双向入路治疗下肢动脉远端流出道闭塞性病变

【摘要】 目的 探讨膝下动脉逆行穿刺建立双向入路治疗下肢动脉远端流出道闭塞性病变的技术特点、安全性和有效性。方法 回顾性分析2018年1月至2019年3月47例患者临床资料,均为顺行入路开通血管失败的腘动脉和远端膝下动脉闭塞,中转采用远端动脉逆行穿刺建立双通路开通血管。结果 技术总成功率为100%（47/47）。无死亡、截肢等严重并发症发生,穿刺并发症发生率为12.8%。术后6、12个月累计通畅率分别为70.5%（31/44）、43.2%（19/44）。结论 在远端血管解剖条件允许下,双向入路治疗下肢动脉远端流出道闭塞性病变能提高血管开通率,并发症发生率低,近期保肢率高。     

益气养阴活血对中国小型猪心肌梗死后早期心肌组织Na^＋-K^＋ATP酶、Ca^2＋-Mg^2＋ATP酶活性及抗氧化的作用

目的采用结扎中国小型猪冠状动脉造成急性前壁心肌梗死（AMI）模型,应用益气养阴活血中药（复方芪丹液）干预动物AMI后早期心室重构（VR）的影响,并研究其对动物心肌钙、镁离子和氧自由基的作用。方法中国小型猪28只,采取结扎冠状动脉左前降支中下1/3部,造成AMI模型。手术成功存活动物随机分为复方芪丹液大、小剂量组及卡托普利（开搏通）组、模型组、假手术组共5组,均予灌胃给药或自来水4周。4周后测定猪的血流动力学指标、心肌Na＋-K＋ATP酶、Ca2＋-Mg2＋ATP酶活性、心肌超氧化物歧化酶（SOD）、丙二醛（MDA）含量等。结果与模型组比较,复方芪丹液大剂量组的左室内压（LVP）、血压（BP）、-dp/dtmax值明显升高（P〈0.01）,复方芪丹液小剂量组及开博通组LVP显著升高（P〈0.05）,开博通组-dp/dtmax值显著升高（P〈0.05）。复方芪丹液大剂量组Na^＋-K＋ATP酶、Ca^2＋-Mg^2＋ATP含量较模型组显著升高（P〈0.05）,复方芪丹液小剂量组、开博通组与模型组相比Ca^2＋-Mg^2＋ATP酶仅有升高的趋势,未有统计学意义（P〉0.05）;复方芪丹液大剂量组、复方芪丹液小剂量组、开博通组SOD活力较模型组均显著升高（P〈0.05）。复方芪丹液大剂量组的MDA含量与模型组比较显著降低（P〈0.05）。结论益气养阴活血中药可提高中国小型猪AMI后心肌收缩力,改善血流动力学指标;增加SOD活性,降低MDA含量,提高细胞膜Ca^2＋-Mg^2＋ATP酶和Na^＋-K^＋ATP酶活力,起到干预AMI后VR和保护心肌的作用。     

股浅动脉首期置入自膨式支架与球囊扩张成形的疗效比较

Objective To compare the mid-term clinical results of primary implantation of a selfexpanding nitinol stent and primary percutaneous transluminal angioplasty (PTA) for long range arteriosclerosis obliterans of the superficial femoral artery. Methods From December 2005 to February 2007,109 patients who had moderate-severe claudication or chronic limb ischemia (CLI)due to stenosis or occlusion of the superficial femoral artery were treated by endovascular technology. 53 patients (73 limbs) were treated by primary stenting and 56 patients (76 limbs)by PTA. We compared the clinical data of stenting group and PTA group at 6,12 and 24 months. Results The mean length of the treated segment was (16± 8)cm in the stenting group and(15±7)cm in the PTA group. At 6 months, the rate of restenosis on duplex ultrasonography was 13.7% in stenting group and 30.2% in PTA group (X2=4.09, P<0.05);at 12 months the restenosis rates were 25.5% in stenting group and 46.9% in PTA group(X2=4.75, P<0.05);at 24 months the restenosis rates on duplex ultrasonography were 38.1% in stenting group and 65.9% in PTA group(X2=6.66, P<0.01). Rutherford stages in stenting group were significantly better than those in PTA group. Conclusion In the mid-term, primary implantation of a self-expanding nitinol stent yielded results that were superior to those with PTA for arteriosclerosis obliterans or long range stenosis of the superficial femoral artery.     

慢性威胁肢体性缺血中医药介入治疗研究进展

综述介入和中医治疗慢性威胁肢体性缺血的研究进展,提示介入结合汤剂内服、中药外敷、针灸等中医辨证的方法治疗本病,临床效果较好。     

血府逐瘀汤治疗下肢动脉硬化闭塞症临床观察

目的观察血府逐瘀汤（XFZY）和前列地尔脂微球载体E1（PGE1）注射液治疗下肢动脉硬化闭塞症（ASO）的疗效。方法动脉狭窄程度及踝/肱指数（ankle-brachial index,ABI）。结果 XFZY组显效率为82.9%,对照组为54.8%（P〈0.05）;两组治疗后凝血功能、动脉狭窄程度等指标均有改善,XFZY组较治疗前可明显提高ABI（P〈0.05）。结论血府逐瘀汤和前列地尔脂微球载体制剂注射液合用能显著改善ASO患者肢体缺血症状,增加组织灌流量。     

