动脉导管溶栓治疗急性肢体动脉栓塞14例分析

目的 探讨动脉导管溶栓治疗急性肢体动脉栓塞的方法和疗效。方法回顾性分析14例肢体动脉栓塞的诊断方法和介入手术治疗方案。结果治愈11例，治愈率78．6％(11／14)；2例好转。无患肢缺血坏死或截肢，无术后因肾功能衰竭死亡。结论动脉导管溶栓是治疗急性肢体动脉栓塞有效的方法，值得进一步开展和探索。     

骨折术后急性下肢动脉血栓形成的溶栓治疗

目的探讨骨折后下肢动脉急性血栓形成的溶栓方法及治疗的临床意义。方法8例骨折术后下肢动脉急性血栓形成,均行骨折内固定术,其中1例骨折内固定并血管吻合术后形成,通过造影确定栓塞的程度、范围、部位后,在抗凝的同时用尿激酶溶栓,开通后常规口服抗凝剂3个月。结果8例急性形成的血栓均溶解,患肢远端血运明显改善或恢复正常,临床症状消失。结论骨折内固定术后急性形成的血栓通过造影明确栓塞的部位、程度、范围,然后采取急诊溶栓措施可有效地解除动脉闭塞。     

动脉造影在骨折术后急性下肢动脉血栓的溶栓治疗的应用

目的 目的探讨应用动脉造影在骨折术后下肢动脉急性血栓形成的溶栓方法及治疗的临床意义。方法 10例骨折术后下肢动脉急性血栓形成，均行骨折内固定术，其中1例骨折内固定并血管吻合术后形成,通过造影确定栓塞的程度、范围、部位后，在抗凝的同时用尿激酶溶栓,开通后常规口服抗凝剂3个月。结果 10例急性形成的血栓均溶解,患肢远端血运明显改善或恢复正常，临床症状消失。结论 骨折内固定术后急性形成的血栓通过造影明确栓塞的部位、程度、范围。然后采取急诊溶栓措施可有效地解除动脉闭塞。     

自体外周血干细胞移植治疗下肢缺血性疾病14例

背景:血管病变引起的肢体缺血性疾病不仅仅是肢体动脉主干发生病变,还常常伴有微循环障碍,通常所采用的动脉搭桥或动静脉转流术只能解决主干动脉阻塞,不能改善微循环障碍,因而其临床效果并不十分理想。近年来,基于内皮祖细胞的自体外周血干细胞移植已成为治疗此类疾病的新方法。目的:观察自体外周血干细胞移植对下肢缺血性疾病的治疗效果。方法:选择2004-09/2006-07在泸州医学院附属医院住院经下肢血管造影确诊的下肢动脉症闭塞患者14例,共23条患肢临床表现为患肢痛,冷感,间歇性跛行,皮温降低,足背动脉搏动减弱或消失,皮色发生变化及皮肤溃疡,严重者趾或足坏死破溃。采用血细胞分离机采集自身外周血单个核细胞制成干细胞混悬液,于患肢一次性按4cm×4cm间距做干细胞混悬液肌肉注射,每点注射1mL,沿缺血下肢动脉走行采取多点肌肉注射。12个月后对移植前后临床症状主观指标和辅助检查客观指标进行评估。结果与结论:自体外周血干细胞移植后12个月患者肢体疼痛、患肢冷感明显减轻,皮肤温度升高,间歇跛行距离延长。例缺血性足溃疡患者的足部创面基本愈合。9例实施了下肢血管造影检查,其中7条患肢侧支血管丰富。未见骨髓动员并发症,1例患者发生外周血单个核细胞移植并发症,患肢移植部位剧烈疼痛,所有疼痛均于移植后第3天缓解。提示自体外周血干细胞移植对于下肢缺血性疾病是一种安全、可行、可选择的治疗方式。     

血管成形与脐带干细胞移植治疗糖尿病足：3个月血管造影评价

背景：目前对糖尿病继发肢体动脉闭塞尚无有效的药物治疗,最终多导致截肢,预后很差。 目的：以血管成形联合人脐带间充质干细胞移植治疗糖尿病足,3个月后行血管造影评价效果。 方法：确诊症状严重伴有下肢动脉不同程度病变的Fontain Ⅳ期糖尿病足40例52条患肢,对照组12例患者18条患肢给予单纯介入治疗,实验组28例34条患肢给予介入联合人脐带间充质干细胞经导管灌注及溃疡周围注射治疗,随访3个月。 结果与结论：治疗后患肢冷感、疼痛、麻木等临床症状持续改善,患肢皮温、踝肱指数值及跛行距离均增加。治疗3个月后复查造影,新生血管增多,溃疡逐渐愈合或缩小,输注前后未出现严重并发症和不良反应。说明采用血管成形联合人脐带间充质干细胞移植治疗糖尿病足,方法可行、安全,近期疗效满意。     

