支气管动脉栓塞治疗肺部出血性病变

３５例咯血患者接受选择性支气管动脉和其他供血动脉栓塞治疗４２次。出血的病因包括：支气管扩张１７例，肺癌９例，肺结核４例，特发性肺出血４便，法乐氏四联症１例，栓塞物质为明胶海绵、携药微球及纲丝圈。本组近期疗效９１．４％，２周后复发咯血率２０．２％，但发作次数和出血量明显减少。本研究表明：支气管动脉栓塞是肺部出血性病变有价值的治疗方法，支气管动脉造影是肺部出血性病灶定位诊断的有效方法。     

支气管动脉造影和栓塞诊治肺咯血

目前已证明绝大多数肺咯血来自支气管动脉，因而支气管动脉造影和栓塞可用于肺咯血的诊断和治疗，我们用此方法于１９９６年１月至１９９７年５月对１２例患者进行诊治，效果好，现报告如下。临床资料肺咯血病人１２例，女３例，男９例，年龄３０～７９（平均５４）岁，咯...     

选择性支气管动脉栓塞术治疗肺结核大咯血的疗效评价

目的 对选择性支气管动脉栓塞术（SBAE）治疗肺结核大咯血的疗效做客观评价，并就该技术的操作要点、注意事项等诸方面的技术问题做进一步探讨总结。方法 将我院2000年以后应用SBAE治疗的所有65例肺结核大咯血患者列为A组，而将我院1997～1999年3年内应用普通内科止血方法治疗的57例肺结核大咯血患者设为B组，对A、B两组的总有效率、病死率、平均止血时间进行分析比较。结果 采取同样的诊断和治疗标准，在总有效率和病死率方面，A组分别为90．77％和7．69％，B组分别为56．14％和22．81％，其差异具有统计学意义；同时A、B两组的平均止血时间分别为2．7天和8．6天。结论 SBAE作为治疗肺结核大咯血的急救手段之一，具有创伤轻饭、可重复性强、疗效高、见效快、并发症少、简便易行等特点，极具推广应用价值。     

介入栓塞治疗肺隔离症并肺动脉瘘所致大咯血1例

1病例报告 女，38岁。因间断咯血4a，加重7d于2004—07—06入院。4a前无明显诱因咳嗽胸闷、咯血，曾来我院就诊，诊断为右肺感染．给予消炎对症（具体治疗不详）治疗后缓解，后患于2002年再次出现咯血，自服消炎药物后缓解，7d前无明显诱因再次出现咯血4次，总量约300ml，晨起患体位变化时容易出现咯血、无盗汗、无发热、咳嗽，咳少量白色粘痰，胸片。     

支气管动脉栓塞治疗肺部病变大咯血

咯血是指喉部以下呼吸道出血,从口腔经咳嗽咯出。常见的疾病有支气管扩张、肺结核、原发性肺癌、支气管动脉畸形等。本病过去常采用内科保守治疗,但对急性大咯血保守治疗常不能奏效,而手术治疗死亡率高,且对病灶不明者无法手术。应用支气管动脉栓塞治疗本病取得了满意的疗效。我们１９９６年至今已治疗５例大咯血病人,现将治疗情况总结如下。１资料和方法１．１一般资料 本组５例中,男３例,女２例,年龄３０～６５岁。原发性肺癌２例,支气管动脉畸形１例,肺结核１例,不明原因１例。１．２治疗方法 选用 ５．０Ｆ ＣＯＢＲＡ,牧羊…     

支气管动脉栓塞术治疗肺咯血

目的 探讨支气管动脉栓塞术治疗肺咯血的临床价值。方法 45例咯血患者(支气管扩张15例、结核23例、肺癌4例、肺麯菌病1例、原因不明咯血2例)行选择性支气管动脉或肋间动脉插管造影确认病变血供，然后对病变血管进行栓塞。支气管动脉栓塞37例，肋间动脉栓塞5例，支气管动脉与肋间动脉一同栓塞2例，支气管动脉、肋间动脉及胸廓内动脉一同栓塞1例，20例使用同轴微导管进行超选择性栓塞。明胶海绵栓塞17例，PVA栓塞23例，联合使用明胶海绵及PVA栓塞5例。全部病例随访疗效6-18月。结果 即刻止血30例，咯血明显减少7例，8例再次咯血，其中4例复发患者行再次栓塞后未出现咯血，有效率83％(37／45)。全部病例均无严重并发症(如脊髓损伤)发生。结论 支气管栓塞术治疗肺咯血疗效明显，适用于内科治疗无效及无外科手术适应症的大咯血患者。     

