Stanford B型主动脉夹层治疗进展北大核心CSCD

近年来主动脉夹层(AD)发病率和检出率日益增高,临床上越来越引起重视。随着介入技术日益发展,血管腔内治疗已成为AD主要治疗方法之一。研究发现,存在AD远端破口是影响胸主动脉腔内修复术中远期疗效的重要因素之一。该文从AD流行病学表现、分期分型、基础治疗和介入治疗方式进行综述分析,并就Stanford B型AD远端破口治疗研究进展作一总结,为临床术式决策提供可行参考。     

人造血管旁路术治疗广泛钙化的主动脉缩窄1例

1　临床资料　　患者男性 ,30岁 ,因发现高血压 2年 ,加重 2个月入院。患者于 1997年查体时发现血压增高 ,达 180 2 2 0 / 10 0 110ｍｍＨｇ ,药物治疗效果不佳。常鼻出血 ,头痛 ,无下肢无力跛行。 1999年 5月突发脑出血 ,住院治疗好转。否认高血压家族史。入院查体 :血压左上肢 180 / 10 5ｍｍＨｇ ,右上肢 190 / 95ｍｍＨｇ ,下肢血压测不出。左锁骨上窝及左颈部可闻及收缩期吹风样杂音 ,心界正常。胸骨左缘第 2、3、4肋间可闻及ⅢⅣ级收缩期吹风样杂音 ,左背部闻及收缩期杂音 ,未闻及腹部血管杂音。双侧股动脉及足背动脉搏动微弱。心电图…     

主动脉夹层动物模型构建方法研究现状

主动脉夹层是一种致死致残率极高的危急疾病,患者出现濒死样剧烈胸背部疼痛应怀疑此病可能,CT或MRI是诊断该病的可靠方法.近年腔内治疗已成为Stanford B型主动脉夹层首选治疗方法,部分无法开放手术治疗的Stanford A型夹层患者也可采用腔内治疗方法.为了改进腔内治疗方法、开发新器械、研究主动脉夹层发病机制,需要构建出稳定的动物模型.该文就主动脉夹层动物模型构建研究现状作一综述.     

主动脉根部溶栓治疗急性心肌梗塞的术中监测与配合

主动脉根部溶栓治疗急性心肌梗塞的术中监测与配合林萍，赵丽娟，徐瑛辉哈尔滨医科大学附属第二医院心内科依兰县人民医院１５４８００急性心肌梗塞是死亡率最高的心脏病之一。自八十年代开展了溶栓疗法以来，使急性心肌梗塞的死亡率明显降低。目前国内外多采用的溶栓疗法...     

主动脉不典型夹层的电子束CT诊断

目的 评价电子束CT（EBCT）在主动脉不典型夹层诊断中的临床应用。方法 1994年5月至2000年4月15000例EBCT检查中诊断主动脉夹层263例,其中25例为不典型夹层。男21例,女4例。全部患者均以主诉急性胸痛入院检查。采用Imatron 150-XP型EBCT扫描机,连续容积增强扫描,层厚3mm,扫描时间为0．1s。扫描范围自主动脉弓水平至左右髂动脉分叉处,共140层。结果 不典型夹层EBCT血管造影（EBCTA）：直接征象为:(1)25例主动脉壁均呈半月状或环状增厚,达5－23mm,平均15．3mm,无内膜破裂形成的双腔主动脉征象,CT值50－87HU,累及长度为2．5－49．0cm,平均16．3cm;（2）内膜钙化移位5例;（3）6例治疗后EBCT随访,管壁厚度呈动态变化。间接征象为：（1）主动脉壁增厚溃疡形成7例;（2）动脉粥样硬化性改变12例。上述征象结合临床急性胸痛病史,诊断可以成立。病变累及升主动脉（StanfordA型）6例;仅累及降主动脉（StanfordB型）19例。全部病例临床均采取保守治疗,其中6例EBCT复查,3个月至1年血肿吸收。结论 急诊胸痛鉴别诊断中EBCT对主动脉不典型夹层诊断是一种无创、安全、有效的诊断方法,且便于治疗后随诊观察。     

原发性逆撕型Stanford A型主动脉夹层的研究进展

目的原发性逆撕型Stanford A型主动脉夹层（RTAD）的特征是原发裂口位于无名动脉以远，夹层的假腔逆行撕裂累及升主动脉。由于其解剖结构复杂，危险性高，RTAD仍是大动脉外科极具挑战性的难题。对于这种特殊类型夹层的治疗方式，目前尚无共识。文章分析了相关文献，主要针对RTAD的流行病学、解剖特征、发病机制及治疗方案等方面作一综述，以期为临床诊疗工作提供指导。     

血管腔内隔绝术治疗降主动脉夹层动脉瘤6例

主动脉夹层动脉瘤为凶险的疾病。传统的治疗方法为主动脉人工血管置换，创伤大，死亡率、并发症都较高。应用人造血管覆膜支架进行血管腔内隔绝术治疗为一种较新的治疗手段。我院于2003—09～2006—03，行腔内隔绝术治疗主动脉夹层动脉瘤6例，报告如下。     

