两种血管移植物在股-腘动脉旁路转流术中的应用比较

目的比较46例（49条肢体）股、腘动脉闭塞症人工血管和自体大隐静脉旁路转流术的远期通畅率。方法选择2000～2010年46例（49条肢体）股、腘动脉闭塞症患者,其中28条肢体行大隐静脉股-腘动脉旁路转流术,21条肢体行人工血管（膨体聚四氟乙烯人造血管,ePTFE）股一胭动脉旁路转流术。其中膝上32条肢体,膝下17条肢体。结果大隐静脉组1、3年通畅率分别为85．7％（24／28）、67．9％（19／28）;人工血管组1、3年通畅率分别为76．2％（16／21）、57．1％（12／21）。结论在股-腘动脉旁路转流术中,自体大隐静脉在性能和远期通畅率上远胜于人造血管。该术式应首选自体大隐静脉作为血管移植物。     

大隐静脉用于冠状动脉旁路搭桥术解剖基础分析

大隐静脉（ITA）作为冠状动脉旁路搭桥术（CABG）搭桥血管易于发生进行性内膜增生,致远期硬化阻塞,术后10年通畅率仅30％～35％,ITA又称乳房内动脉,作为搭桥血管,具有解剖位置恒定,术后跟踪无进行性内膜增生硬化阻塞,10年通畅率高达95％,且具有大隐静脉相似血供率,促使了ITA作为心脏搭桥血管的临床应用。     

关节镜下自体移植与同种异体移植膝关节交叉韧带重建术对比研究

目的：探讨关节镜下自体移植与同种异体移植重建膝关节前后交叉韧带的临床疗效差异。方法：选择2008年6月-2012年6月在本院进行关节镜下膝关节交叉韧带重建术的85例患者为研究对象,将其分为自体肌腱组和同种异体肌腱组。记录并比较两组患者的手术时间、住院时间及不良反应发生情况,统计术后1年Lysholm评分、Larson评分及国际膝关节评分委员会（IKDC）评分,评价关节功能。结果：所有患者均获随访,随访12-48个月。均未发生血管神经损伤,无感染、无植入物断裂。自体组患者手术时间较异体组长,住院时间较异体组短,两组比较差异均有统计学意义（P〈0.001）。自体组与异体组患者Lysholm评分、Larson评分及IKDC评分比较差异均无统计学意义（P〉0.05）。结论：自体肌腱移植与同种异体肌腱移植在重建膝关节交叉韧带治疗效果中无明显差异。     

肾移植受者的静脉营养支持

同种异体肾移植对于各种原因所致的终末期肾病是理想的疗法之一。１年人肾存活率达８６．６％；５年人肾存活率达６０％。影响肾移植预后的因素很多，合理的静脉营养支持能保护移植肾功能，并促进病人康复。１９８６年１月至１９９２年６月，共行肾移植术７例，男５例，女...     

犬自体睾丸移植的实验研究

目的 采用一种改良术式进行犬自体睾丸移植，探讨血管吻合方法对植睾功能的影响。方法 切取带主干血管瓣的右侧睾丸动、静脉与同侧髂外动、静脉端一侧吻合进行犬自体睾丸移植。观察移植犬生存情况，对移植睾丸进行影像学检查并比较实验组与对照组睾丸组织学改变及术后不同时间点的性激素水平。结果 移植成功率为92．8％（13／14）。术后8周两组犬的睾丸重量、精曲小管直径、间质细胞数及细胞核直径之间无统计学差异（P〉0，05）。与术前比较，两组术后各时间点LH明显升高（P〈0．05），T及FSH变化无统计学意义；组间比较术后各时间点的T、FSH及LH水平无显著性差异（P〉0．05）。彩色多普勒超声及DSA检查提示移植睾丸血供良好。结论 改良的自体睾丸移植术可提高移植成功率，且对移植睾丸生精及内分泌功能无明显影响，可进一步应用于异体睾丸移植的实验及临床研究。     

