formen der Luftembolie bei schwangeren Frauen sind bekannt, z. B. im Rahmen von Abtreibungsmaßnahmen und auch bei orogenitalen sexuellen Praktiken. Dargestellt wird der Fall einer tödlichen Luftembolie bei einer 40 Jahre alt gewordenen nicht-schwangeren Frau im Rahmen autoerotischer Handlungen mit einer Karotte. Das Eindringen von Luft über das Endometrium wurde wahrscheinlich durch Mikroläsionen aufgrund eines intrauterinpessars begünstigt.