脑动静脉畸形栓塞术中血流动力学监护及意义

目的　用经颅多普勒（ＴＣＤ） 进行监护,了解脑动静脉畸形（ＡＶＭ）供血状况及其变化。方法　ＡＶＭ 患者１１ 例,均经股动脉穿刺插管后行栓塞治疗。分别于栓塞前、中、后全程动态监护ＡＶＭ 血流状态变化。以大脑前、中、后动脉血流速度（ＢＦＶ）和脉动指数（ＰＩ） 为观察指标。结果　１１ 例中有１０ 例显示明显的ＴＣＤ变化。ＡＶＭ 体积越大,血流量越大,流速增高,ＰＩ下降。频谱形态变化明显。栓塞后,供血动脉主干流速下降,ＰＩ升高,其测量值与栓塞前比较有统计学意义（Ｐ＜ ０－０５）,频谱形态趋于恢复。结论　ＴＣＤ 可敏感地反映ＡＶＭ 栓塞过程中血流状态变化,对了解栓塞程度具有重要意义。     

PVA微粒栓塞治疗支气管咯血

目的：探讨ＰＶＡ微粒在栓塞治疗支气管咯血中的意义。材料和方法：１５例咯血患者经股动脉施行ＰＶＡ微粒加明胶海绵颗粒栓塞在动脉。结果：术后随访６个月、１４例达到满意的止血效果，仅１例病变范围广泛者栓后效果不佳而改手术切除。结论：ＰＶＡ微粒加明胶海绵颗粒栓塞支气管动脉是一种有效的治疗咯血的方法。     

彩色三维经颅多普勒对脑动静脉畸形微导管血管内栓塞疗效的评估

采用彩色三维经颅多普勒对２１例脑动静脉畸形（ＡＶＭ）血管内治疗前后血流改变进行了对比研究。提出栓塞后原供血动脉血流速度的改变是评价疗效的重要指标；栓塞完全的供血动脉其舒张期未血流速度（Ｖｄ）降低率大于收缩峰速（Ｖｓ）降低率，认为舒张期未血流速度的变化更能敏感地反映供血动脉远端阻力的改变；单支供血的ＡＶＭ栓塞疗效远比多支供血的ＡＶＭ效果满意，多支供血的ＡＶＭ情况较复杂，认为与颅内血流再分配有关。应用     

脑动静脉畸形的血管内栓塞治疗

目的：研究血管内栓塞治疗脑动静脉畸形（ｃＡＶＭ）的临床效果。方法：在数字减影全脑血管造影（ＤＳＡ）监视下,经股动脉插管,采用Ｍａｇｉｃ１．５￣１．８Ｆ微导管,α－氰基丙烯酸正丁酯（ＮＢＣＡ）栓寒剂对２１例脑ＡＶＭ患者行血管内栓塞。结果：完全栓塞达解剖治愈４例,脑ＡＶＭ团栓塞达９０％以上６例,７０％￣９０％９例,７０％以下２例,术后出现头晕、７头痛３例,２例栓寒后又行手术切除,３例栓塞后行γ－刀治疗     

外伤性颈内动脉海绵窦瘘的栓塞治疗和TCD监测

目的：评价国产钨丝螺旋圈栓塞颈内动脉海绵窦瘘的疗效和栓塞前后ＴＣＤ监测的价值。方法：在神经安定麻醉下经右股动脉插管,脑血管造影证实后,微导管进入瘘口内,用２～４ｃｍ长钨丝螺旋圈栓塞至自觉血管杂音消失,海绵窦不再显影时结束操作,并于栓塞前后应用ＴＣＤ监测颈内动脉、大脑中动脉和大脑前动脉、大脑后动脉血流速度。结果：２３例１次成功,１例２次成功。无并发症发生。栓塞前患侧ＩＣＡ流速增加,ＭＣＡ、ＡＣＡ流速降低（１例ＡＣＡ信号翻转）,压闭患侧颈内动脉后,所有ＡＣＡ血流信号翻转,ＰＣＡ血流增快,提示脑底动脉环功能良好。栓塞后患侧ＩＣＡ流速降低,而ＡＣＡ和ＭＣＡ流速加快,提示瘘口消失,脑供血改善。结论：国产钨丝螺旋圈价格低廉,易操作,且颈动脉通畅率高,可作为颈内动脉海绵窦瘘的首选栓塞材料。栓塞前应用ＴＣＤ监测可粗略估计瘘口大小及侧枝循环情况,栓塞后可作为评价疗效的一种观察指标。     