股浅动脉首期置入自膨式支架与球囊扩张成形的疗效比较

Objective To compare the mid-term clinical results of primary implantation of a selfexpanding nitinol stent and primary percutaneous transluminal angioplasty (PTA) for long range arteriosclerosis obliterans of the superficial femoral artery. Methods From December 2005 to February 2007,109 patients who had moderate-severe claudication or chronic limb ischemia (CLI)due to stenosis or occlusion of the superficial femoral artery were treated by endovascular technology. 53 patients (73 limbs) were treated by primary stenting and 56 patients (76 limbs)by PTA. We compared the clinical data of stenting group and PTA group at 6,12 and 24 months. Results The mean length of the treated segment was (16± 8)cm in the stenting group and(15±7)cm in the PTA group. At 6 months, the rate of restenosis on duplex ultrasonography was 13.7% in stenting group and 30.2% in PTA group (X2=4.09, P<0.05);at 12 months the restenosis rates were 25.5% in stenting group and 46.9% in PTA group(X2=4.75, P<0.05);at 24 months the restenosis rates on duplex ultrasonography were 38.1% in stenting group and 65.9% in PTA group(X2=6.66, P<0.01). Rutherford stages in stenting group were significantly better than those in PTA group. Conclusion In the mid-term, primary implantation of a self-expanding nitinol stent yielded results that were superior to those with PTA for arteriosclerosis obliterans or long range stenosis of the superficial femoral artery.     

体外血栓形成后血液的流变性变化及体外血栓形成试验的规范化操作

目的:观察体外模拟血栓形成后剩余血液的流变学变化,并探讨体外血栓形成试验的规范化操作。方法:采用30例健康人静脉血液,一部分抗凝后测定血液流变学指标和血细胞计数,另一部分不抗凝,于Chandler环内模拟血栓形成后,再测定剩余血液的血细胞计数及流变学指标,包括血液表观粘度、红细胞聚集指数、红细胞变形指数、血小板最大聚集率、血小板粘附率和血浆纤维蛋白原含量等。结果:体外模拟血栓形成后剩余血液的表观粘度,血小板计数、白细胞计数及纤维蛋白原含量均显著降低(P<0.01);血小板粘附率、最大聚集率也显著降低(P<0.01);但红细胞计数、压积和变形指数变化不明显(P>0.05)。结论:模拟血栓形成后剩余血液的流变性发生了显著变化,尤以血小板数量、血小板聚集性和粘附性以及血浆纤维蛋白原含量的变化更加突出。规范体外血栓形成试验的操作方法,有利于提高该试验的准确性和可靠性。     

周围动脉疾病介入治疗致血管迷走神经反射的探讨

目的 探讨周围动脉疾病(PAD)介入治疗发生血管迷走神经反射(VVR)的情况.方法 回顾我院PAD介入治疗528例患者临床资料,对12例发生VVR患者资料进行分析.结果 12例VVR患者均为混合型,发生在术中2例,术后10例.治疗后症状均缓解,未发生不良后果.结论 PAD介入治疗中应重视VVR,一旦发生应及时发现、处理,一般预后良好.     

益气养阴活血对中国小型猪心肌梗死后早期心甲橹疦a+-K+ATP酶、Ca2+-Mg2+ATP酶活性及抗氧化的作用

目的 采用结扎中国小型猪冠状动脉造成急性前壁心肌梗死(AMI)模型,应用益气养阴活血中药(复方芪丹液)干预动物AMI后早期心室重构(VR)的影响,并研究其对动物心肌钙、镁离子和氧自由基的作用.方法 中国小型猪28只,采取结扎冠状动脉左前降支中下1/3部,造成AMI模型.手术成功存活动物随机分为复方芪丹液大、小剂量组及卡托普利(开搏通)组、模型组、假手术组共5组,均予灌胃给药或自来水4周.4周后测定猪的血流动力学指标、心肌Na+-K+ATP酶、Ca2+-Mg2+ATP酶活性、心肌超氧化物歧化酶(SOD)、丙二醛(MDA)含量等.结果 与模型组比较,复方芪丹液大剂量组的左室内压(LVP)、血压(BP)、-dp/dtmax值明显升高(P<0.01),复方芪丹液小剂量组及开博通组LVP显著升高(P<0.05),开博通组-dp/dtmax值显著升高(P<0.05).复方芪丹液大剂量组Na+-K+ATP酶、Ca2+-Mg2+ATP含量较模型组显著升高(P<0.05),复方芪丹液小剂量组、开博通组与模型组相比Ca2+-Mg2+ATP酶仅有升高的趋势,未有统计学意义(P>0.05);复方芪丹液大剂量组、复方芪丹液小剂量组、开博通组SOD活力较模型组均显著升高(P<0.05).复方芪丹液大剂量组的MDA含量与模型组比较显著降低(P<0.05).结论 益气养阴活血中药可提高中国小型猪AMI后心肌收缩力,改善血流动力学指标;增加SOD活性,降低MDA含量,提高细胞膜Ca2+-Mg2+ATP酶和Na+-K+ATP酶活力,起到干预AMI后VR和保护心肌的作用.