自体外周血干细胞移植促进患者下肢动脉缺血性溃疡愈合

目的探讨应用自体外周血干细胞移植技术治疗患者下肢动脉缺血性溃疡和静息痛可行性及存在的问题。方法自2004年3月—2007年2月,16例下肢动脉缺血性溃疡及静息痛患者通过采用重组人粒细胞集落刺激因子(G-CSF)动员骨髓干细胞增殖并释放入血,在第5~6天应用血细胞分离机进行外周血干细胞的采集,并将采集到的浓集干细胞液作患肢小腿肌肉注射。结果16例患者经干细胞移植治疗后间歇性跛行时间及距离均延长,其中,12例患者静息痛均缓解;11例溃疡愈合。病人均随访3~24个月。4例失访。结论应用自体外周血干细胞移植技术治疗下肢动脉缺血性溃疡和静息痛是一种可行且有效的方法。     

48例急性动脉栓塞取栓术的配合与护理

急性动脉栓塞是源于心脏或动脉脱落的血栓式斑块等随血流向远端动脉流动,造成血管堵塞,导致肢体、脏器等组织急性缺血。发病高峰多在50～70岁,尤其是患有心血管疾病的人群,致死、致残率很高。早期诊断、及时治疗十分重要。1999年4月～2001年4月我院成功采用Fogarty导管为48例急性动脉栓塞患者行取栓术,效果满意。现将手术配合与护理介绍如下: 1 临床资料 本组48例均患有不同程度的心血管疾病,其中男29例,女19例,年龄最大82岁,最小21岁,平均年龄59.7岁。单侧下肢36例,双侧下肢5例,单侧上肢7例,48例取栓术     

血管腔内技术治疗下肢动脉硬化性闭塞症20例

目的:探讨下肢动脉硬化性闭塞症腔内治疗的临床经验。方法:采用腔内微创技术治疗下肢动脉硬化性闭塞症患者20例(24条肢体)。结果:24条肢体均成功进行球囊扩张或球囊扩张加支架置入治疗;1例治疗后第2天出现下肢急性缺血,改行人工血管搭桥术,症状改善;另1例髂动脉支架4月后再次出现下肢动脉闭塞,再次予以球囊扩张支架置入治疗,症状缓解。所有病例随访3~40月,平均22月,患者临床症状明显改善,踝肱指数(ABI)0.64±0.13。结论:腔内治疗是治疗下肢动脉硬化性闭塞症的安全、有效方法。     

动脉栓塞病人围手术期的护理

动脉栓塞是指各种来源的栓子脱落后,被血流冲向远侧,停留在直径小于栓子的动脉内,而导致肢体或内脏器官的急性缺血甚至坏死的一种病理过程。在肢体栓塞中,下肢多于上肢,尤以股动脉的发病率最高。引起栓塞动脉受累的肢体或内脏器官、心血管系统和全身的变化,为血管外科的急症,必须及时处理,处理愈早,效果愈好。动脉栓塞的主要治疗是动脉切开取栓术。我科通过对14例动脉切开取栓病人的护理,拟定出了围手术期护理常规。现报告如下。     

大剂量尿激酶治疗急性下肢深静脉血栓形成18例报告

目的:探讨大剂量尿激酶溶栓治疗急性下肢深静脉血栓形成(DVT)的临床效果.方法:本组18例DVT患者,先将0.9%的生理盐水(N.S)50 ml+尿激酶(UK)50万U,由患肢远端静脉推入,5分钟推完,然后由健肢、患肢分别将0.9%N.S 1000ml+UK 100万U持续24小时静脉滴入,1次/日,共7～10天.结果:12例痊愈,6例显效,总治愈率为100%,未出现肺梗塞、脑溢血和死亡病例.结论:急性下肢深静脉血栓形成时,应用大剂量尿激酶,能显著提高患肢血管通畅率.     

