Angiojet清栓联合髂静脉腔内成形一期治疗急性下肢深静脉血栓合并髂静脉压迫综合征的疗效分析

目的探讨Angiojet机械清栓联合髂静脉腔内成形一期治疗急性下肢深静脉血栓形成(DVT)合并髂静脉压迫综合征(IVCS)的有效性和安全性。方法回顾性分析2016年6月至2017年7月我科采用Angiojet机械吸栓,辅助尿激酶溶栓(PCDT)及选择性导管吸栓,并一期髂静脉球囊扩张、支架植入等腔内成形术治疗急性下肢DVT伴IVCS 18例患者,所有患者术前均植入下腔静脉临时滤器,术后取出。术后1、3、6、12个月门诊随访,彩超或下肢静脉CT复查深静脉及支架血流通畅情况。结果深静脉血栓中央型7例,混合型11例;技术成功率100%,手术时间平均(105.32±25.46)分钟;血栓抽吸时间108~480秒,平均(301.24±56.52)秒。血栓清除率Ⅲ级14例,Ⅱ级4例。1例滤器捕获血栓,无症状性肺栓塞、严重出血等并发症发生。术后均出现一过性血红蛋白尿。平均随访(5.56±2.78)个月,2例Ⅱ级清栓患者术后1个月内股静脉不完全栓塞(1例抗凝好转,另1例复发血栓再次手术),1例肿瘤患者半年后髂静脉支架闭塞,余15例下肢深静脉及髂静脉支架内血流通畅。结论急性下肢DVT合并IVCS患者,Angiojet清栓同期联合髂静脉腔内成形治疗方法高效、安全,对于血栓负荷大、管壁残留血栓明显的患者建议辅助导管溶栓治疗。     

腔内治疗左髂静脉受压综合征并急性髂-股静脉血栓形成临床分析

目的探讨腔内治疗左髂静脉受压综合征(IVCS)并急性髂-股静脉血栓形成(I-FVT)的临床疗效及安全性。方法 2014年10月至2015年12月新疆自治区人民医院血管外科明确诊断为左IVCS并急性I-FVT的22例患者,均接受导管溶栓(CDT)联合球囊扩张及支架植入等腔内治疗。结果 22例均成功实施腔内治疗,患肢肿胀改善有效率为95.5%,溶栓有效率达91%,支架植入有效率100%。治疗期间仅有1例实施再次溶栓治疗,无大出血及症状性肺栓塞发生。15例患者获得随访,随访时间6个月,随访中1例血栓复发堵塞支架,进行干预后痊愈。结论腔内治疗左IVCS并急性I-FVT的临床疗效显著,是一种安全、有效的方法 ,且近期随访效果良好。     

支架置入对接触性导管溶栓治疗下肢深静脉血栓形成合并髂静脉受压综合征疗效的影响

目的 探讨支架置入对接触性导管溶栓(CDT)治疗下肢深静脉血栓形成(DVT)合并髂静脉受压综合征(IVCS)疗效的影响.方法 收集2015年1月至2020年1月于雅安市中医医院接受CDT治疗的49例急性下肢DVT合并IVCS的患者临床资料,根据术中支架置入情况分为观察组(n=37,置入支架)和对照组(n=12,未置入支...     

腔内血管成形术治疗髂静脉压迫综合征患者的临床疗效及影响因素分析

目的 探讨腔内血管成形术治疗髂静脉压迫综合征(IVCS)患者的临床疗效,并分析影响治疗效果的影响因素.方法 收集2015年8月至2019年8月承德市中心医院收治的124例IVCS患者的临床资料.依据治疗方式不同分为球囊扩张组(n=56)和血管成形术组(n=68),球囊扩张组患者接受球囊扩张治疗,血管成形术组患者接受腔内...     

