经皮机械血栓清除术治疗急性下肢缺血的效果分析

目的探讨以Rotarex装置行经皮机械血栓清除术(PMT)治疗急性下肢缺血(ALI)的有效性和安全性。方法选取首都医科大学附属北京朝阳医院血管外科自2016年9月至2017年5月收治的ALI患者23例,年龄(71.0±12.1)岁。患者均表现为突发下肢凉、麻、疼痛或间歇性跛行等症状突然加重,经CT血管成像(CTA)及数字减影动脉造影(DSA)证实为动脉硬化基础上急性动脉血栓形成,肢体缺血Rutherford分级Ⅰ级2例(8.70%),Ⅱa级15例(65.22%),Ⅱb级6例(26.09%)。均以Rotarex装置行PMT。结果 23例患者中联合球囊扩张18例(其中9例为药物涂层球囊),联合支架植入5例,联合导管接触性溶栓(CDT)5例。术后血栓完全清除17例,大部分清除4例,未能清除2例,技术成功率91.3%(21/23)。症状完全消失19例,症状缓解2例,无效2例,临床有效率91.3%(21/23)。23例患者中8例为支架内闭塞,术后缺血症状均完全消失,术中发生远端动脉栓塞3例,术中血管破裂1例,随访期间同侧下肢动脉血栓复发2例。结论严格掌握适应证,使用Rotarex机械血栓清除装置治疗ALI安全有效。     

TurboHawk斑块旋切系统在下肢动脉硬化闭塞症中的临床应用

目的评价TurboHawk斑块旋切系统在下肢动脉硬化闭塞症中的临床疗效和安全性。方法回顾性分析2017年3月至2018年6月宜宾市第一医院血管外科收治的下肢动脉粥样硬化闭塞症患者23例的临床资料。选取TurboHawk斑块旋切系统进行介入手术治疗,所选患者均于术前和术后3 d行踝肱指数(ABI)检查。术后随访6个月。对比患者手术前后的临床资料及随访结果。采用SPSS 19.0软件进行统计学分析。组间比较采用t检验。结果与术前相比,患者术后3 d的ABI显著增加[(0.81±0.13)和(0.26±0.19),t=31.52,P=0.012]。23例患者术后显效9例,有效14例。术后发生腹膜后血肿、斑块腓动脉栓塞、胫前动脉血管切破、股浅动脉夹层各1例,并发症发生率为17.4%(4/23),给予相应处理后均好转。术后随访6个月,所有患者均未出现明显静息痛,仅术后6个月增加了1例跛行患者。术前有6例下肢溃疡患者,均在术后4个月内愈合,随访过程无再发溃疡病例。患者术后6个月ABI与术后3 d相比差异无统计学意义[(0.81±0.17)和(0.81±0.13),P0.05]。结论 TurboHawk斑块旋切系统是下肢动脉硬化闭塞症患者介入开通的一种良好选择,疗效满意,安全性高,值得推广。     

糖尿病合并下肢动脉硬化闭塞症介入术后应用脉管复康片治疗的效果分析

目的分析糖尿病合并下肢动脉硬化闭塞症介入术后应用脉管复康片治疗的效果。方法选择2013年8月—2015年2月间接受该院治疗70例糖尿病合并下肢动脉硬化闭塞症,此次研究将这70例患者列为研究对象,采用电脑随机分组方式分为常规组与研究组,各组35例,其中常规组患者35例给予抗血小板、降脂、抗凝、降糖治疗;研究组35例患者的给予治疗方法,则是在基于常规组治疗办法的基础之上给予脉管复康片进行治疗,最后将两组患者的ABI(踝/肱指数)、间歇性跛行、截肢率以及静息痛发生率进行对比。结果研究组患者应用脉管复康片治疗,使得患者的间歇性跛行、截肢率以及静息痛发生率显著降低,且ABI提升效果均明显高于常规组,数据对比差异具有统计学意义(P0.05)。结论糖尿病合并下肢动脉硬化闭塞症介入术后应用脉管复康片进行治疗,有助于延缓患者病情的发展,临床应用价值较高,值得进一步推广应用。     

下肢缺血的外科治疗进展

正下肢慢性缺血主要是由于下肢动脉慢性闭塞导致下肢远端组织的缺血缺氧,从而出现一系列临床症状和体征,主要表现为早期的间歇性跛行、静息痛和组织的缺损(溃疡和坏疽)。目前我国患者下肢慢性缺血的病因主要为:糖尿病下肢动脉硬化闭塞症、非糖尿病下肢动脉闭塞症和血栓闭塞性脉管炎等。由于轻度的间歇性跛行通过药物治疗、积极的身体锻炼得到一定的缓解,而目前临床上需要外科干预的     