腔静脉滤器置入联合胫后静脉置管溶栓治疗急性下肢深静脉血栓形成

目的：探讨腔静脉滤器置入联合胫后静脉途径置管直接溶栓治疗急性下肢深静脉血栓形成的临床应用价值。方法：18例急性下肢深静脉血栓形成患者,先行患肢血管造影明确诊断后,在下腔静脉滤器置入的基础上采用胫后静脉置管微泵持续推注尿激酶直接溶栓治疗,对其中髂静脉狭窄5例和闭塞1例患者在拔除溶栓导管后实施髂静脉球囊扩张成形术。结果：18例患者置管溶栓治疗后症状均得到明显改善,1例术前合并肺动脉栓塞者症状消失。溶栓后的健、患侧大腿周径差及小腿周径差比治疗前明显减小,差异均有统计学意义（P〈0．001）。治疗期间,无一例围手术期死亡,无肺动脉栓塞发生,无置管处渗血或血肿形成、神经损伤等置管相关并发症发生。术后17例获随访,随访时间1～12个月,平均5个月。15例肢体肿胀基本消退、肌张力减低、恢复正常劳动力;2例活动后肢体出现轻微肿胀伴沉重感,能进行正常家务劳动;17例均未出现患肢浅静脉曲张及静脉营养性障碍。结论：腔静脉滤器置入联合胫后静脉置管直接溶栓治疗急性下肢深静脉血栓形成具有疗效好、创伤小、安全性高、适应证宽,便于护理等优点,是一种安全、有效的治疗方法。     

Atheromatous (cholesterol) embolization

A case is presented of an 89-year-old woman who died following an operation for arterial embolism of the lower limb. The autopsy histology showed acute occlusion of a stenosed sclerotic femoral artery by thrombotic and atheromatous emboli. In addition, it showed chronic cholesterol crystal embolism in multiple small arteries of abdominal organs, particularly of the kidneys. Abdominal aorta with severe ulcerated atherosclerosis appeared as the source of embolism.     

缺血性脑血管病患者血浆内皮素水平昼夜节律变化的研究

应用放射免疫法测定了３２例急性期（３天内）脑血栓患者和短暂性脑缺血发作（ＴＩＡ）患者２３例２４ｈ血浆内皮素（ＥＴ）水平变化，发现脑血栓急性期ＥＴ含量显著高于正常对照组（Ｐ＜０．００１），也明显高于ＴＩＡ组（Ｐ＜０．０１）；ＴＩＡ组明显高于对照组（Ｐ＜０．０１）。血浆ＥＴ水平２４ｈ有节律性变化，即夜间２∶００时最低，早８∶００时最高，二者有显著性变化（Ｐ＜０．０１）；有高血压、糖尿病史脑血栓患者２４ｈ内各时间段ＥＴ水平明显高于无高血压、糖尿病史者（Ｐ＜０．０５０．０１）。脑血栓患者血浆ＥＴ水平２４ｈ内节律性变化与之发病以早晨为高发时间段的现象在时间上有同步关系，可能存在着因果关系，即ＥＴ可能是导致脑血栓的原因之一     

Peripheral arterial disease--natural outcome

Three hundred and twelve patients with peripheral arterial disease were followed up for 8 3/4 years or more (maximum 11 3/4 years) to assess the natural history of the disease and factors determining its outcome. Of the 312 patients, 188 (69%) died during the follow-up, 68% of the deaths having cardiovascular causes. The 10-year relative cumulative survival rate was 0.61 for males and 0.48 for females. The role of smoking as a risk factor could not be analysed without bias. In addition to known risk factors diabetes mellitus, cerebrovascular disease and coronary heart disease, the degree of peripheral arterial disease itself also proved to be a risk factor among men. The expected life lost for men with intermittent claudication was 20%, but 44.3% for men with advanced lower limb ischaemia (p less than 0.01). This difference could not be explained by the well-known association of advanced ischaemia and diabetes mellitus. The present results therefore suggest that the state of advanced ischaemia indicates larger involvement of the whole of the arterial tree and predicts fatal cardiovascular events among these patients.     

Ⅱ型糖尿病和室间隔缺损合并脑血栓患者治疗前后血液流变学指标的检测分析

目的：探讨Ⅱ型糖尿病、室间隔缺损合并脑血栓患者血液流变学各项指标的改变情况,以及血液的宏观、微观流变特性的改变与各种疾病之间的关系,研究不同治疗方案对疾病血液流变学指标的影响。方法：采用血液流变学检测仪检测Ⅱ型糖尿病、室间隔缺损合并脑血栓患者血液流变学指标的变化,并与健康对照组、治疗后组进行比较,观察疾病发生及治疗过程对血液流变学指标的影响。结果：经过治疗后,Ⅱ型糖尿病、室间隔缺损合并脑血栓患者的血液黏度降低,血液流变学各项指标,包括全血高切粘度、全血低切粘度、血浆粘度、红细胞压积等均得到改善。结论：Ⅱ型糖尿病、室间隔缺损合并脑血栓患者的血液流变学指标均有不同程度的异常改变,是导致出现微循环障碍及多种合并症的重要原因。血液粘度的增高、红细胞变形性的恶化,都提示我们在体内肯定存在着诱发病灶,促使我们结合其他检查方法进一步确定疾病的诱因,改善异常的血液粘度学指标有助于临床疾病的治疗。     

