胆道、十二指肠支架置入治疗胆道合并十二指肠恶性梗阻

目的探讨胆道支架、十二指肠支架置入治疗胆道合并十二指肠恶性梗阻的临床价值。方法2008年1月～2013年12月,对24例同时存在胆道和十二指肠恶性梗阻的患者完成胆道支架、十二指肠支架置入,其中介入中心10例患者行经皮肝穿刺造影完成胆道金属支架置入（percutaneoustranshepaticinsertionofbiliarystent,PTIBS）,14例消化内镜中心患者行逆行胰胆管造影放置胆道金属支架（endoscopicretrogradecholangiopancreatography—guidedbiliarystent,ERCP．BS）,其中1例失败后改行经皮肝穿刺胆管外引流术不纳入随访研究。胆管支架置入术后1周完成十二指肠支架置入。观察手术成功率、临床症状缓解率、并发症、支架通畅时间及患者生存期等指标。结果联合支架置入成功率95．8％（23／24）,梗阻症状消失率87．0％（20／23）;十二指肠支架置入术后1周胃出口梗阻评分（2分6例,3分17例）较术前（O分6例,1分17例）明显改善（Z=-4．796,P=0．000）。胆道支架通畅时间（73．9±5．3）d,生存时间（93．0±4．9）d。十二指肠支架再发梗阻率17．4％（4／23）。均未出现严重并发症。结论胆道、十二指肠支架联合置入治疗恶性胆道、十二指肠梗阻安全有效。     

胡桃夹综合征的诊治进展简

胡桃夹综合征又称左。肾静脉压迫综合征,是左肾静脉在腹主动脉和肠系膜上动脉所形成的夹角或腹主动脉和脊柱之间的间隙处受机械挤压后导致左肾静脉回流受阻从而引起左。肾、输尿管及生殖腺静脉内压增高所产生一系列临床症候群的现象,临床上较为少见。结合文献报道和临场诊治经验,对胡桃夹综合征的病理生理、诊断、治疗及其进展进行了总结如下。     

脑卒中患者早期下肢深静脉血栓形成的研究

目的探讨脑卒中患者早期下肢深静脉血栓形成(DVT)的危险因素。方法对144例发病48 hrs内的脑卒中住院患者于入院后24 h内行D-二聚体(DD)、纤维蛋白原(FIB)、C-反应蛋白(CRP)水平测定,并于发病后3d和14d进行双下肢深静脉超声检测,确定下肢早期DVT的发生率;通过比较脑卒中后早发DVT组与非DVT组患者相关临床信息,筛选脑卒中后下肢DVT发生的危险因素。结果脑卒中后患者早期下肢DVT发生率为6.3%。Logistic回归分析显示中重度脑卒中、CPR及FIB升高是脑卒中患者早期DVT的独立危险因素。结论脑卒中患者是发生DVT的高危人群,对CRP、FIB升高的严重脑卒中患者进行DVT监测和预防是十分必要的。     

脑静脉系统血栓形成典型病例临床分析

目的：对脑静脉系统血栓形成进行临床分析。方法对 CVT患者临床资料进行分析。结果早期表现均有头痛、恶心、呕吐、颅内压增高表现,且呈进行性加重、常有癫痫、伴或不伴局灶性神经功能缺失。影像学检查显示：有上矢状窦、横窦血栓形成和乙状窦、横窦血栓形成,经脱水、抗凝、溶栓等治疗患者症状明显改善。结论脑静脉窦血栓形成早期临床无特异性,头颅CT结合CTV检查对本病诊断值较高。     

应变率成像定量评价冠状动脉支架置入术前后左室局部心肌张功能变化

目的 采用应变率成像技术定量评估冠状动脉支架置入术前后左室局部心肌舒张功能的变化.方法 应用应变率成像技术对56例健康体检者和60例冠心病患者冠状动脉支架置入术前后心尖四腔、两腔、左室长轴切面相应节段局部心肌舒张功能进行定量分析.结果 冠心病患者术前缺血节段心肌应变率曲线中舒张期E、A峰值均小于健康体检者相应心肌节段,术后经治疗的缺血节段心肌舒张期E、A峰值较术前明显增加,差异均有统计学意义（P＜0.05）.结论 冠状动脉支架置入术可改善心肌缺血,应变率成像技术能定量评价冠状动脉支架置入术前后左室局部心肌舒张功能的变化.     