腔内修复或药物治疗稳定型B型主动脉夹层

目的 比较胸主动脉腔内修复术(TEVAR)联合药物及单纯药物在稳定型Standford B型主动脉夹层治疗中的价值,探讨稳定型B型主动脉夹层治疗策略.方法 回顾性分析2004年至2015年收治的118例明确诊断为稳定型B型主动脉夹层患者临床资料,其中接受TEVAR联合药物治疗(TEVAR组)57例,单纯药物治疗(药物组)61例.分别统计1个月内、随访期并发症和死亡率,Kaplan-Meier生存曲线比较两组生存率.结果 术后1个月内及住院期间主要并发症发生率、死亡率,TEVAR组分别为5.2％、0％,药物组均为0％.术后随访1～110个月,平均(43.3±36.7)个月,主要并发症、死亡率在TEVAR组分别为7.0％、5.3％,药物组分别为6.6％、8.1％;术后1、2、4、7年累积生存率在TEVAR组分别为100％、97.1％、93.5％、78.0％,药物组分别为98.4％、96.4％、90.8％、72.7％,两组间差异无统计学意义(x2=0.019,P=0.890).结论 与单纯药物治疗相比,TEVAR术治疗稳定型Standford B型主动脉夹层可降低假腔扩展率,但有手术相关并发症,并不能提高生存率.     

先天性主动脉窦瘤的外科治疗

目的总结先天性主动脉窦瘤外科治疗经验。方法先天性主动脉窦瘤(CASV)28例,其中合并室间隔缺损18例(64%)、主动脉瓣脱垂7例(25%)。行窦瘤切除修补术11例,窦瘤切除加室缺修补10例,窦瘤切除加主动脉瓣成形2例、主动脉瓣替换5例。结果全组无手术死亡、无残余分流。结论心脏超声对CASV诊断准确率高。窦瘤破裂对心功能影响迅速而严重且预后较差。故一经确诊,宜尽早手术治疗,以及时纠正血流动力学紊乱。窦瘤破口直径>1.0 cm者宜用补片修补。缝合或修补窦瘤时进针方向要与主动脉长轴平行,并通过主动脉瓣环及其上缘的主动脉壁,以防止窦瘤复发或残余分流。     

主动脉夹层的重新认识

主动脉夹层(AD)在神经科并不少见,以神经功能缺损为主要症状的AD往往就诊于神经内科,表现为累及大脑、脊髓及周围神经的多种症状,甚至以其为首发的并不少见.尽管诊疗技术不断提高,但患者住院期间的总病死率仍高居不下.笔者从概念、分型、分级,以及临床表现、早期诊断与内科治疗作一综述,期望提高神经科医师对该病的总体认识.     

Optimization of the system of medical service of students of Cadet Schools of the Ministry of Defense of the Russian Federation

One of the factors of the successful military career guidance Cadet schools students is preserving and promoting their health. Medical support of children and adolescents aged 10-17 years should include the full range of medical and preventive measures defined for this group. The state of providing outpatient care for pupils at the Cadet School in St. Petersburg was studied. These results show that full medical care in accordance with the standards can be based only on children's health clinics. It is important that the organization of medical support pupils cadet schools should be cooperate with civilian health care.     

带状疱疹83例误诊原因分析

带状疱疹是由水痘—带状疱疾病毒引起的皮肤科常见疾病。其主要的病理损害,一是受累神经的严重炎症性浸润,继而导致受侵犯神经节内神经细胞变性、坏死;二是皮肤的水泡。迅速抑制神经节和相应的感觉神经纤维的充血、水肿和坏死,防止粘连形成,达到迅速镇痛、改善皮损,缩短病程及防止后遗症的发生是治疗的关键。因而,尽早明确诊断,     

Estimation of accumulated dose of radiation by method of ESR-spectrometry of dental enamel of mammals

ESR-spectrometry was used to investigate radiation-induced paramagnetic centers in enamel of mammals: carnivores (polar bear and fox), ungulates (reindeer, European bison, moose), and man. Values at half the microwave power saturation of the radiation signal, P_1/2, evaluated at room temperature, was found to range from 16 to 26 mW for animals and man. A new approach to discrimination of the radiation induced signal from the total ESR spectrum of reindeer enamel is proposed. ‘Dose-response’ dependencies of enamel of different species mammals were measured within the dose range from 0.48 up to 10.08 Gy. Estimations of ‘radiosensitivity’ enamel of carnivores and ungulates showed good agreement with radiosensitivity enamel of man by ESR method.     

Analysis of the results of the international comparison of activity measurements of a solution of Fe

The results of an international comparison of activity measurements of a solution of ⁵⁵Fe organized by the BIPM in 2005 are reported and analysed. This exercise, which follows the procedures of the CIPM mutual recognition arrangement to update older comparisons, is a renewal of the comparison organized by the BIPM that took place in 1978. A EUROMET comparison was organized in 1996 specifically to compare activity measurements of a ⁵⁵Fe solution by means of liquid-scintillation techniques. Results of these three comparisons are presented and discussed in this paper.

The radionuclide solution was provided by the NPL, which also distributed the samples to the participants. The activity of the ampoules was measured by 16 laboratories using 12 methods producing 25 results. Some general considerations on uncertainty assessments pertaining to the different techniques used are drawn. The outcome of four different estimators is compared from which the presence of at least one outlier can be confirmed. Further measurements should be made to try to reduce the discrepancy between the results. To date the outcome of the present comparison does not show an improvement to that of the 1996 comparison.     

Evaluation of the results of various technics of non-surgical therapy of varicocele

A new method of non-surgical treatment of varicocele syndrome is described: it consists in sclerotherapy of spermatic vein by trans-femoral percutaneous catheterization with balloon-catheters. In 8 cases venous thrombosis has been induced by direct electric clotting. The techniques and a 6 months follow-up are discussed. It is pointed out that this procedure should be considered as the method of choice for tubular lesions and sub-fertility prophylaxis in young people and in childhood.     

延迟性脾破裂误漏诊原因分析

目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率.