脑动静脉畸形的影像学诊断

目的：分析脑ＡＶＭ的影像学表现，探讨不同成像手段的诊断价值。材料与方法：报告１４例经ＤＳＡ或临床确诊的ＡＶＭ，行ＣＴ、ＭＲＩ及磁共振血管造影（ＭＲＡ）检查。结果：５例ＣＴ提示ＡＶＭ，ＭＲＩ不能显示供血动脉及引流静脉；ＭＲＡ可显示ＡＶＭ的供血动脉，部分显示引流静脉，有利于观察病变的内部细节。结论：ＭＲＡ是一种无创性血管显像技术，对于制订ＡＶＭ的治疗方案及估计预后具有指导意义，优于ＣＴ及ＭＲＩ。     

福辛普利对急性心肌梗死患者早期校正后QT间期离散度的影响

目的：探讨福辛普利对急性心肌梗死（ＡＭＩ）患者早期校正后ＱＴ间期离散度（ＱＴｃｄ）的影响。方法：对３０例ＡＭＩ患者随机单盲分福辛普利治疗组（１５例）和对照组（１５例）,并对治疗前和３ｄ后ＱＴｃｄ、室性心律失常发生率（ＶＡＭ）进行对比分析。结果：ＡＭＩ患者ＱＴｃｄ较正常人明显延长（Ｐ＜０．０１）,伴室性心律失常组较无心律失常组明显延长（Ｐ＜０．０５）;３ｄ后治疗组ＱＴｃｄ、ＶＡＭ较治疗前明显降低（均Ｐ＜０．０１）,对照组ＱＴｃｄ、ＶＡＭ虽亦有下降趋势但较３ｄ前无显著差异（均Ｐ＞０．０５）,治疗组明显低于对照组（Ｐ＜０．０５）。结论：福辛普利可能通过降低ＱＴｃｄ而降低ＶＡＭ,提示血管紧张素转换酶抑制剂降低ＡＭＩ早期病死率可能有该机制参与。     

老年人脑动静脉畸形

探讨老年人脑动静脉畸形的临床特点，以期提高诊断水平和治疗效果。方法；对１３例老年人ＡＶＭＳ临床资料进行分析和文献复习。结果；老年人ＡＶＭＳ在临床上容易误诊，其临床症状和青年人ＡＶＭＳ相比，头痛发生率高，出血更为常见，癫痫发作少见。结论：老年人ＡＶＭＳ并非非危险性疾病，在临床处理应采取手术和神经放射导管介入栓塞等的治疗措施。     

脉冲多普勒超声心动图对心室程控刺激诱发室性期前收缩的？…

为探讨室性期前收缩对心脏排血和充盈的血流动力学变化和影响，对３０例做电生理检查的患者，利用程控刺激仪诱发室性期前收缩以产生不同提前间期的室性期前收缩，同时运用脉冲多普勒超声技术记录二尖瓣口及主动脉瓣口血流频谱，分别测量主动脉瓣口和二尖瓣口的流速积分（ＡＶＩ，ＭＶＩ）。同景记录动脉内压力曲线。结果显示：室性期前收缩时ＡＶＩ和ＭＶＩ（ＥＡＶＩ和ＥＭＶＩ）明显低于正常心动周期时ＡＶＩ和ＭＶＩ（ＮＡＶＩ和     

腹腔镜下肝动脉门静脉插管栓塞化疗治疗肝癌

目的：评价腹腔镜下双插管栓塞化疗治疗肝癌效果。方法：１８例肝癌病人采用腹腔镜下肝动脉门静脉置入化疗泵,术后经药泵作反复栓塞化疗。药物包括阿霉素（ＡＤＭ）、丝裂霉素（ＭＭＣ）和卡铂（ＣＢＰ）,超乳化碘化油。每次相隔４～６周。结果：１年内死亡７例,成活已超过１年的１１例。结论：作者认为腹腔镜下肝动脉门静脉栓塞化疗是治疗中晚期肝癌的有效方法。     

Targeted embolization reduces hemorrhage complications in partially embolized cerebral AVM combined with gamma knife surgery

