经导管溶栓治疗血栓闭塞性动脉炎

目的：探讨经导管溶栓治疗血栓闭塞性动脉炎的可能性。材料与方法：经健侧股动脉穿刺插管，将端孔直头导管紧靠阻塞近端，15分钟内注射25万单位尿激酶，再一小时内加压滴注25万单位尿激酶。在超滑导丝的作用下，将多侧孔灌注导管头及侧孔埋入血栓内，4小时加压滴注25万单位尿激酶。超滑导丝在血栓阻塞段来回缓慢拉动，保留导管或患肢动脉直接注入尿激酶。结果：9例患者经介入溶栓治疗后，8例血管再通，痊愈出院，1例合并静脉血栓，消化道出血，保留导管治疗后，阻塞端下移。结论：经导管溶栓治疗血栓闭塞性动脉炎安全有效、成功率高，特别适用于急性血栓形成。     

介入溶栓疗法治疗下肢动脉血栓10例分析

目的评估介入溶栓法治疗下肢动脉血栓的临床应用价值。方法 10例确诊为下肢单发动脉血栓的患者,首先使用Seldinger技术明确患肢血栓部位、范围及栓塞的程度,后采用逐层溶栓的方法进行溶栓,术后留置导管,并继续用微量泵尿激酶均速滴注,72 h后造影并拔除导管。结果 8例当时即获完全复通,2例回病房后继续使用尿激酶72 h后经复查动脉造影证实完全溶通。所有病例均未出现出血、再灌注损伤等并发症。结论介入溶栓治疗下肢动脉血栓简便、安全、可靠、有效。     

应用溶栓导管治疗急性下肢动脉血栓形成的效果观察与护理

目的 探讨应用溶栓导管溶栓治疗急性下肢动脉血栓形成的效果及护理方法.方法 对26例急性下肢动脉血栓患者介入下股动脉穿刺血栓内置入溶栓导管,通过术中脉冲推注尿激酶及协同术后经溶栓导管微量泵持续泵入尿激酶溶栓,术后加强溶栓导管的护理及患肢血运的观察.结果 11例术中完全开通,9例48 h内复通,6例部分溶通,但血栓平面均有所下降,症状明显改善.结论 介入置入溶栓导管治疗急性下肢动脉血栓是有效的.     

导管溶栓治疗29例下肢深静脉血栓的护理体会

目的观察尿激酶导管溶栓治疗下肢深静脉血栓的疗效及护理措施和要点。方法回顾性总结29例患者通过导管溶栓治疗下肢深静脉血栓的围术期的护理。结果29例患者利用导管直接尿激酶泵入血栓内溶栓治疗后患肢肿胀、疼痛感消失,无1例发生肺栓塞、出血情况。结论尿激酶导管溶栓治疗下肢深静脉血栓患者给予健康宣教,心理护理,密切观察病情,妥善固定导管,使用溶栓药的护理,预防感染的护理,可提高溶栓成功率,减少并发症的发生,有助于患者恢复。     

超选择性动脉内溶栓治疗急性脑梗塞

目的超选择性动脉插管将高浓度的溶栓剂直接注入血栓部位早期溶栓以达到溶栓的最佳效果。材料与方法42例发病在6h内的急性脑梗塞患者，采用Seldinger技术将微导管超选择插至闭塞血管近端或血栓内注入尿激酶(UK)进行溶栓治疗。结果溶栓后脑血管造影显示：血管完全再通12例，部分再通27例，无变化3例。结论超选择性动脉导管溶栓治疗急性脑梗塞是一种较安全有效的方法。     

经导管动脉溶栓治疗急性脑梗死的临床观察

急性脑梗死是致残率颇高的疾病,早期治疗至关重要,采用超选择性动脉溶栓具有快捷、准确、安全的特点优越于常规采用静脉治疗,我院采用了经微导管超选择性插管动脉内灌注尿激酶溶栓治疗急性脑梗死35例,取得较好疗效,现报告如下.     