腔内治疗髂静脉受压综合征的疗效分析

目的:探讨腔内治疗髂静脉受压综合征(IVCS)的疗效。方法:回顾性分析2014年1月—2015年12月收治的244例腔内治疗的IVCS患者临床资料。结果:全组无手术死亡,1例患者左髂静脉完全闭塞,放弃腔内治疗,技术成功率99.6%(243/244)。243例患者中94例行单纯球囊扩张,149例行球囊扩张联合支架植入术,175例合并下肢静脉曲张者行二期手术治疗。224例随访3~27个月,期间患者静脉曲张无复发,左下肢肿胀均得到不同程度缓解,总有效率达100%;63例皮肤色素沉着得到不同程度减退,30例静脉性溃疡患者得到愈合或缓解。单纯球囊扩张患者与球囊扩张联合支架植入患者的左下肢肿胀完全缓解率、溃疡完全愈合率、髂静脉再狭窄或血栓形成率在术后6个月时均无统计学差异(96.0%vs.99.0%、84.6%vs.100.0%、5.3%vs.2.0%,均P0.05),但术后12、24个月时,后者均明显优于前者(70.0%vs.96.0%、61.5%vs.94.1%、12.8%vs.2.0%;60.9%vs.94.8%、53.8%vs.94.1%、23.5%vs.2.1%,均P0.05)。结论:腔内治疗IVCS具有良好的近、中期疗效。联合支架植入的中期疗效优于单纯球囊扩张。选择合适的支架类型、支架直径、支架长度;精确合理地定位支架;规律足量的抗凝治疗,对于保证远期疗效具有重要作用。     

髂静脉受压综合征的支架治疗

目的评估支架治疗髂静脉受压综合征(IVCS)的临床疗效。方法回顾性分析2008年1月至2013年3月本院67例行支架治疗的IVCS患者的临床资料,合并急性下肢深静脉血栓形成(DVT)52例,施行导管溶栓后存在髂静脉受压的患者植入支架;合并慢性下肢静脉高压15例,直接植入支架。手术前后测支架两端压差,以及患肢大小腿与健肢周径差。术后1、6个月及1、2、3、5年采用多普勒超声检查随访。结果 67例患者共植入支架79枚,直径10~14mm,长度40~100(平均89.7)mm;52例急性病例采用导管溶栓,使用尿激酶量125万~590万(平均297万)U,使用时间2~6(平均2.9)天。支架两端压力差治疗前后比较,差异有统计学意义[(6.23±3.46)cmH2O vs(1.53±1.73)cmH2O,P0.001]。手术前后大、小腿患肢与健肢周径差比较,差异均有统计学意义[(6.13±2.63)cm vs(1.25±1.49)cm;(4.16±2.11)cm vs(1.43±1.13)cm,P0.001]。术后1、6个月及1、2、3、5年通畅率分别为97.0%、92.5%、86.6%、85.1%、83.6%及82.1%。5例(7.5%)患者术后穿刺点渗血,加压包扎后痊愈。无全身大出血、支架断裂及移位等并发症。随访2~61(平均45.0)个月,4例患者下肢轻度肿胀,4例有沉重感,PTS发生率为11.9%(8/67)。结论导管溶栓治疗IVCS合并急性DVT安全有效,支架治疗IVCS疗效满意。     

AngioJet在下肢动脉血栓栓塞性疾病治疗中应用

目的:探讨使用AngioJet治疗下肢动脉血栓栓塞性疾病的临床效果并总结初步经验。方法:回顾性分析2016年8月―2017年7月复旦大学附属中山医院血管外科使用AngioJet血栓抽吸系统治疗10例下肢动脉血栓栓塞性疾病患者(急性下肢动脉栓塞3例,下肢动脉硬化性闭塞症基础上急性血栓形成5例,原发性血栓形成2例)的临床资料。结果:该10例(平均年龄61.60岁)手术均通过单独使用AngioJet或AngioJet联合其他方法获得成功,技术成功率100%。其中2例AngioJet抽吸后狭窄消失,6例患者使用AngioJet抽吸后有残余狭窄结合球囊扩张,2例抽吸后有残余狭窄结合球囊扩张+支架成形。由于抽吸后有残余血栓存在,3例行AngioJet吸栓+球囊扩张者和1例AngioJet吸栓+球囊扩张+支架植入者辅以喷药溶栓,1例行AngioJet吸栓+球囊扩张者和1例AngioJet吸栓+球囊扩张+支架植入者辅以置管溶栓(CDT)。术后平均住院(3.9±2.33)d,患者术后踝/肱指数较术前明显提高(0.84 vs.0.37,P0.05)。术后1例出现血尿,1例出现轻度肾功能损害。疗效评估结果为痊愈6例,良好4例。目前7例患者完成了6个月随访,无肢体缺血加重情况。结论:对于急性下肢动脉血栓栓塞性疾病,使用AngioJet导管抽吸血栓安全、有效、创伤小。较为适合于股腘段血栓栓塞性病变,吸栓后残余狭窄明显可结合球囊扩张或支架植入,抽吸血栓效果不佳的可辅以CDT。     