This study investigated the effect and safety of targeted embolization in partially embolized cerebral arteriovenous malformation (AVM) followed by gamma knife surgery (GKS). We retrospectively analyzed 86 AVM patients who were targeted embolized by Onyx followed by GKS for residual nidus. Embolization-related complications were collected and the clinical effect was evaluated. During targeted embolization, intranidus or hemodynamic aneurysms and AVM-related fistula were evaluated and targeted embolized. Patients with AVM-related aneurysms and fistula were divided into a targeted embolization group and non-targeted embolization group based on the retrospectively determined treatment strategy. The effect of targeted embolization on hemorrhage risk was evaluated. The overall annual hemorrhage rate was 1.66% with 2.26% for ruptured AVMs and 1.08% for unruptured lesions. The annual mortality rate was 0.4%. Only one in 16 patients with embolization-related complications had permanent neurologic deficit. Twenty-four of 29 cases with intranidus aneurysms were targeted embolized, four of five cases with hemodynamic aneurysms were targeted embolized and eight of nine cases with arteriovenous fistula were targeted embolized. Chi square results showed the hemorrhage complications in the target embolization group were significantly lower than those in the non-target embolization group (p < 0.01). Targeted embolization combined with GKS treatment decreased the annual hemorrhage rate and improved clinical outcome with low permanent complications in partially embolized AVMs. This method could be proposed for the treatment of large brain AVMs when a single-technique treatment is not feasible.     

康复干预对脑动静脉畸形介入治疗后神经功能恢复的作用

目的：探讨高危出血的脑动静脉畸形的血管内治疗及栓塞术后康复干预的疗效。方法：经脑CT或MRI确认为脑实质内出血的56例出血的高危脑动静脉畸形病例经数字减影血管造影(digital Subtract Angiography，DSA)全脑血管造影证实为脑动静脉畸形(arterioveinous malformation，AVM)。根据AVM病灶的特点，经血管内超选择应用a-氰基丙烯酸正丁酯栓塞或结合放射外科治疗，同时结合康复干预治疗。结果：56例均进行血管内栓塞治疗，其中36例在1-3次栓塞后病灶完全消除；2例因新生和残留的AVM中存留有动脉瘤而分别在随访1年时和在X-刀治疗后3月时再次出血，经2次栓塞后痊愈。经过康复干预治疗后，患者神经功能恢复满意。结论：经血管内栓塞是治疗高危性脑AVM的一种微创、安全、有效的方法，而栓塞后的康复治疗是脑神经功能的康复的必要手段。     

Onyx resorbtion with AVM recanalization after complete AVM obliteration

Brain arteriovenous malformations (BAVM) are some of the most complex lesions treated by clinical neuroscientists. The recent publication of the ARUBA trial, showing higher complication rates with treatment compared with the natural history over a short period of follow-up, puts even more pressure on the physician to achieve complete BAVM eradication without complication. These lesions are often treated by multimodality therapy with some combination of endovascular embolization, radiosurgery, and microsurgical resection; however, multimodality therapy involves the additive risk of procedural complication with each procedure. While surgical resection has long been accepted as monotherapy with good cure rates, staged pre-operative endovascular embolization has facilitated microsurgical resection with lower blood loss. Endovascular embolization is more often utilized in conjunction with surgical resection, and often the portions of the AVM and feeders that are completely embolized with Onyx or glue may not be surgically resected since they have been “internally obliterated.” We present a case where the AVM was preoperatively embolized with Onyx and subsequently partially surgically resected. Post-operative angiography showed complete obliteration or “cure” of the AVM with no filling of the nidus or early venous drainage. The patient presented 12 months later with seizures and imaging showed volume loss in the residual Onyx cast and recanalization of the AVM nidus. The patient subsequently underwent repeat resection with complete removal of the residual AVM and Onyx cast. To our knowledge this is the first published report of volume loss within the Onyx cast leading to recanalization of the AVM nidus. This suggests that extreme care should be taken with partial resection of the AVM nidus or with embolization for cure, as late recanalization may occur.     

选择性肾动脉栓塞治疗肾脏疾病的临床应用

目的：评价选择性肾动脉栓塞治疗在肾癌、症状性肾血管平滑肌脂肪瘤和肾创伤出血病人中的应用价值。方法：采用改良Seldinger技术经皮股动脉穿刺插管，对68例进行选择性肾动脉栓塞治疗，其中30例为肾癌术前辅助治疗，应用明胶海绵颗粒栓塞；8例为晚期肾癌姑息性治疗，采用丝裂霉素＋碘油的乳剂行末梢栓塞，然后用明胶海绵行肾动脉主干栓塞；6例症状性肾血管平滑肌脂肪瘤，采用真丝线段栓塞；24例肾创伤出血，采用自身血块、明胶海绵或弹簧钢圈栓塞。结果：肾癌术前栓塞者，术中肿瘤易剥离，手术野清晰，出血量少，手术时间缩短；晚期肾癌姑息治疗和症状性肾血管平滑肌脂肪瘤者，栓塞术后1~3周临床症状显著改善，3个月后肿瘤体积明显缩小，平均缩小65.6%；肾创伤性出血者，止血迅速，不影响肾功能。全部病例在栓塞治疗后无严重并发症发生。结论：选择性肾动脉栓塞术是治疗肾脏疾病的一种微创、安全、有效的方法，并发症少，可用于肾癌术前辅助治疗、晚期肾癌的姑息性治疗及肾血管平滑肌脂肪瘤和肾创伤出血的治疗，值得临床推广应用。     

