动脉内溶栓治疗外周动脉阻塞性病变

报告10例外周动脉阻塞性病变动脉内溶栓治疗,开通率100%。讨论其适应证、禁忌证,溶栓剂的应用,操作技术,影响疗效的因素及并发症等问题     

下肢深静脉血栓局部溶栓的疗效与影响因素

目的 探讨下肢深静脉血栓局部溶栓治疗的疗效及影响因素。方法 对60例下肢深静脉血栓形成患者,采用经导管血栓局部先团注量灌注尿激酶250000U,然后以125000－150000U／h持续灌注。结果 全组溶栓治疗时间4－76h,平均38h,尿激酶用量750000U－9750000U,平均5150000U,血管再通率88．3％。病程＜4周的急性或亚急性血栓形成患者46例,溶栓后阻塞段血管再通44例（95．7％）。在14例慢性血栓形成患者中,血管再通9例（64．3％）。对残存狭窄＞30％的23例患者,14例行经皮球囊血管成形术（PTA）治疗,9例行PTA及内支架治疗。溶栓术后继续肝素全身抗凝治疗可增强溶栓疗效。6例溶栓前放置下腔静脉过滤器。本组无严重并发症及肺栓塞发生。结论 经导管血栓局部灌注尿激酶是治疗下肢深静脉血栓的安全有效方法,其疗效与多种因素有关。     

视网膜静脉微穿刺治疗视网膜静脉阻塞的实验研究

目的：探讨视网膜静脉微穿刺介入治疗视网膜静脉阻塞的技术方法、并发症及其处理措施,观察疗效。方法：利用自行研制的超显微手术系统,实现活体视网膜静脉微穿刺;采和光动力学方法建立视网膜静脉阻塞动物模型,在阻塞的视网膜静脉内注入溶栓剂tPA,观察溶栓效果和术中、术后视网膜及其血管改变。结果：超显微手术系统能够实现稳定的视网膜血管微穿刺,并向血管内持续注药。在视网膜静脉血栓形成早期,该方法能使血栓迅速溶解脱落,疏通血管,恢复静脉血流。病理结果显示,视网膜静脉微穿刺介入溶栓后,不但能够逆转视网膜静脉阻塞的 病理改变,而且对视网膜及其血管无明显损伤。结论：视网膜静脉微穿刺,注入溶栓可能为视网膜静脉阻塞早期治疗提供一条新途径。该技术的不断完善,不仅可望用于视网膜静脉阻塞的治疗,而且还可用于清除视网膜下出血、视网膜组织活检、视网膜肿瘤介入治疗以及视网膜细胞移植等操作精度较高的手术。     

周围动脉急慢性闭塞疾病的综合介入治疗

目的:探讨血管内局部溶栓,血栓碎吸,经皮血管成形(percutaneous transcatheter angioplasty,PTA) 和内支架置入,联合治疗急慢性动脉闭塞性疾病的临床效果和应用价值.方法:周围动脉阻塞接受了介入治疗共259例.急性动脉血栓性闭塞58例,局部溶栓+血栓碎吸;动脉狭窄合并急性血栓闭塞61例,局部溶栓+PTA;慢性动脉狭窄阻塞140例,局部溶栓+PTA+内支架置入.结果:全组总的介入治疗成功率98.8%(256/259).局部溶栓+血栓碎吸成功率 100%(58/58),血管完全开通91.4%(53/58),部分开通8.6%(5/58).局部溶栓+PTA治疗成功率85.2%(52/61),9例辅以内支架置入治疗获得成功;PTA+内支架置入治疗成功率97.8%(137/140).并发症发生率7.7%(20/ 259),局部溶栓+血栓碎吸8.6%(5/58),局部溶栓+PTA14.8%(9/61),PTA+内支架置入4.2%(6/140).结论:经皮经腔综合介入治疗周围动脉急慢性闭塞疾病是安全有效的方法.恰当选用局部溶栓、血栓碎吸、PTA 和内支架置入技术并个体化有机地组合应用,可显著提高成功率和疗效并减少并发症发生.     