支气管动脉栓塞治疗危重大咯血2例

支气管动脉栓塞治疗危重大咯血２例陈文娟刘林英戚好文李唯贺洪德曾祥龙李萌萌作者单位：７１００３２西安市第四军医大学西京医院咯血是肺部疾病常见的临床症状，大咯血的病死率高达５０％～１００％。死亡原因通常不是因为血容量不足，而主要是由于窒息造成突然死亡。大...     

支气管动脉介入治疗的栓塞剂选择和应用

目的：探讨肺咯血支气管动脉栓塞治疗中，栓塞剂的选择和应用对治疗效果和安全性的影响。方法：本文47例中，支气管扩张30例、肺癌11例、肺结核6例，采用单用明胶海绵颗粒5例、明胶海绵颗粒＋超液化碘油7例、聚乙烯醇8例、聚乙烯醇＋明胶海绵颗粒11例、聚乙烯醇＋明胶海绵颗粒＋超液化碘油16例五组进行对比研究，分析讨论。结果：五组病例中，单用明胶海绵颗粒组有3例复发；明胶海绵颗粒加超液化碘油组2例复发；聚乙烯醇组1例复发；聚乙烯醇＋明胶海绵颗粒、聚乙烯醇＋明胶海绵颗粒＋超液化碘油组均无复发。结论：支气管动脉介入栓塞治疗中的栓塞剂选择中，单用明胶海绵易复发，单用聚乙烯醇不如聚乙烯醇＋明胶海绵颗粒、聚乙烯醇＋明胶海棉＋超液化碘油栓塞的方法安全持久。     

经导管栓塞治疗咯血的临床应用

目的探讨PVA微粒和/或可脱弹簧圈栓塞支气管动脉和/或肺外体循环动脉治疗咯血的临床应用价值。方法 2002年1月至2008年10月,20例咯血患者,病变支气管动脉和/或肺外体循环动脉应用PVA微粒和/或可脱弹簧圈栓塞。20例患者咯血的病因为,结核8例、肺癌4例、结节病4例、支气管扩张3例、结节穿刺活检1例。栓塞后,病例随访1～23个月。结果 20例患者,栓塞的技术成功率为95%。栓塞后24h内,所有栓塞的患者咯血停止。随访中,4例患者再次咯血。2例仅弹簧圈栓塞的患者在随访中因栓塞血管再通而复发。1例肺癌患者和1例结节病患者由于病变进展新生供给动脉和漏栓锁骨下动脉发出的供血动脉而复发。术中,没有严重并发症发生。结论咯血患者,栓塞术前常规行多排螺旋CT血管造影和胸主动脉造影检查有助于术中寻找供血的支气管动脉和肺外体循环动脉,避免供血动脉漏栓。仅用弹簧圈栓塞支气管动脉和肺外体循环动脉易于导致早期咯血复发。栓塞剂的选择应首选PVA颗粒,联合弹簧圈使用双重栓塞可取得即刻和长期止血效果。     

预见性护理结合预警评分预防骨折患者静脉血栓栓塞症发生的效果

目的 探讨预见性护理结合预警评分预防骨折患者静脉血栓栓塞症(VTE)发生的效果.方法 选取2018年4月至2020年4月收治的88例骨折患者作为研究对象,根据入院顺序随机将其分为对照组和观察组,各44例.对照组予以常规护理,观察组在此基础上加以预见性护理结合预警评分干预.比较两组凝血功能指标、血栓弹力图指标、下肢静脉血...     