血管内栓塞治疗脊髓血管畸形的护理

目的：着重探讨脊髓血管畸形血管内栓塞治疗的临床护理经验。方法：对32例行血管内栓塞治疗的脊髓血管畸形患者进行围手术期的护理和观察。结果：25例患者双下肢功能及小便功能障碍有不同程度的改善。结论：合理的护理有助于脊髓血管畸形患者的恢复。     

颅内动静脉畸形的治疗选择

目的总结颅内动静脉畸形的各种治疗措施及预后,探讨颅内动静脉畸形的合理治疗选择。方法 63例颅内动静脉畸形患者,手术治疗43例,保守治疗20例。患者有放射治疗史4例,后因合并症而手术切除。手术前曾行介入栓塞治疗者2例。结果手术治疗的43例中,经过造影检查证实全切除30例,不全切除13例,死亡5例,重残生存2例,轻度残疾或完全康复36例;保守治疗的20例中(12例为IV级病例),死亡5例,重残生存3例,轻度残疾或完全康复12例,随访提示再次出血3例,继发脑积水1例。结论手术全切除是颅内动静脉畸形最有效的治疗方法。对于无法手术的病例,建议患者行放射治疗或保守治疗和随访;介入栓塞治疗可作为巨大颅内动静脉畸形手术治疗前的辅助处理;对于放射治疗后出血或放射性脑病的病例,建议患者积极手术切除病灶。     

Transcatheter arterial embolization of cerebral arteriovenous malformations

An arteriovenous malformation (AVM) is a tangled mass of arteries and veins. These abnormal dilated vessels shunt blood away from normal brain tissue, resulting in adjacent tissue damage. In the past surgical removal of an AVM was often complicated by hemorrhage. In some cases the location or size of an AVM made it unresectable. The risks of surgical removal have led to the development of alternative approaches for the treatment of AVMs, such as transcatheter arterial embolization therapy. A variety of substances can be introduced via a catheter to occlude the abnormal vessels and obliterate the AVM or to decrease size to ease surgical management. This article discusses patient selection for embolization therapy, the materials and methods used and related nursing care and patient education. A case history is presented.     

Embolization of vascular malformations

Often vascular malformations (VMs) can only be treated by multiple modalities. Alongside surgical interventions and laser therapy, embolization and sclerotherapy of such lesions have become mainstays of clinical management and sometimes represent the sole option for treating acute and life-threatening hemorrhages. In a total of 315 sessions, we embolized 133 patients with VMs of non-cerebral origin. Primary focus was placed on arteriovenous malformations (AVM). The outcome was classified as successful only when we were able to embolize the shunt level. For this purpose, liquid embolizing and sclerosing agents were applied alone or in combination with particle suspensions. Recurrence rates, especially for maxillofacial malformations, were dependent on disease spread, pretreatment status and patient age, and proved high overall. In practical terms, it was not possible to completely or permanently eliminate AVMs which had been long-standing or had received pretreatment by unsuitable methods. Embolization represents an indispensable part of every overall therapeutic concept for VM management. Acute hemorrhages are manageable in nearly all cases; in selected disease processes, a cure can be accomplished by embolization alone.     

超选择性动脉内栓塞治疗临床难治性血尿的价值

目的:探讨临床难治性血尿经超选择性动脉内栓塞治疗的价值。方法:采用超选择性动脉插管技术,对31例急性血尿患者的肾动脉或膀胱动脉进行血管造影,并选用不同的材料栓塞出血病变。经一侧肾动脉栓塞27例,双侧膀胱动脉栓塞4例。结果:本组31例均完成超选择性动脉内栓塞治疗,27例(87%)于48h内血尿停止;3例(10%)48h后出血量减少,经保守治疗后止血;1例(3%)栓塞治疗失败并行患肾切除术。经随访没有发生严重并发症和肉眼血尿复发。结论:超选择性动脉内栓塞方法为临床难治性血尿提供了新的治疗途径,同时也是一种安全有效的急救手段。