介入溶栓治疗下肢深静脉血栓合并急性肺动脉栓塞的疗效分析

目的探讨介入溶栓治疗下肢深静脉血栓合并急性肺动脉栓塞的疗效。方法选取2014年8月~2015年1月我院收治的下肢深静脉血栓合并急性肺动脉栓塞患者80例作为研究对象,将其随机分为观察组与对照组,各40例。对照组采用常规治疗,观察组采用介入溶栓治疗,并对比两组患者的疗效。结果经过治疗后,观察组总有效率为95.0%,对照组总有效率为75.0%,差异有统计学意义(P0.05);对患者进行随访,观察组血栓复发率为12.5%,对照组血栓复发率为30.0%,差异有统计学意义(P0.05)。结论对下肢深静脉血栓合并急性肺动脉栓塞实施介入溶栓治疗的疗效较好,可有效改善患者临床症状并且复发率较低,值得临床推广与应用。     

老年下肢深静脉血栓形成患者尿激酶联合低分子肝素钠治疗前后血浆D-二聚体的表达水平及意义

目的分析老年下肢深静脉血栓(DVT)患者溶栓抗凝治疗前后血浆D-二聚体的表达水平及临床意义。方法经血管造影确诊的98例老年DVT患者,分为合并肺栓塞(PE)组和无PE组;依据血栓形成部位不同,分为周围型、中央型和混合型组,并给予尿激酶联合低分子肝素钠溶栓抗凝治疗。检测患者治疗前后D-二聚体含量,并比较组间D-二聚体表达有无差异。结果合并PE组患者D-二聚体含量及阳性率明显高于无PE组(t=6.424,P0.001;χ~2=12.086,P0.001);周围型、中央型和混合型组溶栓抗凝前D-二聚体含量和阳性率差异有统计学意义(P0.001,P=0.045),治疗后各组D-二聚体含量均明显下降(P0.05),但组间比较差异无统计学意义(P0.05)。结论老年DVT患者若D-二聚体阴性,可基本排除合并PE;周围型、中央型和混合型DVT患者D-二聚体表达及阳性率逐渐升高;DVT溶栓抗凝过程中D-二聚体动态变化与血栓演变过程一致。     

溶栓与单纯抗凝治疗急性次大面积肺栓塞的疗效及安全性

目的：探讨溶栓与单纯抗凝治疗急性次大面积肺栓塞患者的疗效与安全性。方法：63例急性次大面积肺血栓栓塞症患者,被随机分为溶栓组（n＝32）与单纯抗凝组（n＝31）。观察两组治疗前与治疗2周后动脉血气指标及右心功能指标变化,进行疗效分析。统计两组出血、血小板减少发生情况。结果：治疗后两组动脉血气指标及右心功能指标较治疗前显著改善（P＜0.05或＜0.01）;与单纯抗凝组比较,溶栓组动脉血氧分压[PaO2,（77.8±7.3）mmHg比（83.4±8.7）mmHg]、右室前壁活动度[RVAWM,（4.9±1.7）mm比（5.8±2.2）mm]显著上升,肺泡-动脉血氧分压差[P （A-a）O2,（23.1±2.8）mmHg比（16.5±2.4）mmHg]、肺动脉收缩压[PASP,（54.6±7.9）mmHg比（34.2±7.5）mmHg]显著下降（P＜0.05或＜0.01）。溶栓组总有效率显著高于单纯抗凝组（100％比80.6％,P＝0.002）。两组出血发生率及血小板减少发生率无统计学差异（P＞0.05）。结论：溶栓治疗可显著降低急性次大面积肺栓塞患者的肺动脉压力,改善氧合及右室功能指标,无禁忌患者可考虑优先推荐。     

瑞替普酶与尿激酶溶栓治疗中危肺栓塞的临床疗效

目的对比分析瑞替普酶与尿激酶溶栓治疗中危组肺栓塞临床疗效。方法根据不同的治疗方案将所有患者分成瑞替普酶组(23例)与尿激酶组(39例),将两组患者溶栓效果进行对比与分析。结果治疗后两组D-二聚体、肌钙蛋白T、N-Pro BNP及PASP均较治疗前降低(P0.05),Pa O2较治疗前升高(P0.05),两组患者治疗前与治疗后24小时D-二聚体及肌钙蛋白T差值无明显区别(P0.05),但瑞替普酶组Pa O2、N-Pro BNP、PASP治疗前后差值明显大于尿激酶组(P0.05)。结论瑞替普酶及尿激酶均可以用于治疗急性中危组PTE,但于住院期间给予中危组肺栓塞患者,瑞替普酶溶栓治疗效果优于尿激酶。     

超声检查在老年急性肺栓塞诊断及疗效评估中的价值

目的探讨超声检查在老年急性肺栓塞诊断及疗效评估中的价值。方法选择老年急性肺栓塞患者27例,所有患者均于急性肺栓塞发病前、发病时以及治疗病情缓解后进行超声心动图、下肢深静脉超声检查,并行末梢血氧饱和度、血压、血浆D-二聚体等检测。结果与发病前比较,老年急性肺栓塞患者发病时收缩压、舒张压、末梢血氧饱和度明显下降,血浆D-二聚体明显升高,差异有统计学意义(P<0.05)。经治疗病情缓解后,患者的血压、末梢血氧饱和度均恢复或接近急性发病前的平时水平,血浆D-二聚体明显下降(P<0.05)。急性肺栓塞发病时,患者右心房、右心室增大,主肺动脉及下腔静脉增宽,三尖瓣反流速度增快,肺动脉收缩压明显增高,与发病前比较,差异有统计学意义(P<0.05)。经治疗病情缓解后,患者右心房、右心室、主肺动脉及下腔静脉均恢复或接近急性发病前的平时水平,三尖瓣反流速度及肺动脉收缩压明显下降。老年急性肺栓塞患者发病时下肢深静脉血栓超声检出率高达77.8%。结论超声心动图及下肢深静脉超声同时结合其他各类检查是老年急性肺栓塞诊断必不可少的辅助检查手段,为老年急性肺栓塞的早期诊断、治疗及疗效评估提供有力的帮助。     