急性缺血性脑卒中动脉内接触性溶栓治疗

目的 探讨急性缺血性脑卒中患者动脉内接触性溶栓的治疗疗效。方法 回顾性分析27例急性缺血性脑卒中患者，左侧颈内动脉系统闭塞14例，右侧颈内动脉系统闭塞13例，治疗前头部CT检查均除外脑出血，将微导管导丝系统送人血栓部位，经微导管注入尿激酶，或将微导丝轻柔地穿过血栓，将微导管放在血栓内注入尿激酶溶栓治疗。结果 治疗后27例患者16例血管完全再通，临床症状恢复满意。7例部分再通，临床症状部分恢复。2例血管影像学及临床症状无变化。TLA反复发作2例，脑血管造影未见异常，溶栓后瘫痪肢体即恢复正常活动。结论 急性缺血性脑卒中动脉内接触性溶可使闭塞血管再通，缺血脑组织得以再灌注。对急性脑血管闭塞患者应尽早行脑血管造影，明确血管闭塞部位，动脉内接触性溶栓对本病治疗是有效的。     

经导管动脉溶栓治疗急性脑梗死的临床观察

急性脑梗死是致残率颇高的疾病，早期治疗至关重要，采用超选择性动脉溶栓具有快捷、准确、安全的特点优越于常规采用静脉治疗，我院采用了经微导管超选择性插管动脉内灌注尿激酶溶栓治疗急性脑梗死35例，取得较好疗效，现报告如下。     

大剂量尿激酶溶栓治疗内瘘血栓形成

目的探讨外周和经皮穿刺股动脉导管注入尿激酶对动静脉内瘘血栓形成的治疗效果.方法对16例内瘘血栓形成的患者分别进行了外周溶栓和股动脉插管溶栓治疗.方法是12例患者于内瘘的动脉端穿刺后输注尿激酶,4例患者在DSA下经动脉插管至血栓部位,灌注尿激酶,尿激酶用量为75～100万IU,外周溶栓输注时间为3～4小时,导管溶栓时间为45～60分钟.结果 12例外周溶栓患者再通6例,外周溶栓成功率为50%,6例失败,其中4例进行了插管溶栓,3例成功,1例失败,成功率为75%,再通后的内瘘次日可行血液透析,并随访了6～44个月,情况良好.结论尿激酶局部输注治疗内瘘血栓形成是安全有效的,可以作为首选的治疗措施.     

下肢动脉血栓栓塞的介入治疗及护理体会

下肢动脉血栓栓塞常见。急性动脉血栓形成起病突然,发展迅速,主要表现为5“P”征犤1犦,若处理不当,可造成患肢坏疽,甚至截肢,给患者的身心健康造成极大的影响。以往采用手术取栓或静脉溶栓,并发症多,效果不满意。我院对8例下肢动脉血栓栓塞患者采用动脉插管经导管滴注脲激酶等溶栓药物溶栓,成功率高,且无严重并发症,值得推广。1资料与方法1.1临床资料我院自1998年6月～2001年9月利用PHILIPS数字减影系统,对8例下肢动脉血栓栓塞患者采用经导管灌注并保留导管缓慢滴注脲激酶溶栓,其中男5例,女3例;最大年龄84岁,最小年龄52岁,平均65岁;就诊…     

Methods of arterial site skin preparation and dressing

Before an arterial line is inserted, the skin at the site is prepped typically with the traditional iodophor-based preps. The arterial site is then covered with an occlusive dressing. When arterial lines are maintained for even a few days, it is not uncommon that some form of complication develops at the arterial site, such as redness, inflammation, positional problems, or even infection. Unfortunately, due to the nature of this traditional preparation and dressing method, the site is obscured constantly and complications are not always detected before a resulting infection occurs. This prospective study was designed to examine the efficiency and effectiveness of a new transparent prep, used with a transparent dressing at the arterial site. Sixty patients' arterial line sites were evaluated to determine the incidence of complications of the two arterial site prep and dressing methods. The effectiveness that the dressings may serve in securing the arterial lines in place was also evaluated. There were no complications in this study directly related to either skin preparation or dressing method, thus, there were no statistically significant differences. However, the transparent prep and transparent dressing method provided constant visual access to the arterial site and required fewer steps, clearly significant advantages not provided by the traditional method.     