483例静脉血栓栓塞症临床资料分析

目的了解静脉血栓栓塞症(VTE),包括肺血栓栓塞症(PTE)和下肢深静脉血栓形成(DVT)的临床流行病学资料,探讨PTE和DVT的危险因素,为PTE和DVT的防治工作提供依据.方法分析PTE和DVT住院患者近十二年内发病趋势,人口学特点,伴随疾病,获得性危险因素和预后.结果患者的男女比例为1.45:1,50岁以后男女构成比基本相等;PTE和DVT的复发率依次为11.8%(4/34)和28.2%(124/439).结论 PTE和DVT发病率呈逐年上升趋势.手术、创伤和骨折是PTE和DVT主要的危险因素.女性雌激素水平可能与PTE和DVT有关.     

内科住院患者静脉血栓栓塞症的预防

现已明确,对有静脉血栓栓塞症（VTE）高危风险的内科住院患者给予血栓预防措施可明确降低VTE的发病率和病死率。2009年我国颁布了＂内科住院患者静脉血栓栓塞症预防的中国专家建议＂〔1〕。2012年美国胸科医师学会颁布了血栓形成抗栓治疗和预防第9版指南〔2〕,此文对该指南中有关内科住院患者VTE预防的建议进行解读。     

Betrixaban for first-line venous thromboembolism prevention in acute medically ill patients with risk factors for venous thromboembolism

ABSTRACT

Introduction: Compared to other direct oral anticoagulants, betrixaban has a longer half-life, smaller peak-trough variance, minimal renal clearance, and minimal hepatic Cytochrome P (CYP) metabolism. The Acute Medically Ill VTE Prevention with Extended Duration Betrixaban (APEX) trial evaluated the efficacy and safety of extended duration betrixaban compared to standard duration enoxaparin in acutely ill hospitalized patients.

Areas covered: This article describes the role of betrixaban in the prevention of venous thromboembolism (VTE) in acutely ill medical patients. This article provides a consolidated summary of the primary APEX study findings as well as prespecified and exploratory substudies. This article also provides a review of the results of studies in which other direct factor Xa inhibitors have been evaluated in an extended duration regimen in this patient population.

Expert commentary: While previous agents have demonstrated that extended duration VTE prophylaxis can be efficacious, betrixaban is the first agent to demonstrate efficacy without an increase in major bleeding. The totality of the data from the APEX trial supports extended duration betrixaban for VTE prophylaxis in the acute medically ill patient population. As such, betrixaban has been approved in the USA for extended VTE prophylaxis in at-risk acute medically ill patients.     

Physician compliance with advanced electronic alerts for preventing venous thromboembolism among hospitalized medical patients

Summary.  Background:  Worldwide, more than half of the hospitalized medical patients at high risk do not receive venous thromboembolism (VTE) prophylaxis. Although VTE among hospitalized patients at risk is reduced with electronic alerts (eAlerts), the majority of eAlerts are being ignored by the responsible physician. Methods:  We investigated physician compliance with an advanced eAlert system in 1027 (age 59 ± 17 years) hospitalized medical patients. A continuously flashing non-interruptive eAlert, visible to all healthcare professionals, was issued in the electronic patient chart 6 h after admission if the physician did not order prophylaxis. Results:  The rate of appropriate prophylaxis increased from 44% before to 76% after the implementation of the eAlert system. Although the patients whose physicians cared for ≥ 20 patients during the study period had a more frequent physician response to the eAlert than patients whose physicians cared for fewer patients (69% vs. 40%, P  < 0.001), they received appropriate prophylaxis less often (72% vs. 81%, P  = 0.016). After adjustment for significant patient predictors of appropriate prophylaxis, including cancer, age, duration of hospital stay, and thrombocytopenia, patients whose physicians cared for ≥ 20 patients during the study period were less likely to receive appropriate prophylaxis (odds ratio 0.65, 95% confidence interval 0.44–0.96; P  = 0.032) than patients whose physicians cared for fewer patients. Conclusions:  The introduction of an advanced eAlert system accompanied by continuing medical education for the prevention of VTE resulted in a substantial increase in the rate of appropriate prophylaxis among hospitalized medical patients. However, many eAlerts may cause decreased physician compliance owing to 'alert fatigue'.     