急性肢体动脉血栓的血管内介入治疗

目的：探讨急性肢体动脉血栓的血管内治疗方法、临床效果及治疗过程中的注意事项。方法：13例患者，男8例、女5例，年龄33—79岁，平均年龄56岁。经血管造影均显示动脉栓塞，病变涉及动脉16段，首先采用血管内尿激酶溶栓治疗，对不能达到临床效果者再进行经皮穿血管成形术（PTA）治疗。结果：溶栓治疗后，11段血管再通，5段血管溶栓失败；再通率为68．75％（11／16）。PTA治疗5段，有3段达到临床效果（造影复查显示残存余狭窄小于30％），治疗成功率为60％（36）。13例均未见明显副作用及并发症。结论：血管内局部溶栓及PTA是一种安全有效的方法，成功率高，并发症少，可作为急性肢体动脉血栓的首选治疗方法。     

手术后立即进行选择性动脉内链激酶治疗

作者报告一例腹膜后剥离和修复同侧股动脉撕裂伤之后七小时的病例,向动脉内选择性地灌注链激酶,成功地溶解了小腿动脉急性血栓,未发生全身反应和并发症。作者认为局部动脉内溶栓治疗比全身静脉内输入更有效,更安全。可以考虑在手术后立即局部溶栓治疗。以往有关手术后使用溶栓剂的报告已有几例,主要描述了动脉粥样硬化血管再建手术失败后使用     

尿激酶介入性治疗急性脑梗塞的临床影像观察

本文总结了采用尿激酶超选择性动脉内溶栓治疗的８例急性脑梗塞，经ＣＴ扫描证实，并作脑血管造影检查确定梗塞部位在ＩＣＡ（Ｃ１～４）３例，ＭＣＡＭ＿１段５例，本法的特点是直接向被栓塞的动脉内灌注溶栓剂，可充分发挥溶栓作用，疗效满意。对急性脑梗塞的影像诊断、溶栓技术、并发症及有关注意事项进行了简要的讨论。     

动脉内溶栓治疗外周动脉阻塞性病变：附10例报告

笔者报告１０例动脉内溶栓治疗外周动脉阻塞性病变，开通率１００％。对适应证的选择，禁忌证，溶栓剂的应用，操作技术，影响疗效的因素及并发症等问题进行了讨论。     

31例急性心梗再灌注心律失常的治疗体会

开通梗塞相关血管是目前抢救急性心肌梗死(AM1)中最重要的治疗方法。静脉溶栓疗法是通过静脉注入溶栓剂,溶解梗塞相关血管中的血栓,恢复梗塞区的血供应。静脉溶栓疗法是溶解梗塞相关血管中血栓的一种有效手段。但溶栓后再灌注可产生再灌注心律失常,再灌注心律失常严重时可危及生命。我院1998.9～2000.10间采用溶栓治疗     

外周动脉阻塞的动脉内直接溶栓治疗

外周动脉阻塞性病变以往多采用静脉法溶栓治疗,但其用药量大,疗程长,出血并发症高,尤其是病程较长者,成功率低。随着器械及技术进步,应用动脉插管局部溶栓疗法,使其成功率显著提高。目前,动脉内局部溶栓已成为治疗外周动脉阻塞性病变的首选方法。我院自1999年8月以来经导管治疗外周动脉阻塞性病变5例,临床疗效满意,现予报道。     

The effects of supplemental carbohydrate ingestion on intermittent isokinetic leg exercise.