下肢动脉硬化闭塞症:炎症机制与抗炎治疗的研究进展

下肢动脉硬化闭塞症(PAD)是由于下肢动脉管腔狭窄或闭塞,而引起患者间歇性跛行与静息痛的一种动脉粥样硬化性疾病。其发病率在世界范围内逐年增高,可导致心血管事件高发。现综述动脉粥样硬化炎症在PAD发生发展过程中的作用,讨论有间歇性跛行症状的PAD患者的介入治疗及抗炎治疗的效果。最后,展望探讨了一种新的治疗方式,即声动力疗法,通过靶向清除动脉粥样硬化斑块内巨噬细胞来减轻动脉炎症反应,从而改善PAD患者的跛行症状。     

经皮腔内血管成形术联合血管内支架治疗老年下肢动脉硬化闭塞症患者的疗效

目的探讨经皮腔内血管成形术(PTA)联合血管内支架治疗老年下肢动脉硬化闭塞症(ASO)的临床疗效。方法收集28例老年患者、31条肢体,共53处病变部位行血管形成术联合支架植入术(PTAS)进行治疗,术后1个月对患者的跛行距离及踝肱指数进行监测,同时对术后病变部位的血管通畅率进行随访。结果行PTAS手术后,髂动脉的成功率为100%,股腘动脉的成功率为95.24%;术后1个月,患者的踝肱指数由术前的(0.35±0.11)增加至术后的(0.95±0.09),间歇性跛行距离由术前的(117.3±29.9)m增加至术后的(518.4±122.7)m,手术前、后比较差异显著(P0.05);术后2年髂动脉的血管通畅率为91.67%,股腘动脉的血管通畅率为80.95%。结论 PTA联合PTAS治疗下肢动脉ASO手术成功率高、创伤性小、安全有效,且能有效改善缺血区的血液供应,再狭窄可能性减小。     

下肢动脉硬化性闭塞症伴腰椎管狭窄症的诊疗分析

目的 探讨下肢动脉硬化性闭塞症伴腰椎管狭窄症的临床特点及诊疗方法.方法 对我院2010年1月至2013年6月同时患有下肢动脉硬化性闭塞症和腰椎管狭窄症住院患者的电子病历数据进行回顾性调查研究,分析性别、年龄、症状、体征、诊疗过程等相关资料.结果 共25例患者,男性16例,女性9例,年龄（68.6±10.5）岁,首诊骨科23例,首诊血管科2例.25例患者就诊的主要原因均为间歇性跛行,首发症状以腰痛最为常见（48％）,共病以高血压最为常见（64％）.25例患者均首先行腔内治疗,行“球囊成形术”8例,行“球囊成形＋支架置入术”17例;完全缓解16例,部分缓解5例,未缓解4例.未缓解4例行椎管减压术后,完全缓解3例,部分缓解1例.结论 下肢动脉硬化性闭塞症伴腰椎管狭窄症与高龄、高血压、缺血性心脏病、糖尿病、高脂血症、脑血管病、高同型半胱氨酸血症等相关.在诊断以间歇性跛行为主要临床表现的患者时,应提高对下肢动脉硬化性闭塞症合并腰椎管狭窄症现象的认识.     

前列腺素E1脂微球载体制剂治疗下肢动脉硬化闭塞症60例临床观察

本研究对60例下肢动脉硬化闭塞症患者采用前列腺素E1脂微球载体制剂(PGE1,商品名为凯时)治疗,取得了较好疗效。1一般资料及方法1.1一般资料收集2009年6月至2011年6月的下肢动脉粥样硬化闭塞症住院患者60例,年龄53～89岁,平均(70±7.6)岁,其中男51例,女9例,合并糖尿病者49例,吸烟者50例,合并高脂血症者53例。临床表现均有下肢疼痛、间歇性跛行、发凉、麻木等症状,体格检查     

经皮腔血管成形术联合血管内支架治疗下肢动脉硬化闭塞症的临床疗效研究

目的探讨经皮腔血管成形术(PTA)联合血管内支架治疗下肢动脉硬化闭塞症的临床疗效。方法选取2010年12月—2015年10月武汉市第一医院收治的下肢动脉硬化闭塞症患者32例。均在DSA室的X线引导下行PTA;对于近两年内有髂动脉严重狭窄的患者,行PTA后置入血管内支架。记录患者的临床疗效。结果 PTA的即时成功率为90.6%(29/32),手术成功的29条患肢中3条踝肱指数(ABI)无明显改善,余26条由术前的(0.42±0.11)恢复至(0.82±0.12)。随访3~45个月,1例患者的胫后动脉在术后第9个月发生再次闭塞,2例患者的腘动脉在术后第12个月发生再次闭塞,手术通畅率为88.5%(23/26)。结论 PTA联合血管内支架治疗下肢动脉硬化闭塞症的临床疗效确切,可有效提高患者病变血管通畅率,值得在临床上推广应用。     