自体牙移植改良术式临床治疗分析

目的探讨自体牙移植改良术式的临床治疗效果及应用价值。方法选择2009年明-2010年4月接受自体牙移植治疗的80例患者作为观察对象，结合实际情况划分为下颌后牙与下前牙两个小组，全部都接受自体牙移植改良术式治疗。结果下颌牙组4例（7．69％）轻度吸收，14例（26．92％）牙根完好，5例（5．76％）牙根未完全发育，5例（5．76％）骨性愈合，28例（5；5．85％）牙周膜清晰；下前牙组5例（17。86％）轻度吸收，8例（2．8．57％）牙根完好，2例（7．14％）牙根未完全发育，4例（14．29％）骨性愈合，9例（32．14％）牙周膜清晰。结论自体牙移植改良术式具有充足的临床应用理论依据，相关人员应正确施行手术治疗，迅速提升患者生活质量及水平。     

自体骨髓单个核细胞移植治疗糖尿病性下肢缺血的临床观察

目的观察自体骨髓单个核细胞移植治疗糖尿病性下肢缺血的疗效。方法应用自体骨髓单个核细胞移植治疗20例22条糖尿病性下肢缺血。全部为2型糖尿病的下肢血管并发症。结果总的疼痛缓解率为85．0％，截肢3例（13．6％）。对缓解患者的冷、凉感觉，总有效率为100．0％。7例患者接受了下肢动脉造影显示有不同程度的新生侧支血管形成。踝部经皮氧分压测定显示绝大多数高于临床上截肢的最低临界值20mmHg（1mmHg=0．133kPa）。结论自体骨髓单个核细胞移植治疗糖尿病性下肢缺血是一种相对简单、安全、有效的方法。     

注射毒品所致假性股动脉瘤的外科治疗

目的 探讨注射毒品所致假性股动脉瘤的外科治疗方法。方法 对13例注射毒品所致假性股动脉瘤患者的临床资料进行回顾分析。13例病人均接受手术治疗。手术方式包括：瘤体切除 动脉破口修补术1例；瘤体切除 血管移植12例(移植血管包括自体大隐静脉、人造血管)。结果 全部病例保肢成功。血管移植术后复查彩色多谱勒超声显示，移植血管通畅。结论 彻底清创、血管重建、恰当处理并发症是注射毒品所致假性股动脉瘤外科治疗取得成功的关键。     

38例四肢血管损伤诊治体会

目的 对38例四肢主要血管损伤的救治进行回顾性分析。方法 2001年5月-2004年12月救治四肢主要血管损伤38例，其中男28例，女10例；年龄4．5-60岁，平均34．6岁。全组手术清创和探查后，针对不同的情况选择血管修复方法。结果 采用血管端吻合15例（39．4％），血管修补8例（21．1％），自体静脉移植8例（21．1％），死亡1例（2．6％），截肢6例（15．8％）。结论 四肢主要血管损伤救治原则是保证生命安全后尽快重建血液循环、恢复肢体功能；正确诊断、快速救治是前提；快速止血是重点；强调对深静脉的修复并正确处理感染性血管损伤。     

上海地区丙型和戊型肝炎人群流行病学调查及其流行因素的研究

１９９３～１９９４年上海地区病毒性肝炎监测点２３５５０例散发性急性肝炎血清学分型检测结果，丙型肝炎分别占 ２． ２％，２． ５％，戊型肝炎分别占１５． ５％，１８． １％。 １９９１～１９９４年对不同年龄健康人群 １２３０ 人，作抗－ＨＣＶ检测，阳性２８人，流行率为２．３％。对２０８６人作抗－ＨＥＶ检测，阳性１７１人，流行率为８．２％。并对 １３４０名特殊人群开展ＨＣＶ和 ＨＥＶ感染率调查，发现透析病人和静脉吸毒者ＨＣＶ流行率分别为 ６９． ６％和 ６７． ７％，献血员为 ２．７％，性乱人群为 １． ９％，弱智儿童为 １． １％，在押犯人 ２． ３％。 ＨＥＶ流行率分别为性乱人群１７．６％，弱智儿童３０．１％，卡拉ＯＫ女３２．１％，在押犯人２１．６％。本次病例配对调查结果发现，经血传播丙型肝炎主要传播途径（ＯＲ值在 １０以上），戊型肝炎以粪－口途径传播为主（ＯＲ值在３～４）。通过调查证实，上海地区存在着丙型和戊型肝炎流行，其中戊型肝炎已成为第三种（甲型肝炎、乙型肝炎）影响上海地区的肝炎病种。作者建议应继续加强对丙型戊型肝炎的防治研究。     