介入溶栓治疗下肢深静脉血栓合并急性肺动脉栓塞的效果解析

目的分析下肢深静脉血栓合并急性肺动脉栓塞患者行介入溶栓疗法的效果。方法从2012年9月-2015年10月我院收治的下肢深静脉血栓合并急性肺动脉栓塞患者中抽选29例作为对象,按患者的入院编号将其分成两组:14例对照组患者行基础疗法,15例实验组患者行介入溶栓疗法,统计治疗后的效果。结果实验组患者的治疗效果高于对照组,血栓复发率后遗症发生率低于对照组,经由统计学分析得知,两组患者的治疗效果、血栓复发率后遗症发生率有区别,P0.05。结论临床针对下肢深静脉血栓合并急性肺动脉栓塞患者实施介入溶栓疗法作用突出,可立即缓解病症,预防复发,减少后遗症值得借鉴。     

肺源性心脏病急性加重期患者下肢深静脉血栓的预防分析

目的探讨肺源性心脏病急性加重期患者并发下肢深静脉血栓的预防与治疗措施。方法将我院2013年3月-2014年3月接收的80例肺源性心脏病急性加重期患者作为研究对象,随机将其分为观察组与对照组各40例,给予对照组常规护理,观察组则在对照组的基础上采用针对性预防护理,并采用药物抗凝、导管溶栓等治疗,观察两组患者的临床疗效与下肢深静脉血栓发生率情况。结果对照组26例并发下肢深静脉血栓,发生率为65.0%,观察组8例并发下肢深静脉血栓,发生率为20.0%,两组下肢深静脉血栓发生率对比差异显著(P0.05);34例患者行下腔静脉过滤器植入治疗,12例患者行药物抗凝治疗的总有效率为75.0%,22例患者行导管溶栓治疗的总有效率为90.7%,导管溶栓与药物抗凝对比差异显著(P0.05)。结论给予肺源性心脏病急性加重期患者针对性预防护理后,可有效降低下肢深静脉血栓发生率,一旦发生下肢深静脉血栓,应及时采取药物抗凝、导管溶栓等积极有效的治疗,以提高治疗效果。     

严格控制饮食中维生素K摄入量对应用华法林治疗急性肺栓塞患者的疗效

目的探讨严格控制饮食中维生素K摄入量对应用华法林治疗急性肺栓塞患者的疗效及不良反应的影响。方法经肺动脉血管造影确诊的适用于抗凝治疗的中低危成年急性肺栓塞患者40例,随机分为观察组20例和对照组20例。观察组采取严格控制饮食,对照组给予传统的饮食健康教育。比较两组应用华法林抗凝治疗3个月内血浆国际标准化比值的达标率、不良反应发生率。3个月后所有患者复查肺动脉血管造影,比较两组肺动脉血栓清除率。结果观察组血浆国际标准化比值达标率明显高于对照组(P<0.01);观察组不良反应发生率明显低于对照组(P<0.05);观察组肺动脉血栓清除率明显高于对照组(P<0.05)。结论严格控制饮食中维生素K摄入量能够提高急性肺栓塞患者应用华法林抗凝治疗时的血浆国际标准化比值达标率、肺动脉血栓清除率,并降低不良反应发生率。     

12例老年下肢骨折术后并发肺栓塞的临床诊治体会

目的总结老年下肢骨折术后并发肺栓塞(PE)的诊断与治疗方法,利于该病的早期防治。方法对12例老年下肢骨折术后并发肺栓塞患者资料进行分析。结果胸闷,呼吸困难,心悸为临床主要症状,少数出现胸痛、咯血、喘憋;查体,部分患者出现肺部湿啰音,肺栓塞发生时间以1~3周最多;血管超声检查有合并下肢深静脉血栓。CT肺动脉造影阳性率100%;治疗后PaO2、PaCO2、SaO2随着时间的推移逐渐上升,各指标与治疗前比较差异具有显著性(P0.05)。结论肺栓塞是老年下肢骨折术后严重的并发症,由于缺乏特异性,为早期诊断造成困难,重视动脉血气分析及D-二聚体检查,及时溶栓治疗可迅速稳定病情。     

探讨心脏彩超及心电图对肺栓塞诊断的临床价值

目的探讨心脏彩超及心电图对肺栓塞诊断的临床应用价值。方法收集2008年2月至2015年1月安徽省立医院呼吸科患者中,疑诊肺栓塞患者210例(咯血、晕厥、胸痛、氧饱和度下降等),后经肺动脉CTA明确诊断为肺栓塞病例89例,排除肺栓塞病例111例,疑似肺栓塞病例10例,对确诊肺栓塞病例分为高危组、中危组、低危组,均在抗凝或溶栓治疗前行心脏超声及心电图检查,重点观察右心系统变化、估测肺动脉压力及心电图改变情况。结果高危肺栓塞组肺动脉收缩压明显高于对照组,差异具有统计学意义(P0.05),中危及低危肺栓塞组,肺动脉收缩压与对照组比较,差异无统计学意义(P0.05),肺动脉高压对诊断高危肺栓塞的敏感度高,同时具有肺动脉高压及心电图改变,对诊断高危肺栓塞的特异度高。结论高危肺栓塞患者常合并肺动脉高压,联合检测心脏彩超及心电图有助于早期对高危肺栓塞的诊断。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.