BACKGROUND: The purpose of this investigation was to examine the effects of carbohydrate (CHO) supplementation on isokinetic leg extension/flexion exercise performance, blood glucose responses, blood free fatty acid (FFA) responses, and blood lactate (La) responses. METHODS: Eight resistance trained males (mean+/-SEM, age: 23.7+/-1.3 yrs, height: 180.0+/-3.5 cm, bodymass: 94.9+/-4.9 kg) participated in a randomized, double blind protocol with testing sessions separated by 7-d. Subjects were given CHO or placebo (P) while performing 16 sets of 10 repetitions at 120 degrees x s(-1) on a Cybex isokinetic dynamometer. Performance variables measured were; total work (TW), average work (AW), peak torque (PT) and average torque (AT). Plasma glucose (PG), FFA, and La were measured prior to testing (PRE), after set 8 (MID), and 16 (POST). RESULTS: Results indicated that the CHO treatment elicited significantly (p<0.05) more TW (CHO: 41.1+/-3.9 kJ; P: 38.1+/-3.9 kJ) and AW (CHO: 2.6+/-0.2 kJ; P: 2.4+/-0.2 kJ). There were no differences (p<0.05) between treatments for PT of the hamstrings (CHO: 91.6+/-6.5 Nm; P: 87.4+/-8.5 Nm) and quadriceps (CHO: 129.7+/-9.5 Nm; P: 123.0+/-10.6 Nm). The AT of the hamstrings (CHO: 77.8+/-5.2 Nm; P: 75.7+/-8.7 Nm) and quadriceps (CHO: 116.9+/-8.9 Nm; P: 110.0+/-8.5 Nm) were not statistically different (p>0.05) between the treatments. PG was significantly higher at the POST blood draw in the CHO treatment. No significant differences (p>0.05) were observed between the treatments for FFA and La concentrations. CONCLUSIONS: The data from this investigation indicate that the use of CHO supplementation during isokinetic leg exercise allows for the performance of more work.     

蛋白激酶C在肢体缺血预处置中的作用

目的：探讨缺血预处置（ＰＣ）减轻骨骼肌组织缺血再灌注（Ｉ／Ｒ）损伤的作用机制．方法：采用大鼠后肢原位灌流方法观察ＰＣ和ＰＣ加用蛋白激酶Ｃ抑制剂ｐｏｌｙｍｙｘｉｎＢ或Ｈ７对Ｉ／Ｒ的影响．实验动物分为５组：Ｉ／Ｒ组，ＰＣ组，ＰＣ＋ＰＢ组，ＰＣ＋Ｈ７组，对照组．比较各组灌流液中和肌组织中的损伤性指标变化．结果：ＰＣ可以明显减轻肢体的Ｉ／Ｒ损伤，使用ｐｏｌｙｍｙｘｉｎＢ或Ｈ７则阻断ＰＣ对Ｉ／Ｒ骨骼肌细胞内酶漏出、丙二醛产生及钙超载等损伤性指标的改善作用．结论：ＰＣ对Ｉ／Ｒ肢体具有保护作用，其保护机制与蛋白激酶Ｃ的激活有关     

肝细胞癌边缘部的CT与病理对照研究

目的：探讨肝细胞癌边缘部的ＣＴ征象与病理基础。材料和方法：搜集４５例经手术、病理证实的肝细胞癌，观察其术前边缘部的ＣＴ表现及各种病理改变。结果：（１）找出了肿瘤边缘部三种不同形态的病理学基础；（２）ＣＴ增强扫描后，肿瘤呈边缘不清者，病灶大多有缩小；（３）发现了瘤旁小门静脉癌栓的ＣＴ征象，并得到病理检查证实，其发生率的高低与ＣＴ的肿瘤边缘形态分类及癌细胞的分级有关。结论：（１）肝细胞癌边缘部的ＣＴ形态分类，能较好地反映肿瘤包膜的完整程度；（２）肝细胞癌边缘部的ＣＴ形态分类，对于术前评估肿瘤的浸润程度和范围、预测瘤旁小门静脉癌栓的发生率及评价癌细胞的分级均有一定的帮助     

原发性肝细胞癌向右肾周间隙扩散的MRI表现特征

探讨原发性肝细胞癌经肝裸区向右肾周间隙扩散的ＭＲＩ表现特点及规律。搜集１９９２－１９９４年经手术、病理及临床检验证实的２８例具有不同程度腹膜后侵儿的ＨＣＣ病例，均在０．５ＴＭＲ扫描机上行ＳＥ序列横断和冠状扫描。     

Nicorandil administration shows cardioprotective effects in patients with poor TIMI and collateral flow as well as good flow after AMI

