经导管血管内局部溶栓治疗髂股静脉血栓形成（附13例报告）

目的 探讨经导管局部溶栓治疗髂股静脉血栓形成的安全性和有效性。方法 采用导管置于血栓部位行大剂量团注、中等量持续灌注和经患肢小剂量静脉滴注尿激酶等3方法序贯给药治疗13例髂股静脉血栓形成。经导管平均给药时间18h，尿激酶平均用量331万U。结果 髂股静脉部分开通率100％，完全开通率84．6％。临床症状明显改善．无1例发生严重并发症。结论 经导管血管内局部溶栓治疗髂股静脉血栓形成是一种安全有效的方法。     

尿激酶在介入治疗髂股静脉血栓中的合理应用

目的:探讨尿激酶在髂股静脉血栓形成溶栓治疗中的合理应用。方法:本组病例共13例,平均年龄44.6岁,平均病程23.7 d。治疗时穿刺颈内静脉,插入6F导管鞘,经导管鞘插入4F或5F直头带侧孔导管至血栓的近心端造影,换入6F导引导管进行抽吸,清除新鲜血栓;对于腹股沟以下股静脉尚通畅的患者,我们穿刺股静脉插入9F导管鞘,以7F长鞘作为抽吸导管,清除患侧髂股静脉局部新鲜血栓。在已经建立血流的髂股静脉内置入溶栓导管,并保留。在病房,经溶栓导管持续注入尿激酶进行溶栓,并以肝素抗凝治疗。结果:本组13例患者中,显效8例,有效3例,总有效率达84.6%。2例病程>2个月的病例临床治疗效果不明显。结论:成功治疗髂股静脉血栓形成的关键是早期恢复髂股静脉内的血流,并局部进行溶栓治疗。足量有效的抗凝治疗则是治疗成功的保障。     

下腔静脉滤器置入后介入治疗急性髂股静脉血栓的临床应用

目的 探讨下腔静脉滤器置入后,经腘静脉置管溶栓治疗急性髂股静脉血栓的临床应用价值.方法 17例急性髂股静脉血栓患者均经血管超声及造影证实,均在置入下腔静脉滤器后,在B超引导下行经腘静脉置入溶栓导管,采用抗凝及经溶栓导管脉冲式灌注尿激酶治疗,其中行左髂总静脉球囊扩张术4例.结果 溶栓导管平均放置时间为(5±2)d.17只...     

经导管局部溶栓治疗髂-股静脉血栓形成的护理

目的:总结经导管局部溶栓治疗髂-股静脉血栓形成的护理。方法:回顾56例经彩超或静脉造影确诊为髂-股静脉血栓形成的患者的护理要点。结果:56例患者中显效40例,有效11例,无效5例,无严重并发症和肺栓塞症发生。结论:加强对经导管局部溶栓治疗患者的病情观察及患肢护理,尤其是心理护理及健康宣教,是溶栓治疗安全有效的保障。     

导管溶栓联合支架植入术治疗急性髂股静脉血栓形成

目的比较经导管溶栓联合髂静脉支架植入与单纯导管溶栓治疗急性髂股静脉血栓形成的效果。方法选择经抗凝及导管溶栓治疗后存在严重髂静脉狭窄的急性髂股静脉血栓形成病人86例,其中32例经导管溶栓后,联合球囊扩张支架植入术开通髂静脉（观察组）;另54例单纯行导管溶栓治疗（对照组）。统计血栓消除率、肢体肿胀缓解情况及围手术期并发症;术后第3、6、12、24个月分别采用Villalta评分量表和Vcss量表评估血栓形成后综合征（PTS）发生情况及静脉临床症状严重程度。结果2组经导管溶栓治疗血栓Ⅲ级消除率达82.6%;溶栓时间、尿激酶用量、住院时间、围手术期并发症、PTS的发生率及血栓复发率差异均无统计学意义（P>0.05）;观察组膝上15 cm周径差较对照组小（P < 0.05）;随访3、6、12、24个月,观察组Villalta体征和症状评价、Vcss评分均低于对照组（P < 0.05~P < 0.01）。结论经导管溶栓治疗急性髂股静脉血栓形成血栓清除率高,联合球囊扩张支架植入术开通髂静脉有助于改善症状,提高临床治疗效果。     

30例髂-股静脉血栓形成的导管溶栓疗效分析

目的:评价经小隐静脉/腘静脉路径的溶栓导管治疗髂-股静脉血栓形成的疗效。方法:2008年8月～2009年7月,对30例髂-股静脉血栓形成患者施行了经小隐静脉/腘静脉路径的溶栓导管治疗,同时行下腔静脉滤器置放保护。结果:溶栓导管平均置放时间为(7.0±1.2)天。髂-股静脉血栓完全溶解28例(Ⅲ型),部分溶解2例(Ⅱa型1例,Ⅱb型1例),无出血、肺动脉栓塞等并发症。所有患者均获随访,随访11～21个月,所有患者治疗效果满意。结论:经小隐静脉/腘静脉路径的溶栓导管治疗髂-股静脉血栓形成是一种安全、有效的方法。     