彩色多普勒超声对上肢动脉病变的诊断价值

目的 探讨彩色多普勒超声对上肢动脉病变的诊断价值：方法 对我院2001年2月至2003年8月期间200例拟诊为上肢动脉疾病患者的彩色多普勒超声检查结果进行总结。结果 检出上肢动脉疾病57例，阳性率为28．5％，疾病种类包括动脉硬化斑块、动脉扭曲、多发性大动脉炎、胸廓出口综合征、肢端动脉痉挛病(雷诺氏病)、动脉瘤、急性动脉栓塞和锁骨下动脉盗血综合征。其中，以动脉粥样硬化病变常见；结论 彩色多普勒超声对上肢动脉病变的诊断和鉴别具有准确性和实用性．     

Course of peripheral occlusive arterial disease in diabetes. Vascular laboratory assessment

To determine comparative rates of development and progression of peripheral occlusive arterial disease, 110 healthy nondiabetic control subjects, 112 patients with peripheral occlusive arterial disease (POAD), 240 patients with diabetes mellitus (DM), and 100 patients with diabetes mellitus and peripheral occlusive arterial disease (DM + POAD) were studied over 4 yr with noninvasive techniques. The presence of peripheral occlusive arterial disease was determined by postexercise ankle-brachial index (ABI) values; progression of peripheral occlusive arterial disease was determined by the rate of change in postexercise ABI. Patients who underwent peripheral arterial reconstructive surgery or amputation were also classified as having progression of their peripheral occlusive arterial disease. On this basis, follow-up revealed that peripheral occlusive arterial disease developed and therefore progressed in 1 (1%) of the control group and 22 (9%) of the DM. Peripheral occlusive arterial disease progressed in 31 (28%) of the POAD and 26 (26%) of the DM + POAD. The presence of peripheral occlusive arterial disease predisposes to progression of disease, and peripheral occlusive arterial disease is more likely to develop in diabetic patients who do not have peripheral occlusive arterial disease than in nondiabetic control subjects. However, the presence of diabetes mellitus in patients with peripheral occlusive arterial disease does not seem to increase the risk of progression.     

多层螺旋CT血管成像诊断四肢动脉损伤的初步研究

目的探讨64层螺旋CT血管成像后处理图像结合轴位图像对四肢动脉损伤的诊断价值。方法收集21例四肢动脉损伤患者的下肢或上肢动脉多层螺旋CT血管成像（MSCTA）资料进行回顾性分析,总结其影像学表现,并与手术所见进行对照。结果本组病例中动脉断裂5例,其中1例显示有血栓形成;动脉闭塞4例,均有血栓形成;动脉狭窄2例,其中1例为外压性,另1例为血栓形成所致;假性动脉瘤形成9例,均有血栓形成;动静脉瘘1例。14例患者进行了血管探查手术,MSCTA对于血管损伤和假性动脉瘤的诊断与手术所见完全符合,而对动脉血栓显示的准确率为71.4%。结论MSCTA对于创伤性血管损伤的诊断具有很高的准确性,可推广用于创伤患者血管损伤的筛查。     

Doppler ultrasound diastolic flow analysis for the early identification of peripheral arterial disease.