彩色多普勒超声评定下肢穿静脉功能不全的诊断效能研究

目的:探讨彩色多普勒超声评定下肢穿静脉功能不全的诊断效能。方法:选取医院收治的107例下肢浅静脉曲张患者将其作为观察组(根据静脉曲张分级标准再分为C1~C2级组、C3~C4级组和C5~C6级组),同期选择20名健康体检者作为健康对照组。所有受检者均完成多普勒超声检查,观察下肢静脉曲张情况。将超声诊断结果与X射线造影结果进行对照,分析超声对功能不全的穿静脉形态及功能的诊断效能。结果:(1)C5~C6级患者大隐静脉内径宽于C1~C2级、C3~C4级患者,LSD-t检验其差异有统计学意义(P<0.05);(2)不同分级患者大隐静脉及股静脉反流程度比较差异无统计学意义;(3)C5~C6级患者患肢穿静脉内径均宽于C1~C2级、C3~C4级患者,LSD-t检验其差异有统计学意义(P<0.05),C5-C6级组患者穿静脉瓣膜反流所占比例高于C1~C2级组、C3~C4级组患者,LSDt检验其差异有统计学意义(P<0.05);(4)超声诊断功能不全穿静脉灵敏度、特异度及符合率分别为86.67%、82.35%和85.11%;(5)下肢静脉曲张患者穿静脉开放数目与肢体远端挤压试验反流、穿静脉内径均呈正相关(r=0.276,r=0.367;P<0.05);穿静脉瓣膜功能与大隐静脉瓣膜功能则呈负相关(r=-0.244,P<0.05);大隐静脉瓣膜功能不全患者反流速度与深静脉瓣膜功能不全呈正相关(r=0.295,P<0.05)。结论:超声检查对下肢功能不全的穿静脉诊断与X射线造影一致度高,可作为一种灵敏度及特异度都很高的诊断穿静脉功能不全的检查方法。     

Non-suture end-to-end anastomoses between polytetrafluoroethylene graft and vessels for blood access

BACKGROUND: Non-suture end-to-end anastomoses between polytetrafluoroethylene grafts and blood vessels were achieved using absorbable cuff material in experimental and clinical studies. The cuff was made of a synthetic biodegradable material, a lactic-glycolic acid copolymer, similar in composition to conventional absorbable surgical sutures. METHODS: In the experimental study, vascular anastomoses for prosthetic interposition of the infrarenal aorta in rabbits were created using the cuff method. Six months after surgery, the cuff anastomoses sites were examined angiographically and microscopically and found to be patent and smooth without neointimal hyperplasia. RESULTS: The cuff layer had been completely absorbed. The clinical application used a similar technique and involved the creation of forearm bridge graft fistula in twelve patients for hemodialysis. In eight patients, Doppler fistula flow rate ranged from 167 ml/min to 392 ml/min. Ten of the twelve patients continued dialysis uneventfully. The one-year patency rate was 78% (7/9). The longest patency period was 920 days and the graft access continued to maintain sufficient blood flow for hemodialysis. CONCLUSIONS: This absorbable cuff material is therefore well suited for the construction of prosthetic vascular end-to-end anastomoses.     