生骨胶囊联合低分子肝素治疗脊柱术后下肢深静脉血栓48例疗效观察

目的 观察生骨胶囊联合低分子肝素对脊柱术后下肢深静脉血栓(DVT)疗效及安全性的影响。方法 选择2015年12月至2016年11月于石家庄市第一医院行脊柱外科手术病人96例作为研究对象,采用随机数字表法将其分为观察组(48例)与对照组(48例)。对照组给予低分子肝素治疗,每天4 100 IU,皮下注射。观察组则在对照组用药治疗基础上加以口服生骨胶囊,5粒/次,3次/天。观察两组临床疗效、DVT发生率、不良反应发生情况以及治疗前后血液流变学、腘静脉内径(POPV)、股浅静脉内径(FSV)等变化情况。结果 观察组总有效95.83%高于对照组77.08%,DVT发生率4.17%低于对照组20.83%,差异有统计学意义(P＜0.05)。治疗后观察组PT、FIB、D-D指标水平较高于治疗前,差异有统计学意义(P＜0.05)。治疗后观察组FIB(4.02±0.46) g/L、D-D(385.24±26.41) μg/L指标水平较低于对照组FIB(4.63±0.51) g/L、D-D(511.61±22.29) μg/L,差异有统计学意义(P＜0.05)。治疗前两组FSV与POPV检测结果对比,差异无统计学意义(P＞0.05);治疗后观察组FSV与POPV较治疗前对比,差异无统计学意义(P＞0.05);治疗后对照组FSV(7.03±1.79) mm与POPV(7.96±1.63) mm显著低于观察组FSV(8.52±1.23) mm与POPV(9.52±1.23)mm,差异有统计学意义(P＜0.05)。治疗期间两组用药不良反应发生率差异无统计学意义(P＞0.05)。结论 生骨胶囊与低分子肝素联合治疗有助于降低脊柱术后下肢深静脉血栓发生率,加速病人术后康复,改善血液流变学,安全性良好,临床普及价值高。     

Transapical mitral valved stent implantation: Enhanced survival and decreased paravalvular leakages

Background/Objectives

This study presents the recent results of transapical implantation of a new design of a mitral valved stent with up to three months follow-up.

Methods

A self-expanding re-designed mitral valved stent was implanted via transapical approach into the beating heart of eight pigs. Echocardiographic- and hemodynamic parameters were assessed before (n = 8), at 1 h (n = 8), at one month (n = 6), at two months (n = 2), and at three months (n = 1) after implantation and a cardiac CT was conducted.

Results

The stent was successfully deployed in all animals. Two animals died within the first month due to incorrect fixation force. Echocardiographic evaluation showed low gradients (3.9 ± 1.4 mm Hg and 1.9 ± 0.8 mm Hg across the valved stent and aortic valve) and a normal mitral annular plane systolic excursion (1.1 ± 0.2 cm) after one month. No paravalvular leakages (PVL) were detected after 1 h. The pulmonary artery pressure did not increase after valved stent implantation (p ≥ 0.106). The pulmonary capillary wedge pressure (PCWP) slightly increased to 16 ± 3 mm Hg after one month (p = 0.033). The left ventricular end-diastolic pressure was mildly elevated (15.8 ± 8.6 mm Hg) after one month.

Conclusions

Secure deployment and correct position of the valved stents were reproducibly achieved in the off-pump implantation procedure. No paravalvular leakages after 1 h as well as low gradients, few stent fractures and a normal longitudinal function after one month were achieved with this newly developed and well-aligned prototype. However, a number of challenges have been identified during this study and potential for improvement has been identified.     

Clinical outcomes of patients treated with Nobori biolimus-eluting stent: Meta-analysis of randomized trials

Backgrounds

The Nobori is a new-generation, biodegradable-polymer coated, biolimus-eluting stent (BES) that has recently been investigated in several randomized trials with inconsistent results. The aim of this study was to assess the efficacy and safety of Nobori BES versus other drug-eluting stents (DES) in patients treated with percutaneous coronary intervention (PCI).

Methods

We undertook a meta-analysis of randomized trials investigating Nobori BES versus other DES. Primary efficacy and safety outcomes were target lesion revascularization (TLR) and definite/probable stent thrombosis (ST), respectively. Secondary outcomes were the composite of cardiac death/myocardial infarction (MI)/target vessel revascularization (TVR), MI and death.

Results

A total of 9114 PCI-patients randomly received Nobori BES (n = 5080) or other DES (n = 4034). This latter group comprised patients receiving everolimus- (n = 2533), sirolimus- (n = 1376) or paclitaxel-eluting stents (n = 125). Median follow-up was 11 months [interquartile range 9–12]. The Nobori BES versus other DES showed comparable risk of TLR (odds ratio [95% confidence interval] = 0.91 [0.57–1.46], p = 0.71). There was significant heterogeneity across trials due to significant lower TLR risk with Nobori BES versus paclitaxel-eluting stent (0.32 [0.10–0.98], p = 0.046; p for interaction = 0.009). Nobori BES versus other DES showed comparable risk of definite/probable ST (1.40 [0.66–2.97], p = 0.39), cardiac death/MI/TVR (1.05 [0.88–1.25], p = 0.59), MI (1.13 [0.87–1.48], p = 0.37) and death (1.09 [0.81–1.48], p = 0.56).

Conclusions

Nobori BES has comparable efficacy with other limus-eluting stents at 1-year follow-up. There is no difference in terms of safety profile between these stent platforms.     

经皮冠状动脉介入治疗术后亚急性支架内血栓形成并发肝功能异常患者的药学服务

目的 通过临床药师参与经皮冠状动脉介入治疗（PCI）术后亚急性支架内血栓形成并发肝功能异常患者的临床治疗和药学服务,探讨临床药师所起的作用。方法 临床药师通过分析患者PCI术后亚急性支架内血栓形成及发生肝功能异常的原因,根据患者病情、基因型、合并用药、相互作用、不良反应等,及时调整患者抗血小板治疗药物为替格瑞洛90 mg,po,bid,同时减少瑞舒伐他汀剂量为10 mg,po,qn,并行药学监护和用药教育。结果 医师采纳临床药师建议,患者病情好转。结论 临床药师应发挥自身专业所长,协助医师调整患者药物治疗方案,保证患者用药安全、有效。