腔内介入治疗髂静脉受压综合征

目的评价腔内介入技术治疗髂静脉受压综合征(IVCS)的疗效。方法对2007年3月~2012年3月我科收治行腔内介入治疗的87例IVCS患者的临床资料进行回顾性分析。结果 87例患者均进行腔内介入治疗,技术成功率为98.9%(86/87),77例(88.5%)行髂静脉球囊扩张联合支架植入术,9例(10.3%)行髂静脉球囊扩张术。7例(8.0%)合并急性深静脉血栓形成者行下腔静脉滤器置入联合导管溶栓术,65例(74.7%)合并浅静脉曲张患者行曲张浅静脉腔内激光治疗术。术中及术后无严重并发症发生。平均随访25.5(2~67)个月,治疗后第24个月髂静脉通畅率为100%,溃疡愈合率为85.7%,下肢肿胀缓解率为75.6%,无浅静脉曲张复发及深静脉血栓形成。结论腔内介入治疗是一种安全、有效的微创手段,可作为治疗IVCS的首选方法。     

急性髂股静脉血栓形成的介入治疗

目的 探讨介入技术在急性髂股静脉血栓治疗中的应用价值.方法 回顾性分析2006年1月至2009年10月我院32例急性髂股静脉血栓形成患者综合介入治疗的临床资料.采用彩色超声多普勒引导下经腘静脉穿刺置管溶栓联合髂静脉支架植入治疗,静脉造影评价静脉通畅程度.结果 32例均行临时性下腔静脉滤器植入术,在彩色超声多普勒引导下经腘静脉穿刺置管溶栓;27例行球囊扩张及髂静脉支架植入术,放置支架29枚,其余5例单纯行球囊扩张术;术后患肢临床症状明显减轻或消失,未出现肺动脉栓塞,经腘静脉溶栓后经导管静脉造影见髂静脉再通率为40%～90%,平均60%,股静脉再通率为50%～80%,平均70%,32例随访2～45个月,平均16个月,27例髂静脉支架植入髂静脉通畅率为100%,5例行球囊扩张术患者中,1例髂静脉完全闭塞,4例髂静脉再通率为20%～30%.结论 经腘静脉置管溶栓联合髂静脉支架植入术是治疗急性髂股静脉血栓的有效方法,创伤小、恢复快、安全、疗效肯定.     

改良式球囊血栓抽吸术治疗急性下肢深静脉血栓

目的探讨采用改良式球囊血栓抽吸术配合腘静脉入路深静脉置管溶栓治疗下肢深静脉血栓(DVT)的技术、方法和疗效。方法对76例DVT患者采用改良式球囊血栓抽吸术配合经皮腘静静脉穿刺深静脉置管溶栓治疗(治疗组),对137例急性期DVT患者采用患肢足背静脉溶栓方法治疗(对照组),比较两组患者的疗效。结果治疗组,76例患者的治疗效果满意,技术成功率100%,治疗前后血管周径差差异有统计学意义(t=2.91,P0.01),血管通畅率90.79%(69/76),并发症发生率15.79%(12/76);对照组治疗前后血管周径差差异有统计学意义(t=2.21,P=0.03),血管通畅率59.85%(82/137),并发症发生率24.82%(34/137)。结论采用改良式球囊血栓抽吸术联合腘静静脉入路深静脉置管溶栓技术治疗DVT是一种安全、有效的方法,且疗效满意。     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.     

Immunomodulation in Transplantation with Photopheresis

Abstract: Photopheresis is a technique in which peripheral blood mononuclear cells, in the presence of a photoacti-vatable compound, are exposed extracorporeally to ultraviolet A light and reinfused, inducing a host autoregula-tory immune response. Experimental work and ongoing clinical studies are helping to define the role of this novel, safe, and non-toxic immunomodulating technology in the field of transplantation.