腺苷蛋氨酸治疗白毒伞中毒的初步探索

目的 观察腺苷蛋氨酸(SAMe)治疗白毒伞中毒的临床疗效.方法 回顾性分析12例白毒伞中毒病例资料,按是否使用SAMe治疗分为两组:A组接受洗胃、导泻、补液、利尿、护肝、抗感染及血液净化等治疗;B组在A组治疗的基础上加用SAMe.比较两组病例中毒后第1、3、5及7天肝功能变化及病死率.结果 A组6例患者中毒后2人死亡,病死率为33.3%(2/6),2例死亡病例的天冬氨酸转氨酶(AST)和丙氨酸转氨酶(ALT)在3、5 d持续增加(5 d时＞2000 U/L),在7 d下降;总胆红素(TBIL)则3、5及7 d持续增加.B组6例患者中毒后无死亡病例.SAMe治疗后7 d,TBIL下降,5例ALT升高,3例AST降低.结论 腺苷蛋氨酸可能对降低白毒伞中毒的病死率起到重要作用.

Abstract：

Objective To observe the curative effects of transmetil on Amanita verna poisoning.Methods Twelve cases with Amanita verna poisoning were reviewed. The patients were divided into 2 groups according to usage of transmetil: Group A was treated with traditional protocol (gastric lavage, catharsis,rehydration, diuresis, anti-infection and hemodialysis), Group B was treated with traditional protocol combined with transmetil. The liver function changes on the 1st, 3rd, 5th and 7th day after poisoning and the mortality were compared between 2 groups. Results Two cases in group A (6 patients) died. The mortality of group A was 33.3%. The AST levels continued to increase on the 3rd and 5th day, but decreased on the 7th day. TBIL continued to increased on the 1st, 3rd, 5th and 7th day. None in group B died. The TBIL level dropped at 7 d 5 patients showed an increase in ALT at 7 d and 3 patients showed a decrease in AST at 7 d.Conclusion Transmetil may play an important role in reducing the mortality of Amanita vema poisoning.     

Infective tricuspid valve endocarditis due to abscess of an endogenous arteriovenous fistula in a chronic hemodialysis patient

Patients on chronic hemodialysis are at high risk for endocarditis due to prosthetic access devices. Right-sided endocarditis without any predisposing factors is rare in dialysis patients. A 76-year-old female, who had chronic renal failure had been treated by hemodialysis and had a permanent pacemaker implanted, was admitted to our hospital with a high fever and lumbago after abscess formation at an autogenous arteriovenous fistula for hemodialysis. Methicillin Resistant Staphylococcus Aureus was identified by blood culture examination. Echocardiography revealed vegetation attached to the tricuspid valve. Chest X-ray and perfusion lung scintigraphy showed pulmonary infarction, perhaps due to vegetation-derived emboli. Computed tomography also showed pyogenic spondylitis in L4 and L5. Repeated vascular punctures even of autogenous grafts expose dialysis patients to bacteremia and imply a higher risk of infectious endocarditis.     

Influence of postural changes on the variations of blood volume in hemodialysis and reincidence post-dialysis blood volume

The aim of the present work is to study the possible increment of blood volume, in the seated as well as the lying position, and to analyse the influence of changes of posture on the changes of blood volume during the hemodialysis. 17 patients were studied, evaluating the variations of the hematocrit in the extracorporeal circuit on entry into the dialyzer, by means of a photometric system (Crit-Line Instrument, Izasa). Every 15 minutes the values of the hematocrit were taken and heir repercussion in the blood volume in different changes of posture. Initially all of the patients improved their blood volume, both seated and lying down. During the session of hemodialysis and ultrafiltration, with the patient in a seated position, an important drop in the blood volume was noticed; this was the case in the 1st, 2nd and 3rd hours. This drop improved when the patient adopted a lying position and there was a "reincidence of post-dialysis blood volume" at the end. According to these results, the supine posture improves the refill, confirming that the patients position influences the vascular refill.     