BACKGROUND: Nicorandil (NCR) has been reported to have cardioprotective effects in patients with AMI. And collateral flow and TIMI flow are also important determinants of final salvaged myocardium in patients with AMI. There is no evidence as to whether TIMI or collateral flow modifies the cardioprotective effects of NCR in patients with AMI. Methods and Results: We studied 68 initial AMI patients without restenosis which was defined as 50% diameter reduction of the intervention site in the chronic period. On initial CAG, 41 patients with poor flow (collateral: Rentrop 0 or 1 and TIMI 0 or 1) were NCR/Non-NCR = 20/21. Twenty-seven patients with good flow (collateral: Rentrop 2 or 3 or TIMI 2 or 3) were NCR/Non-NCR = 13/14. NCR was administered intravenously (4 mg) via intracoronary injection (2 mg) or continuously (4 mg/h). 99mTc-tetrofosmin (TF) and 123I-BMIPP SPECT were performed in the subacute and chronic (6 Mo) periods. In 20 SPECT segments, summed defect scores (TDS) and regional wall motion (WMS: -1=dyskinesis -4 = normal) of AMI segments using TF-QGS were estimated. In poor flow patients, the following values for NCR patients were higher (p < 0.05) than for Non-NCR patients in the improvement degree of TDS (BMIPP) (NCR: 6.5 +/- 3.9 vs. Non-NCR: 4.0 +/- 3.4), the improvement degree of TDS (TF) (NCR: 5.7 +/- 4.6 vs. Non-NCR: 2.2 +/- 4.6), and delta WMS (NCR: 1.4 +/- 1.1 vs. Non-NCR: 0.9 +/- 1.0). In good flow patients, the following values for NCR patients were better (p < 0.05) than for Non-NCR patients in TDS (BMIPP) (subacute) (NCR: 9.9 +/- 5.2 vs. Non-NCR: 16.5 +/- 10.4) and (chronic) (NCR: 5.1 +/- 5.2 vs. Non-NCR: 12.4 +/- 8.5), WMS (subacute) (NCR: 1.7 +/- 1.3 vs. Non-NCR: 1.0 +/- 1.0), and WMS (chronic) (NCR: 3.0 +/- 1.5 vs. Non-NCR: 2.1 +/- 1.3). Conclusion: We conclude that the cardioprotective effects of nicorandil administration are observable in both AMI patients with poor collateral and TIMI flow and good flow before reperfusion therapy.     

Exercise-induced muscle damage: absence of adaptive effect after a single session of eccentric isokinetic heavy resistance exercise

BACKGROUND: Unaccustomed eccentric exercise induces muscle damage. A single session of eccentric exercise can induce an "adaptive effect" protecting exercised muscles during several weeks. Our aim was to verify this phenomenon in isokinetic exercise. Tested hypothesis was: the progressive muscle rise in tension due to isokinetic eccentric actions would be insufficient to induce the adaptive effect. METHODS: Experimental design: prospective study. Setting: general community. Participants: six healthy and moderately active (untrained) males (29.1 yr +/- 1.5 SEM). Interventions: subjects performed two isokinetic eccentric exercises (EE1 and EE2) of the quadriceps femoris of both legs (120 degrees.s-1; 8 sets of 15 repetitions) separated by 4 weeks. Measures: type I serum myosin heavy chains (MHC) and creatine kinase concentrations (CK), and rate of perceived soreness (DOMS) were collected before each exercise and on days 1, 2, 4, 6 and 9. RESULTS: Both exercises induced significant (p < 0.01) increases in MHC and CK concentrations, and DOMS score. There was no significant difference between EE1 and EE2, at any measurement time for any parameter. Mean peak values (SEM) were respectively (EE1; EE2): MHC (microU.l-1): 308 (192); 285 (191). CK (U.l-1): 1217 (760); 1297 (1039). DOMS score: 2.67 (0.52); 2.33 (0.52). CONCLUSIONS: The first session of eccentric isokinetic exercise (EE1) had no adaptive effect against muscle damage when an identical session was performed 4 weeks later (EE2). Muscle adaptation could have resulted in increased work production (+10.2%; p < 0.05; from EE1 to EE2).     

