新型冠状病毒肺炎疫情防控时期主动脉急症患者诊治的建议

近期新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)疫情爆发,恰逢主动脉急症高发的冬春时节,而主动脉急症大多起病急骤,病情危重,死亡率高,需紧急处理。在国家"重大突发公共卫生事件一级响应机制"之下,疫期主动脉急症患者的诊疗需制订全新的流程。如何在这一特殊时期增强医护人员的防护和正确救治意识,既让主动脉急症患者获得及时、有效的治疗,又能避免救治期间可能发生的院内疫情传播,是急诊科、心外科、血管外科等相关学科当前面临的重大课题。本文呼吁各医疗单位在严格遵守政府和医院感控部门规章制度的基础上开展医疗实践,在"疫情防控为重,严防院内感染,确诊COVID-19患者首选保守"的前提下,提倡"择期手术适当推迟,限期手术术前隔离排查,急诊手术严格防护"的诊治原则,同时针对COVID-19疫期主动脉急症患者的急诊科接诊、病房收治、术前准备、术中防护、术后处理等方面提出了建议。     

自发性孤立性肠系膜上动脉夹层的诊断和非手术治疗

目的:探讨自发性孤立性肠系膜上动脉夹层(SISMAD)的诊断和非手术治疗。方法:回顾性分析2008-02-2012-01收治的13例SISMAD患者的临床资料。结果:根据Sakamoto影像学分型,Ⅰ型夹层2例,Ⅱ型6例,Ⅲ型4例,Ⅳ型1例;11例保守治疗效果良好,已随访3～46个月(平均27.3个月),无明显腹部症状复发;CTA随访(8例)结果显示,SMA夹层稳定或不同程度改善,假腔内血栓减少,夹层远端动脉开放。2例保守治疗无效后改行腔内支架植入术,其中1例用弹簧圈栓塞假腔,已分别随访7个月和19个月,无腹部症状复发。结论:CT增强或CTA对于SISMAD的诊断具有重要帮助。保守治疗SISMAD有效,一旦无效或病情进展,根据病情改行腔内治疗或手术治疗。     

腹主动脉瘤腔内修复治疗的进展

腹主动脉瘤（Abdominal aortic aneurysm,AAA）是指腹主动脉局限性瘤样扩张,超过3cm或超过正常直径的50%即可诊断为腹主动脉瘤,75%的患者并无临床症状〔1〕,破裂是其最常见、最凶险的并发症,破裂后的死亡率高达80%~90%〔2〕。     

脾动脉瘤7例诊治分析

目的：探讨脾动脉瘤的诊断和手术治疗方法。方法：回顾性分析7 例脾动脉瘤患者的临床资料。结果：6例经彩色多普勒超声（B超）初步诊断;4例经CT动脉造影（CTA）,2例经数字减影血管造影术（DSA）,1例经磁共振造影（MRA）确诊;无1例依靠临床症状而确诊。单纯脾动脉瘤切除术1例,脾动脉瘤加脾脏切除术1例,脾动脉瘤切除加动脉重建术1例,动脉瘤近远端脾动脉结扎术1例,脾动脉瘤栓塞术2例,脾动脉瘤栓塞术加脾切除术1例。随访2个月至3年。无死亡及严重并发症病例。结论：脾动脉瘤依赖临床表现难以诊断,B超有筛选价值,CTA,MRA,DSA均有诊断价值。一旦确诊应尽早选择腔内介入栓塞治疗或手术方法。     

Analysis of 287 patients with aortic dissection: General characteristics,outcomes and risk factors in a single center

The general characteristics,outcomes and risk factors of the patients with aortic dissection(AD) were evaluated in a single medical center.From January 2002 to December 2008,284 patients with AD were treated and followed-up at our institution,including 105 cases of type A AD and 179 cases of type B AD.The patients in each type were divided into three groups according to management:medical treatment group(A or B),open surgery group(A or B),and stent-graft group(A or B).The characteristics and follow-up outcomes were compared between the groups or subgroups.The results showed that there was significant difference in the prognosis for type A AD between medical treatment group and open surgery group,but there was no significant difference in the prognosis for type B AD between medical treatment group and stent-graft group.Independent risk factors of follow-up mortality for patients with type A AD included a history of atherosclerosis(HR,3.807;95% confidence interval [CI],1.489 to 7.611;P=0.003),in-hospital hypotension/shock(HR,4.687;95% CI,1.846 to 11.900;P=0.001),in-hospital myocardial ischemia or infarction(HR,3.734;95% CI,1.613 to 8.643;P=0.002),pleural effusion(HR,2.210;95% CI,1.080 to 4.521;P=0.030),branch vessel involvement(HR,2.747;95% CI,1.202 to 6.278;P=0.016) and surgical treatment(HR,0.177;95% CI,0.063 to 0.502;P=0.001).And there were insignificant independent predictors for mortality of the patients with type B AD.It was concluded that there were significant differences in characteristics and one year mortality between type A AD and type B AD,but after one year,there was no significant difference in the mortality and complications of them.There were several discordant risk factors of AD,such as female gender,age,thrombus,abrupt onset of pain that were considered as the risk factors in some papers.And there was no definite risk factor of mortality in this study in the patients with type B AD.     