细胞因子在静脉血栓栓塞形成中的研究进展

静脉血栓栓塞症(VTE)包括深静脉血栓(DVT)形成和肺栓塞(PE),具有较高的致残率和致死率.在过去的10年里,随着动物模型的改进,静脉血栓的研究领域取得了较大的突破,揭示了VTE为免疫和炎症相关过程,而不仅仅只是凝血因子依赖性的血栓形成过程.免疫细胞、细胞因子等在VTE的形成和消退过程中起着至关重要的作用.但目前的...     

Relation of psychological distress to the international normalized ratio in patients with venous thromboembolism with and without oral anticoagulant therapy

Summary. Background: Psychological distress might affect the international normalized ratio (INR), but effects might vary depending on oral anticoagulant (OAC) therapy. Objectives: To investigate the association of psychological distress with INR and clotting factors of the extrinsic pathway in patients with and without OAC therapy. Patients and methods: We studied 190 patients with a previous venous thromboembolism (VTE); 148 had discontinued OAC therapy and 42 had ongoing OAC therapy. To assess psychological distress, all patients completed validated questionnaires to measure symptoms of depression, anxiety, worrying, anger and hostility. INR, fibrinogen, factor (F)II:C, FV:C, FVII:C and FX:C were measured as part of outpatient thrombophilia work‐up. Results: In VTE patients without OAC therapy, the odds of a reduced INR (< 1.00) were significantly increased from 1.5 to 1.8 times for an increase of 1 standard deviation (SD) in symptoms of depression, anxiety, worrying and anger, respectively, after adjusting for gender, age, body mass index, socioeconomic status, hematocrit and C‐reactive protein. Worrying, anger and hostility also showed significant direct associations with FVII:C. In patients with OAC therapy, INR was unrelated to a negative affect; however, lower FVII:C related to anxiety and worrying as well as lower FX:C related to anger and hostility were observed in patients with OAC therapy compared with those without OAC therapy. Conclusions: Psychological distress was associated with a reduced INR in VTE patients without OAC therapy. The direction of the association between psychological distress and activity in some clotting factors of the extrinsic coagulation pathway might differ depending on whether VTE patients are under OAC therapy or not.     

Clinical outcome in patients with venous thromboembolism and hidden cancer: findings from the RIETE Registry

Summary.  Introduction:  Although extensive screening in patients with venous thromboembolism (VTE) may result in early identification of hidden cancer, it is unknown whether the prognosis of these patients may be favorably influenced. Patients and methods:  RIETE is an ongoing, prospective registry of consecutive patients with objectively confirmed, symptomatic, acute VTE. We compared the 3-month outcome of patients with hidden cancer with that in patients in whom no symptoms of cancer were noted. Results:  Of 17 475 patients with acute VTE, 2852 (16%) had cancer diagnosed before VTE or during admission. Hidden cancer was detected in 178 (1.2%) of the remaining 14 623 patients. The most common sites were lung, prostate, colorectum, or hematologic, and 51% had metastases. As compared with patients in whom no symptoms of cancer were noted, those with hidden cancer had an increased incidence of recurrent VTE (11.4% vs. 2.1%; P  <   0.001), major bleeding (5.1% vs. 2.1%; P  =   0.007), and mortality (20% vs. 5.4%; P  <   0.001). In the multivariate analysis, patients aged 60–75 years [odds ratio 1.8; 95% CI 1.2–2.7], with idiopathic VTE (odds ratio 3.0; 95% CI 2.2–4.2), with bilateral thrombosis (odds ratio 2.3; 95% CI 1.3–4.1) or with anemia (odds ratio 1.9; 95% CI 1.4–2.6) were at an increased risk for hidden cancer. Conclusions:  VTE patients with hidden cancer have an increased incidence of recurrences, major bleeding or death during the first 3 months of therapy. With four simple, easily obtainable variables, it is possible to identify a subgroup of VTE patients with a higher risk for hidden cancer.