门诊血液透析患者血管通路感染目标性监测

目的了解门诊血液透析患者血管通路感染发病情况及其危险因素。方法采用前瞻性监测方法,参照国内外相关指南及规范制定监测方法,对某院2014年6月1日—2016年5月31日所有门诊血液透析患者进行目标性监测。结果 2014年6月1日—2016年5月31日共有门诊血液透析患者584例,血管通路总次数为64 203例次,发生感染79例,85例次,血管通路感染例次发病率为1.32‰。其中血管穿刺部位感染36例(42.35%),血管通路相关血流感染49例(57.65%)。不同血管通路类型患者中人工血管患者的血管通路感染发病率最高(19.67‰),其次为非隧道式中心静脉置管患者(4.91‰)、隧道式中心静脉置管患者(0.73‰)、动静脉内瘘患者(0.09‰)。年龄60岁、透析时间1年、伴有糖尿病、高血压是门诊血液透析患者发生血管通路感染的危险因素(均P0.05)。49例血管通路相关血流感染患者送检的血标本中共分离病原菌39株。革兰阳性球菌36株(92.31%),主要为金黄色葡萄球菌(30株,其中6株为耐甲氧西林金黄色葡萄球菌);革兰阴性杆菌3株(7.69%)。结论加强前瞻性目标监测,可以更好地了解门诊血液透析患者血管通路感染的现状、特征及其危险因素,有利于采取针对性的预防控制措施,从而减少门诊血液透析患者血管通路感染的发生。     

锡类散治疗口腔溃疡的临床观察

目的：观察锡类散治疗口腔溃疡的临床疗效。方法：117例患者应用锡类散治疗，每日2次，5天为一疗程，分别观察一疗程、二疗程、三疗程以上的治愈情况。结果：117例患者中一疗程治愈者78例，占总例数66．6％。二疗程治愈者34例，占总例数29．1％。三疗程以上治愈者3例，占总例数2．6％。无效者：2例，占总例数1．7％。随访6个月也年，复发10例，占总例数8．4％。结论：锡类散治疗口腔溃疡，止痛和促进溃疡面愈合效果迅速明显，简便易行，无痛苦，未见不良反应，值得在基层医院及社区医疗系统推广。     

注射毒品引起假性股动脉瘤的外科治疗(附11例报告)

目的　探讨对注射毒品引起的假性股动脉瘤行血管移植的疗效 ,提高治疗效果。方法　行血管移植手术治疗 11例 ,其中人工血管移植 9例 ,自体血管移植 2例 ,均行股动脉及股静脉移植。结果　 11例患者术后平均随访 2年 ,均获得良好效果 ,移植血管通畅 ,未出现血管阻塞 ,伤口愈合欠佳 1例。结论　血管移植是注射吸毒引起假性股动脉瘤外科治疗取得成功的关键。     

Retrospective analysis of catheter-related infections in a hemodialysis unit.

OBJECTIVE: To compare the incidence rates of catheter-related bloodstream infection associated with different vascular access methods in patients receiving hemodialysis. SETTING: Tertiary care public hospital in Western Australia. DESIGN: Retrospective analysis of surveillance data collected by the hospital's infection control department. METHODS: The number of confirmed bloodstream infections for each type of vascular access was identified for the period from July 2002 through June 2003. The corresponding number of patient-days was determined to calculate the infection incidence rates. The serially correlated data were then analyzed using Poisson generalized estimating equations. RESULTS: A total of 32 confirmed bloodstream infections were identified. Infection rates, in number of infections per 1,000 patient-days, were as follows: 0.4 for native arteriovenous fistulae; 2.86 for synthetic arteriovenous grafts; 4.02 for permanent, tunneled, cuffed central venous catheters; and 20.2 for temporary, nontunneled, noncuffed central venous catheters. Compared with permanent catheters, the monthly infection rate associated with the temporary catheters was significantly higher (incident rate ratio [IRR], 5.025 [95% confidence interval {CI}, 1.532-16.484]; P=.008) and that of arteriovenous fistulae was significantly lower (IRR, 0.099 [95% CI, 0.030-0.324]; P=.001). The monthly infection rate for arteriovenous grafts was not significantly different from that for permanent central venous catheters (IRR, 0.702 [95% CI, 0.246-2.008]; P=.510). CONCLUSIONS: A hierarchy of infection risk associated with vascular access type is evident. Native arteriovenous fistulae should be recommended for all patients receiving chronic hemodialysis, to minimize infection.