Peripheral arterial disease

To provide an overview of the epidemiology, links to cardiovascular disease, diagnosis, and management of patients suffering from peripheral arterial disease (PAD). The most common symptom of PAD is intermittent claudication, but non-invasive measures, such as the ankle–brachial index, show that asymptomatic PAD is several times more common in the population than intermittent claudication. PAD prevalence and incidence are both sharply age-related, rising to more than 10% among patients in their 60s and 70s. The major risk factors for PAD are those for coronary and cerebrovascular disease, with some differences in the relative importance of different factors. Smoking is a particularly strong risk factor for PAD, as is diabetes mellitus. PAD is strongly associated with concomitant coronary and cerebrovascular diseases. Diagnosis includes both clinical examination and objective imaging. The severity of PAD is broadly classified as asymptomatic, causing symptoms of intermittent claudication, or resulting in critical limb-threatening ischaemia (CLTI). Treatment may be conservative in the early stages with medical therapy to address cardiovascular risk factors and exercise therapy. People with CLTI have a threatened limb and will in addition require lower limb revascularization, by surgical, endovascular or combined (‘hybrid’) techniques. In some people primary amputation is the best option, either because they have no revascularization option or the limb is non-salvageable.     

超选择动脉栓塞联合外科序贯治疗Ⅰ型神经纤维瘤伴巨大神经纤维瘤临床疗效观察

目的:探究DSA联合外科序贯治疗是否可以作为Ⅰ型神经纤维瘤伴巨大神经纤维瘤的重要治疗策略之一。方法:纳入2017年7月-2021年8月收治的11例神经纤维瘤患者作为研究对象。肿瘤大多位于躯干及四肢,瘤体重量2.5~25 kg。全部患者术前备自体血,瘤体切除术前介入超选择栓塞瘤体滋养动脉及其分支,切除瘤体后将栓塞后的部分瘤体组织制备皮瓣及全厚皮片回植于继发创面。观察患者术后恢复情况及并发症发生情况。结果:11例患者中,9例在瘤体切除术后利用部分瘤体皮肤制备全厚皮片回植于组织缺损区域,2例制备皮瓣回植。其中1例患者回植后全厚皮片少部分坏死,经换药等保守治疗愈合可。随访至今,11例患者术后均无复发,术后肢体外形改善,恢复正常行走等组织功能。结论:超选择栓塞瘤体滋养动脉及其分支联合序贯疗法,在治疗NF-I合并巨大神经纤维瘤中术中失血量小,术后并发症少,患者恢复效果好,可作为该疾病的一种治疗策略。     

肝结核的病理特征与临床相关问题探讨

目的 探讨肝结核的病理特征与临床表现、诊断和治疗的关系。方法 对经手术与病理证实的肝结棱患者的临床资料进行回顾分析。结果 肝结核病理改变以粟粒样和结节瘤样病灶为主，临床表现和影像学表现多样，且无特异性，误诊误治率高。结论 了解肝结核的病理特征，有助于理解分析肝结核的临床表现和影像学检查结果，有助于治疗方法的选择，从而降低误诊误治率。     

危重患者毛细血管渗漏综合征

目的探讨代血浆与血制品对毛细血管渗漏综合征(Capillary leak syndrome,CLS)患者中心静脉压(CVP)和平均动脉压(MAP)的影响.方法依据单纯输入706代血浆、单纯输入新鲜冰冻血浆(FFP)和二者兼输,将临床诊断为CLS的48例患者分3组,监测治疗前后CVP与MAP的变化.结果总体分析,48例患者治疗前后的CVP与MAP的变化有显著性.分组比较,706代血浆输入组的CVP变化与非706代血浆输入组比较有显著性差异,而三组中任何两组间的MAP变化均无显著性.结论706代血浆对CLS患者的血容量恢复效果优于FFP.     

癃闭舒胶囊治疗良性前列腺增生症出现肝功能损害的报告

目的评价癃闭舒胶囊治疗良性前列腺增生症的安全性.方法以癃闭舒胶囊(0.3 g/粒)为阳性对照药,对218例良性前列腺增生症1、2期患者(平均年龄63.73±7.50岁)进行治疗,每日2次,每次3粒,口服,连续服药6周为1个疗程,每2周复诊1次.观察时间为1个疗程.结果服用癃闭舒胶囊6周后,218例患者ALT中位数值升高,与治疗前比较,差异有统计学意义(P=0.001 7);ALT治疗前正常,治疗后转异常者占7.80%(17/218),其中3例发生严重肝功能损害(ALT＞200 IU/L).结论癃闭舒胶囊中所含易被混淆的中草药有黄药子,其别名山慈菇文献记载有小毒,为薯蓣科植物黄独的块茎,有明确的肝功能损害作用.本研究结果提示,为确保中药制剂的安全性,在中药制剂的标准中应规定处方组成的中药材基原,制药企业在验收原料时,应严格按标准鉴别中药材基原,特别是含有毒性成分的易混淆品种.     