Ⅱ型糖尿病患者情绪职能的影响因素研究

目的探讨临床Ⅱ型糖尿病患者情绪职能的影响因素,为提高该人群心理健康水平提供指导和建议。方法自拟糖尿病健康状况调查表对某医院内分泌科就诊的246例Ⅱ型糖尿病患者进行调查,并采用健康测量量表(SF-36)中情绪职能维度进行健康评价。结果单因素筛查分析发现医疗保险(t=3.896,P=0.001)、家庭关怀(t=2.021,P=0.041)、舒张压(t=2.011,P=0.046)、下肢血流(t=2.545,P=0.012)、脑血流(t=2.421,P=0.017)、周围神经病变(t=2.819,P=0.006)与型糖尿病患者的情绪职能有关;继而多元回归分析表明,影响情绪职能的主要因素为医疗保险、脑血流、周围神经病变。结论无医疗保险、脑血流障碍、周围神经病变的Ⅱ型糖尿病患者情感职能差。     

Development of argatroban as an anticoagulant and antithrombin agent in Japan

Argatroban is a synthetic direct thrombin inhibitor which has been used in Japan for three indications, namely, chronic arterial occlusion, acute cerebral thrombosis and hemodialysis in AT-deficient patients or in patients with decreased AT. In patients with chronic arterial occlusion, argatroban increased the skin temperature, reduced the size of skin ulcers, and decreased the thrombin-antithrombin complex. In patients with acute cerebral thrombosis, neuronal symptoms improved significantly compared with the placebo group, wherein activated partial thromboplastin time (aPTT) was prolonged by about 1.5-fold and fibrinopeptide A was reduced. In some patients in whom hemodialysis is difficult due to the generation of blood clots in the dialyzer, hemodialysis is now possible with the replacement of heparin by argatroban.     

Unusual forms of venous thrombosis and thrombophilia

Venous thromboembolism (VTE) results from multiple interactions between inherited and environmental risk factors. The lower limbs are the most common site of VTE, but more rarely other venous sites can be involved. The role of risk factors for VTE can be different in the various thrombotic manifestations, and there are specific risk factors for specific sites. Coagulation abnormalities causing inherited thrombophilia are frequently found in patients with cerebral vein thrombosis, but are more rare in those with "isolated" pulmonary embolism, upper limb or retinal vein thrombosis. Transient situations, such as surgery, trauma, prolonged immobilization, the use of oral contraceptives or hormone replacement therapy, and pregnancy or puerperium, are often recognized in patients with lower limb deep vein thrombosis, "isolated" pulmonary embolism, abdominal and cerebral vein thrombosis, but not in patients with upper limb deep vein thrombosis. Major risk factors for deep vein thrombosis of the upper limbs are strong efforts with the arms, whereas for abdominal vein thrombosis are myeloproliferative disorders and liver cirrhosis. In conclusion, there is increasing evidence that inherited and environmental risk factors may interact differently in determining VTE in different sites.     

Arterial reconstructive surgery and myoglobin

To assess the diagnostic value of myoglobin between elective surgery and acute arterial occlusion, serum and urine myoglobin (S-Mb, U-Mb) levels were measured before and for 7 consecutive days following arterial reconstructive surgery in 7 patients with abdominal aortic aneurysm or arteriosclerosis obliterans (elective surgery group), and in 20 patients with acute arterial occlusion due to embolism or thrombosis. They were divided into three groups based on symptoms and other features: mild, moderate, and severe groups. S-Mb and U-Mb levels were normal before surgery with a maximum of 389 ng/ml and 1,670 ng/ml after surgery in the elective surgery group, and 489 ng/ml and 11.7 ng/ml before surgery with a maximum of 703 ng/ml and 294 ng/ml after surgery in the mild cases. These two groups showed no complications after surgery. In the moderate group, high values of 2,420 ng/ml and 25,300 ng/ml were noted before surgery, and these values were elevated to 14,900 ng/ml and 175,000 ng/ml after surgery with complications of acute renal failure or peripheral nerve paresis. In the severe group, the values were 9,440 ng/ml and 260,000 ng/ml before surgery, and 160,000 ng/ml and 1,300,000 ng/ml after surgery, the elevation being associated with the severe clinical complication, myonephropathic metabolic syndrome (MNMS). All patients in this group died of MNMS. S-Mb and U-Mb levels before surgery proved useful for predicting the prognosis of patients with acute arterial occlusion. The findings obtained in our canine studies on the mechanism and treatment of MNMS suggest that alpha-tocopherol, a free radical scavenger, may be effective for treating dreadful complications such as MNMS.