Influence of progestin bioactivity on cutaneous vascular responses to passive heating

PURPOSE: Oral contraceptives influence the regulation of cutaneous vascular tone, and both estrogen and progesterone have been shown to affect nitric oxide (NO)-mediated vasodilation. We tested the hypothesis that cutaneous vascular conductance (CVC) during passive heating would be lower in women taking oral contraceptives with higher progestational bioactivity compared with those taking oral contraceptives with lower progestational bioactivity. We further hypothesized that this difference could be attributed to the relative degree of NO-dependent vasodilation. METHODS: Fourteen women (20.3 +/- 0.3 yr) taking combined oral contraceptives (low progestin: 6 subjects, high progestin: 8 subjects) participated in a whole-body heating protocol and were tested during the end of active and placebo pill phases. Red blood cell (RBC) flux was measured by laser-Doppler flowmetry at a control microdialysis site (Ringer's solution) and an experimental site where NO-synthase (NOS) was inhibited (10 mM L-NAME). CVC was calculated as RBC flux/MAP. RESULTS: Baseline oral temperature (Tor) was significantly higher during the active pill phase for all subjects (active: 36.8 +/- 0.1 degrees C; placebo: 36.6 +/- 0.1 degrees C) (P = 0.02) but was not affected by progestational bioactivity. CVC at the control site during heating did not differ between low and high progestin users during either phase of oral contraceptive use. However, CVC in the NOS inhibited site was diminished during both phases of oral contraceptive use in the low progestin group at a given change in Tor (active: DeltaT(or) of 0.6-1.0 degrees C, placebo: DeltaT(or) of 0.8-1.0 degrees C) (P < 0.05). (DeltaT(or) 1.0 degree C: active: 30.86 vs 46.56%CVC(max); placebo: 26.29 vs 49.22% CVC(max)) (P < 0.05). CONCLUSION: Progestational activity in oral contraceptives may alter the mechanisms by which skin blood flow increases during passive heating via NO-dependent cutaneous active vasodilation.     

Multidetector-row helical CT: analysis of time management and workflow

The purpose of this study was to evaluate time management and workflow for multidetector-row helical CT (MDCT). Time for patient and data handling of at total of 580 patients were evaluated at two different time periods (December 1999, August 2000), each for the following baseline measurements: (a) change of clothes/instruction; (b) patient placement on the CT table/i.v. catheter; (c) CT planning and programming; (d) CT data acquisition; (e) CT data reconstruction; (f) CT data storage/printing. All imaging was performed on a Somatom Volume Zoom (Siemens, Erlangen, Germany). Time measurements summarized for different CT protocols revealed the following: (a) 5:01 min (+/- 2.06 min); (b) 4:36 min (+/- 2.43 min); (c) 4:11 min (+/- 2.55 min); (d) 0:43 min (+/- 0.15 min); (e) 6:59 min (+/- 2.39 min); (f) 09:51 min (+/- 3.51 min). Planning and programming was most time-consuming for CT angiography, whereas chest and abdominal CT needed only 3:26 and 3:30 min, respectively. Reconstruction time was highest for HRCT (9:22 min) and CTA (9:03 min). Data storage/printing was most time-consuming for HRCT (13:02 min), followed by combined neck-chest-abdomen examinations (12:19 min). Comparing the two time periods, during which a software update was performed, a mean time reduction of 4:31 min per patient (15%, p<0.001) was achieved. Whereas CT data acquisition time is no longer a problem with MDCT, patient management, data reconstruction, and data storage are the most time-consuming parts. Well-trained technicians, state-of-the-art workstations, and fast networking are the most important factors to improve workflow.     