主髂动脉硬化闭塞症的腔内治疗

目的:探讨主髂动脉硬化闭塞症的腔内治疗方法和初步临床经验。方法:2002年1月至2010年6月主髂动脉硬化闭塞症腔内治疗患者161例,其中4例行单纯髂动脉球囊扩张,157例患者行髂动脉球囊扩张及支架植入术,共植入支架207枚,其中累及腹主动脉末端的10例患者采用对吻技术行支架植入。结果:161例患者均成功完成手术。术后患者踝臂指数(ABI)由术前的0.46±0.28提高至0.89±0.26,二者差异有统计学意义(P0.01)。间歇性跛行及静息痛症状均较术前有明显改善。围手术期并发症包括急性血栓形成2例,穿刺部位血肿4例,肺部感染2例,脑梗死2例,急性心肌梗死1例,消化道出血2例。其中1例患者术后出现应激性溃疡消化道出血,后并发多脏器功能衰竭死亡,围手术期死亡率为0.62%,随访12个月的一期通畅率为91.8%,二期通畅率为100%。结论:主髂动脉病变的腔内治疗有良好的效果,部分复杂病变使用杂交技术可以提高成功率及通畅率。     

Treatment of patients with Eisenmenger's syndrome with Bosentan

We treated prospectively 14 patients with Eisenmenger's syndrome, with a mean age of 10 years, ranging from 3 to 18 years. Treatment continued for 12 months, and demonstrated a lasting symptomatic improvement, but no improvement in terms of mean saturation of oxygen over 24 hours. Exercise capacity, as judged by peak uptake of oxygen, worsened in the six patients able to perform a treadmill test. The symptomatic benefit from dual blockage of endothelin receptors in these patients may be due to mechanisms other than selective pulmonary vasodilatation alone.     

Satisfaction with ambulatory care of persons with AIDS

OBJECTIVE: To examine the relation of patient characteristics and site of care to the perception of ambulatory care quality by persons with AIDS (PWAs). DESIGN: Patient surveys and medical record review were used to determine PWAs’ perceptions of their ambulatory care, self-perceived health status, primary care relationships, sociodemographic characteristics, and severity of illness. SETTING: A public-hospital HIV clinic, an academic group practice, and a staff-model health maintenance organization (HMO) that together care for 20% of all Massachusetts PWAs. PATIENTS: All active patients as of February 12, 1990, and all new AIDS patients at each of the three sites during the subsequent 13 months. MEASUREMENTS AND MAIN BESULTS: The primary outcome measure was a six-item scale of patient-rated quality of care (PRQC), a newly developed measure that combined patients’ ratings of their physician care, nursing care, involvement in medical decisions, and overall quality of care. Multiple logistic regression was carried out with low PRQC (lowest quart He) as the dependent variable, to identify correlates of patient perceptions of poor quality. Patients who had a primary nurse were significantly less likely to have low PRQC scores (OR=0.50, 95% CI=0.26 to 0.97). Black patients and patients who used injection drugs were significantly more likely to rate their care in the lowest quartile (OR=2.22, 95% CI=1.04 to 4.78; and OR=2.43, 95% CI=1.13 to 5.23, respectively), as were those who had lower self-perceived health status, after controlling for confounders; no association was found by site or severity. CONCLUSIONS: These results show that primary nursing may be an important determinant of how PWAs rate the quality of their ambulatory care. Furthermore, PWAs who are black or who are injection drug users are less satisfied than are others with the quality of their ambulatory AIDS care. Presented in part at the annual meeting of the Society of General Internal Medicine, April 30, 1993, Arlington, Virginia. Supported by the Agency for Health Care Policy and Research, grant number HS06239.     

Experience with the treatment of patients with hypertrophic cardiomyopathy with obsidan and isoptin

Forty-five patients with hypertrophic cardiomyopathy were examined clinically and echocardiographically. The results of their treatment with obsidan and isoptin in relation to various types of central hemodynamic disorders are presented. The data have been obtained making it possible to treat patients differentially with regard to the form of the disease. The treatment of this category of patients requires the echocardiographic monitoring of the parameters of the central hemodynamics and myocardial contractility.     

分析老年糖尿病患者应用甘精胰岛素联合阿卡波糖治疗的效果

目的探讨甘精胰岛素联合阿卡波糖在老年糖尿病患者中的临床疗效。方法选取该院2018年7月—2019年7月收治的113例老年糖尿病患者作为研究对象,经随机数字表法,划分A组(n=56,阿卡波糖)和B组(n=57,甘精胰岛素+阿卡波糖),比较两组临床疗效、血糖指标。结果B组患者临床治疗总有效率显著高于A组;经治疗,B组患者空腹血糖(FBG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbAlc)水平明显低于A组。两组之间比较差异有统计学意义(P<0.05)。结论在老年糖尿病患者中应用甘精胰岛素+阿卡波糖,临床疗效显著,使患者的空腹血糖、餐后2 h血糖、糖化血红蛋白等指标得到了明显改善,安全性强。     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.