原发性肝癌的MRI征象与肝癌转移发生的相关性分析

目的　总结原发性肝癌的MRI征象 ,分析其与肝癌转移之间的相关性。方法　收集我院经病理确诊为原发性肝癌的患者 5 0 0例 ,分别行平扫、Gd DTPA及SPIO增强扫描。结果　小肝癌 65例 (13 % ) ,结节型 81例 (16.2 % ) ,块状型 3 2 5例(65 % ) ,弥漫型 2 9例 (5 .8% )。多发肿瘤 190例 (3 8% )。淋巴结转移率为 12 % ;静脉癌栓为 3 1.4%。结论　原发性肝癌的MRI征象中大病灶、多病灶、T1信号不均匀者发生转移的几率较大 ,而四种转移形式之一均提示其他转移的几率增加。     

Changes in hepatic hemodynamics after orthotopic liver transplantation: color Doppler sonography

Background: Liver perfusion has an influence on therapy results in patients undergoing orthotopic liver transplantation (OLT). The objective of the present study was to investigate changes in hepatic hemodynamics in patients after OLT with color-coded Doppler sonography (CCDS). Methods: Forty-five consecutive patients were included. The examinations were done before, on postoperative day 1, and then weekly until the patients were discharged. Mean velocity of the portal (PV-V) and splenic (SV-V) veins and the maximum velocity and resistance index of the hepatic artery were determined. Results: After OLT a significant increase in PV-V and SV-V was observed. Twenty-five patients had normal perfusion of the hepatic artery, whereas 16 patients had abnormal flow patterns. In these patients prostaglandin I₂ was used until flow rates normalized. In four patients, CCDS could not detect perfusion of the hepatic artery. Conclusions: CCDS is a suitable method for evaluating hepatic hemodynamics before and after OLT. Changes in blood flow velocities in the liver-supplying vessels are detectable, but perfusion of the hepatic artery is seldom detectable. These observations are of special interest after OLT, where liver circulation has an influence on therapy results. Received: 12 January 2000/Accepted: 5 April 2000     

肝硬化合并急性胆囊炎和胆管炎的外科治疗

目的：探讨肝硬化合并发急性胆囊炎和胆管炎的外科治疗。方法：回顾分析38例肝硬化合并急性胆囊炎和胆管炎的病例资料。结果：36例痊愈，治愈率94．7％，好转1例（2．65％），死亡1例（2．65％）。结论：做好围手术期处理，术中精细操作，肝硬化合并急性胆囊炎和胆管炎患者仍可取得盘好的效果。     

榄香注射液及华蟾素注射液分别联合TACE治疗中晚期原发性肝癌临床研究

目的:观察比较榄香注射液及华蟾素注射液分别联合肝动脉导管化疗栓塞治疗中晚期原发性肝癌的临床疗效及不良反应发生率的差异。方法:纳入104例2018年8月—2020年1月于肿瘤科治疗的中晚期原发性肝癌患者作为研究对象,按照治疗方案的不同随机分成2组各52例。2组患者均给予肝动脉导管化疗栓塞(TACE)治疗1次,华蟾素注射液组予华蟾素注射液10 mL加入到5%葡萄糖注射液500 mL中静脉滴注,每天1次。榄香注射液组加用榄香注射液静脉滴注,每次0.4 g,每天1次,2组连续治疗15 d后休息15 d,连续治疗2个疗程。观察比较2组临床疗效、肝功能指标[(谷丙转氨酶(ALT)、谷草转氨酶(AST)及总胆红素(TBil)]的变化及甲胎蛋白(AFP)、卡氏评分(KPS)和肿瘤体积的变化,以及不良反应发生率的差异。结果:临床疗效总有效率榄香注射液组88.46%,华蟾素注射液组71.15%,2组比较,差异有统计学意义(P<0.05)。治疗后,2组血清ALT、AST和TBil水平较治疗前均显著降低,差异均有统计学意义(P<0.05);2组间血清ALT、AST和TBil水平相比较,差异无统计学意义(P>0.05)。治疗后,与华蟾素注射液组比较,榄香注射液组AFP降低值、肿瘤体积缩小值及KPS评分升高值均多于华蟾素注射液组,差异均有统计学意义(P<0.01)。治疗期间,2组不良反应总发生率比较,差异无统计学意义(P>0.05);华蟾素注射液组发生的不良反应以恶心呕吐为主,发生率高于榄香注射液组,差异有统计学意义(P<0.05);榄香注射液组发生的不良反应以注射部位疼痛为主,发生率高于华蟾素注射液组,差异有统计学意义(P<0.05)。结论:榄香注射液联合TACE治疗中晚期原发性肝癌的临床疗效优于华蟾素注射液,2种中药制剂治疗期间仍需要注意不良反应的发生情况。     

不同护理干预对开胸术后肺部并发症的预防效果研究

目的探讨传统拍背咳痰与振动排痰机对胸部手术后肺部并发症的预防、排痰效果及改善呼吸功能的作用。方法选择120例胸部手术患者,按随机原则分为实验组与对照组,各60例,对2组患者术后发生低氧血症、肺不张、需纤维支气管镜(纤支镜)介入吸痰的情况,以及术后6h与术后48h的动脉血气结果进行对比分析。同时观察并记录2组病例的排痰感受。结果2组患者发生低氧血症、肺不张、需纤支镜介入吸痰情况,实验组均明显少于对照组(P<0.01);观察2组病例的排痰感受,实验组感觉舒适与对照组相比有显著差异;对照组感到剧痛而不愿排痰,与实验组相比相差亦显著;术后48h的PaO2、PaCO2与排痰前即术后6h比较均有显著性差异(P<0.01),pH值两者前后均无统计学意义。但实验组术后48h与术后6h的PaO2、PaCO2差值与对照组术后48h与术后6h的差值相比较,有非常显著性差异。结论使用振动排痰机行胸廓振动法对开胸术后肺部并发症的预防与治疗起了积极有效的作用。