肠系膜上动脉瘤六例诊治分析

肠系膜上动脉瘤(superior mesenteric artery aneurysms,SMAAs)是极少见但有较大破裂风险的内脏动脉瘤,发病率仅占内脏动脉瘤的5.5%~([1]).为探讨肠系膜上动脉瘤的外科手术方法,本文回顾性分析我院2005年3月至2008年12月收治的6例此类患者的临床资料,报告如下.     

Topical propranolol hydrochloride gel for superficial infantile hemangiomas

The clinical efficacy and safety of topical propranolol hydrochloride gel in the treatment of superficial infantile hemangiomas (IHs) were assessed. Fifty-one cases of IHs from Oct. 2010 to Sept. 2011 were subjected to the topical propranolol hydrochloride gel intervention in Fuzhou General Hospital of Nanjing Military Commands, China. Changes in size, texture, color, peak systolic velocity of the hemangiomas, resistance index and adverse effects were observed. The results were evaluated by using Achauer system, and responses of IHs to pranpronolol were considered scaleⅠ(poor) in 4 patients (17.24%), scaleⅡ(moderate) in 18 patients (24.14%), scale Ⅲ (good) in 22 patients (44.83%) and scale Ⅳ (excellent) in 7 patients (13.79%). The response of superficial hemangiomas was significantly better than other hemangiomas (P<0.05), and no differences in response were found among different primary sites (P>0.05). Our study indicates that topical application of 3% propranolol hydrochloride gel is effective and safe in treating IHs.     

Expression of RECK Gene and MMP-9 in Hilar Cholangiocarcinoma and Its Clinical Significance

Theincidence of pri mary hilar cholangiocarci-noma has anincreasingtrend year by year.The di-agnosis and prognosis of hilar cholangiocarcinomasare poor due to its special location,invasivegrowth,difficulty of early discovery and difficultsurgical operation.At present,some scholars dis-covered a reversion-inducing-cysteine-rich proteinwith Kazal motifs(RECK),which possesses thefunctions uniquelyinhibitingthe expression and ac-tivity of matrix metalloproteinases(MMPs).Thestructure of RECKge…     

人arresten基因转染对自体移植静脉内膜增生的影响

目的:探讨体内转染arresten基因对自体移植静脉内膜增生的影响。方法:建立大鼠自体静脉移植模型。血管吻合术前，用脂质体介导重组质粒pSecTag2-AT（Ⅰ组），空载体pSecTag2转染（Ⅱ组）移植血管，等体积脂质体溶液处理移植血管(空白对照组，Ⅲ组）。各组动物均于4周后切取移植血管，RT-PCR检测移植血管中arresten mRNA的表达；常规HE，Verhoeff弹力纤维染色；计算机图象分析检测移植静脉血管内膜及中膜面积、厚度；免疫组化检测移植血管内膜α-SMA及PCNA的表达；Western blot检测TGF-β1蛋白的表达。结果:Ⅰ组转染的移植静脉中有目的基因mRNA的表达, 而Ⅱ、Ⅲ组无Ⅰ组内膜、中膜面积小均于Ⅱ组和Ⅲ组，差异有显著性（P<0.05）。而内膜面积/中膜面积3组间无统计学差异（P>0.05）；Ⅰ组内膜厚度小于Ⅱ组和Ⅲ组，组间比较有统计学差异（P<0.01）；α-SMA染色表明增生内膜中的细胞是血管平滑肌细胞；PCNA阳性细胞数及表达指数Ⅰ组均低于Ⅱ组和Ⅲ组（P<0.05）；Ⅰ组TGF-β1蛋白的表达明显低于Ⅱ组和Ⅲ组。结论:移植血管转染arresten基因，可有效抑制自体移植静脉内膜的增生，在防治血管移植术后再狭窄方面显示出良好的临床应用前景。     

急性出血坏死性胰腺炎肝损伤Toll样受体2/4mRNA的表达变化

目的研究急性出血坏死性胰腺炎（AHNP）肝损伤Toll样受体（TLR）2／4 mRNA表达的变化规律。方法采用逆行胰胆管牛磺胆酸钠（TAC）注射制造AHNP肝损伤动物模型。动物分为假手术组（S组）、胰腺炎组（P组）。RT—PCR方法检测不同时间点肝组织TLR2和TLR4 mRNA表达变化。结果P组大鼠3h肝组织TLR2和TLR4 mRNA表达开始增高，伤后6～12h肝组织TLR2和TLR4 mRNA表达迅速达到峰值（P〈0.05或P〈0．01），肝损伤加重（P〈0.05或P〈0.01）。S组变化不明显。结论AHNP肝组织内TLR2和TLR4的基因表达上调。肝组织内TLR2和TLR4的基因表达增高可能在AHNP肝脏损伤的发生、发展中起作用。