OBJECTIVE: The viscoelastic mechanical compliance properties of the human arterial system were examined in 100 subjects with A-mode Doppler ultrasound diastolic flow analysis. This technique of diastolic flow analysis is utilized to identify early atherogenic peripheral arterial disease. The sensitivity of the commonly utilized standard traditional ultrasound pressure-grade pneumatic cuff examination will be increased when accompanied by the diastolic flow analysis technique. SETTING: Diastolic flow analysis will aid in the early identification of lower extremity vascular claudication when lumbar spinal canal stenosis and elevated cardiovascular risk factors are present. This examination may be performed in the office setting with standard A-mode Doppler ultrasound equipment along with the usual pneumatic cuff procedure. The standard ultrasound cuff examinations are based on pressure gradients to identify lower extremity arterial disease. The low level of sensitivity of this test requires arterial obstruction of at least 50% to be present before positive identification is possible. Pathological alterations of the arterial wall occur during the early stages of atherosclerotic disease, are reflected by reduced wall distensibility and may be quantified by Doppler ultrasound. SUBJECTS: Studied were a total of 100 subjects, 50 with arterial disease risk factors and 50 normal controls. All subjects were screened for aortic coarctation, myocardial infarction, tachyarrhythmia, aortic value stenosis and mitral prolapse. The risk group subjects were all smokers and had a mixed distribution of hypertension, hypercholesterolemia and hyperglycemia. The commonly utilized standard traditional ultrasound pneumatic cuff examination was negative in all subjects. Anthropometric measurements and percent body fat were also obtained. Arterial diastolic antegrade flow analysis was performed with Doppler ultrasound on each subject. RESULTS: This study demonstrated that the elevated vascular risk factor group had a mean arterial distensibility measurement of 4.4 +/- 5.0%, and the control group displayed a mean measurement of 20.0 +/- 6.0%. The 50 elevated risk factor subjects showed approximately 5 times greater arterial stiffness and were identified with significance at an F test level of (p less than .001). CONCLUSION: This arterial compliance evaluation procedure is shown to be a reliable sensitive indicator of early atherosclerotic disease prior to the development of obstructive arterial lesions.     

Noninvasive mapping of lower limb arterial lesions

Thirty patients with peripheral arterial disease were evaluated using an ultrasonic duplex scanner. A total of 338 arterial segments from the level of the iliac to the popliteal artery were studied and compared with the results of arteriography read independently by two radiologists who were unaware of the results with the scanner. The results demonstrate that this method is not only suitable for clinical use but is as good as arteriography in defining both the location and extent of the arterial involvement.     

预防性切开减压在急性下肢动脉栓塞取栓术中的应用

目的 观察预防性切开减压在急性下肢动脉栓塞取栓术中的应用效果。方法 回顾性分析2016年1月至2021年12月间皖南医学院附属弋矶山医院17例取栓术中行预防性切开减压处理急性下肢动脉栓塞患者的临床资料,观察其有效性和安全性。结果 17例患者均成功接受预防性切开减压,平均随访时间12个月,13例患者痊愈,2例轻度下肢感觉或运动功能障碍(不影响日常生活),2例重度下肢感觉或运动功能障碍(影响日常生活但未坏死),无坏死或截肢。切口愈合方面,1例自行愈合无需缝合,10例二期清创缝合,6例一期术中预留缝线,延期闭合减压切口,无患者需植皮或截肢。结论 对急性下肢动脉栓塞取栓患者预防性切开减压具有较好的安全性和有效性。     

伴发血小板减少症的下肢动脉栓塞围手术期治疗

目的：探讨伴发血小板减少症的下肢动脉栓塞围手术期的治疗。方法：回顾性分析2008-12-2011-10期间手术取栓的5例伴发血小板减少症的下肢动脉栓塞患者的临床资料。结果：5例患者均手术成功,无创面渗血。1例取栓后急性肾功能不全;2例患者再次动脉栓塞后肢体坏死截肢。随访18个月（4个月～27个月）,1例19个月后死于晚期胃癌,其余病例生活状态良好。结论：血小板减少不是急诊动脉取栓手术的绝对禁忌症;根据具体的情况调整治疗方案,创造条件尽早手术是十分重要的。     

叶间动脉血流动力学参数对慢性肾疾病的早期诊断价值

目的 探讨彩色多普勒超声检测叶间动脉血流动力学参数对慢性肾疾病(chronic kidney disease,CKD)的早期诊断价值.方法 运用彩色多普勒超声对78例CKD患者和65例健康人的叶间动脉进行超声检查,测量收缩期峰值流速(PSV)、舒张末期血流速度(EDV)、搏动指数(PI)、阻力指数(RI),同时进行血清...     

肝动脉灌注化疗和栓塞治疗肝癌（附72例报告）

目的 分析经导管肝动脉灌注化疗（HAI）和栓塞（HAE）治疗肝癌的疗效。方法 72例中晚期肝癌均采用经导管肝动脉化疗栓塞术。结果 6个月、1年和2年生存率分别为75％、58．3％和20．8％。结论 经导管肝动脉化疗栓塞术是治疗肝癌的有效方法。