Effects of radiographic contrast media on proliferation and apoptosis of human vascular endothelial cells

The aim of the study was to determine the effects of radiographic contrast media (RCM) on proliferation and apoptosis of human vascular endothelial cells. Human umbilical vein endothelial cells (HUVECs) were exposed for either 1 min or 15 min to RCM (diatrizoate, ioxaglate, iopromide, iotrolan) at an iodine concentration of 250 mgl ml-1. Controls were complete growth medium (CGM) and saturated mannitol (osmotic control). [3H]thymidine incorporation was used to determine cell proliferation 24 h after exposure. Apoptosis was determined at 1 h and 6 h by terminal uridine nick end labelling (TUNEL), time lapse video microscopy (TLVM) and DNA electrophoresis. Mean proliferation rates (%) (+/- SEM) (p-values compared with the CGM control) at 1 min and 15 min, respectively, were: diatrizoate: 31.9 (10.6), 5.8 (1.5) (p < 0.001); ioxaglate: 48.4 (10.9), 20.4 (4.5) (p < 0.001); iopromide: 63.4 (8.7), 58.2 (10.2) (p < 0.05); iotrolan: 84.7 (7.3), 72.8 (12.4) (p = ns); saturated mannitol 50.5 (9.6), 45.9 (10.0) (p < 0.001). Mean apoptotic indices (%) (+/- SEM) at 1 h and 6 h following 1 min exposure, respectively, were: CGM: 0.25 (0.13), 0.23 (0.08); diatrizoate: 2.18 (0.19), 2.69 (0.34) (p < 0.001); ioxaglate: 1.90 (0.23), 1.69 (0.02) (p < 0.05); iopromide: 0.59 (0.04), 0.33 (0.02) (p = ns); iotrolan: 0.30 (0.07), 0.27 (0.1) (p = ns); saturated mannitol 2.11 (0.24), 1.4 (0.1) (p < 0.05). After 15 min exposure, apoptosis rates at both 1 h and 6 h, respectively, were: iotrolan: 0.29 (0.17), 0.51 (0.16) (p = ns); diatrizoate: 3.19 (0.81), 11.66 (1.75) (p < 0.001); ioxaglate: 1.88 (0.14), 2.87 (0.20) (p < 0.05); iopromide: 1.06 (0.11), 1.52 (0.15) (p < 0.05); saturated mannitol 1.62 (0.09), 4.63 (0.74) (p < 0.05). TLVM and DNA electrophoresis confirmed the occurence of apoptosis after exposure to RCM. In conclusion, saturated mannitol and all tested RCM, with the exception of iotrolan, (diatrizoate > ioxaglate > iopromide) reduced proliferation and increased apoptosis of HUVECs. The effects were more pronounced with ionic RCM and seem to depend on osmolality as well as the chemical structure of these agents. Endothelial injury and apoptosis may be responsible for some of the side effects associated with intravascular use of RCM.     

国产与进口丁氰酯类医用胶栓塞脑动静脉畸形后的病理学对比研究

目的：对国产α－氰基丙烯酸异丁酯（ＩＢＣＡ）、α－氰基丙烯酸正丁酯（ＮＢＣＡ）和进口ＮＢＣＡ栓塞脑动静脉畸形（ＡＶＭ）后进行病理学对比研究。材料和方法：３２例脑ＡＶＭ的栓塞治疗中，用国产ＩＢＣＡ１８例、ＮＢＣＡ１１例和进口ＮＢＣＡ３例，经过１～３次栓塞后，最短１０小时，最长１９３天行脑ＡＶＭ切除，所有标本经ＨＥ及弹力纤维染色，光学显微镜观察病理变化。结果：（１）管腔内有胶样物质；（２）血管壁及周围脑组织急性期以多核白细胞浸润为主，伴血管壁变性、坏死，中晚期以淋巴细胞和嗜酸粒细胞浸润为主（中晚期管腔内大量异物巨细胞反应）；（３）血管壁纤维化、钙化；（４）未发现栓塞剂移至管腔外或脑实质内的现象，被栓塞的血管腔内未见血管重生及再通现象。国产ＮＢＣＡ与进口ＮＢＣＡ病理变化相似。结论：（１）ＩＢＣＡ和ＮＢＣＡ可做永久性栓塞剂；（２）可以用国产ＩＢＣＡ、ＮＢＣＡ代替进口同类产品；（３）ＩＢＣＡ和ＮＢＣＡ的病理变化相似；（４）未发现有致畸致癌作用，无ＡＶＭ复发