髂-股静脉血栓形成的影像诊断与介入治疗

目的:阐明髂-股静脉血栓形成的不同影像学诊断手段,评价其介入治疗的方法与价值。方法:回顾性分析24例髂-股静脉血栓形成患者的影像诊断与介入治疗资料。24例患者均行患肢彩色多普勒影像诊断术(CDFl)检查,16例行血管造影检查,8例行MRI检查。按治疗方式分为2组:15例行静脉内导管直接灌注溶栓治疗(A组);9例行超声血栓消融结合导管直接灌注溶栓治疗(B组)。结果:经CDFI、血管造影及MRI等影像学检查均获得了明确的诊断。8只下腔静脉滤器均展开良好,无移位。24例髂-股静脉血栓形成者均治疗成功,无严重并发症发生,其中临床痊愈5例,显效10例,有效9例,愈显率为62.50%,A、B两组间无显著性差异。但A组的溶栓时间明显长于B组(P<0.05),A组的尿激酶用量明显多于B组(P<0.05)。结论:CDFI、血管造影及MRI等影像学检查的相互补充有助于本病的正确诊断。血管内介入治疗是髂-股静脉血栓形成的安全有效的治疗方法。     

下肢深静脉血栓形成的治疗策略(附50例报告)

目的探讨溶栓、抗凝、祛聚和扩张血管等综合治疗及置下腔静脉滤器且行经导管溶栓治疗下肢深静脉血栓形成（DVT）的疗效.方法对25例周围型DVT患者行溶栓、抗凝、祛聚和扩张血管综合治疗;对15例髂股静脉血栓及10例髂外至腘静脉血栓,因其完全阻塞血流,利用血管腔内技术先行下腔静脉滤器置入术后,于静脉腔内将导管插入血管内行局部溶栓治疗.结果共治愈32例,其中包括经溶栓导管直接灌注溶栓治疗中央型血栓15例及混合型血栓10例;经外周静脉溶栓7例;显效12例（经外周静脉溶栓）;有效6例（经外周静脉溶栓）.结论对周围型DVT患者应行溶栓、抗凝、祛聚和扩张血管综合治疗;对中央型血栓及混合型血栓患者应及时行下腔静脉滤器置入后行经导管溶栓.     

顺行法保留溶栓导管治疗下肢深静脉血栓

目的:探讨经腘静脉/胫后静脉顺行保留溶栓导管治疗下肢深静脉血栓的可行性及疗效?方法:59例单侧下肢深静脉血栓患者,左侧46例,右侧13例?起病时间0.5~21.0天,平均5.9天?采用超声多普勒或X线透视引导技术,穿刺患侧腘静脉/胫后静脉?放置下腔静脉滤器后,留置溶栓导管于髂股静脉血栓近心端,溶栓治疗3~7天,平均5.6天?合并髂/股静脉明显狭窄者结合球囊扩张技术?术后3~7天造影复查血管通畅度及调整溶栓导管留置水平?术后随访包括患肢周径?血栓复发和相关并发症等?结果:术前经超声引导下腘静脉穿刺52例,透视监视引导下穿刺7例,穿刺成功率100%?尿激酶总用量300 000 0~500 000 0 U?患肢肿胀于溶栓后第2~3天开始消减,第7天完全消退47例(79.7%),部分消退12例(20.3%)?38例辅助球囊扩张技术,髂/股静脉7天通畅率84.2%(32/38);21例单纯保留导管溶栓,髂/股静脉7天通畅率61.9%(13/21)?11例髂总静脉主干未复通,盆腔侧枝循环均开放充分?随访3~12个月,均无症状性复发,无肺动脉栓塞?脑出血等并发症?结论:顺行法保留溶栓导管治疗下肢深静脉血栓,总体疗效优良,技术操作相对简单,无严重并发症,是下肢静脉溶栓治疗的有效方法?     

逆行置管溶栓治疗急性髂股静脉血栓形成的对照研究

目的探讨经健侧股静脉穿刺逆行置溶栓导管治疗急性髂股静脉血栓形成的效果。方法对27例B型超声明确诊断为急性髂股静脉血栓患者,分为经对侧股静脉穿刺逆行置管溶栓组(A组)12例和全身静脉溶栓组(B组)15例。对2组患者患肢周径缩小值、远期瓣膜功能进行观察比较。结果治疗14d下肢周径缩小值,A组为(3.4±0.8)cm,B组为(2.8±0.8)cm,差异无统计学意义(P>0.05);治疗6个月后,经光电容积描记法(PPG)评价深静脉瓣膜功能,A组静脉充盈时间(VRT)为(22.2±3.5)s,B组为(16.6±4.1)s,差异有统计学意义(P<0.05)。结论经健侧股静脉穿刺置溶栓导管治疗急性髂股静脉血栓形成可有效改善深静脉瓣膜功能,降低静脉血栓后遗症发生率。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.