介入性腔内机械性血栓碎吸及溶栓术治疗周围动脉急性血栓栓塞

目的探讨介入性腔内机械性血栓碎吸和局部溶栓术治疗周围动脉急性血栓栓塞的临床效果和应用价值。方法124例周围动脉急性血栓性阻塞患者接受DSA检查和介入性腔内机械性血栓碎吸联合局部溶栓术治疗。结果全组总的介入治疗成功率97.58%（121/124）。血管完全开通率82.26%（102/124）,部分开通率15.32%（19/124）,无效率2.42%（3/124）。部分开通的19例辅以PTA联合内支架植入术后血管完全开通。并发症发生率6.45%（8/124）。结论介入腔内机械性血栓碎吸和局部溶栓治疗周围动脉急性血栓闭塞疾病,疗程短、成功率高、疗效显著、并发症少,恰当辅以PTA和内支架植入可显著提高治疗成功率。     

多种介入技术联合治疗周围动脉闭塞性疾病

目的探讨腔内溶栓、血栓碎吸、经皮血管成形(percutaneous transcathete angioplasty,PTA)和经皮血管内支架成形术(percutaneous transtuminl angioplasty and stenting,PTAS)联合治疗周围动脉闭塞性疾病(pe-ripheral arterial obliterans disease,PAOD)的临床效果和应用价值。方法选取1994年5月至2008年5月期间在我院接受介入治疗的285例PAOD患者,其中63例急性动脉血栓性闭塞行血栓碎吸+腔内溶栓,61例动脉狭窄合并急性血栓闭塞行腔内溶栓+PTA,161例慢性动脉狭窄阻塞行腔内溶栓+PTA+PTAS。结果介入治疗有效率为98.25%(280/285)。腔内溶栓+血栓碎吸成功率为96.83%(61/63),血管完全开通者达88.89%(56/63),部分开通者占7.94%(5/63),无效者占3.17%(2/63);腔内溶栓+PTA成功率为85.25%(52/61),9例辅以内支架置入治疗均获得成功;PTA+PTAS成功率为98.14%(158/161)。并发症发生率为7.02%(20/285),其中腔内溶栓+血栓碎吸5例,腔内溶栓+PTA9例,PTA+PTAS6例。结论多种介入技术联合治疗周围动脉急、慢性闭塞疾病,可使闭塞血管得到长期有效的开通,显著提高血流动力学指标,是安全、有效的治疗方法。     

血管内血栓的介入性局部溶栓治疗

目的 探讨血管内血栓的介入性局部溶栓治疗效果和临床应用中有关问题。方法 对１８例血管阻塞性病变进行新进性脉冲－喷射血管内局部溶栓治疗。尿激酶１００００Ｕ／ＭＬ，剂量１００００Ｕ／分钟，总量３０～８０万Ｕ，平均３８万Ｕ。结果 阻塞血管完全开通１４例（７７．８％）部分开通２例（１１．１％）无效２例（１１．１％）平均溶栓时间２．８小时，结论 血管内血栓的介入性局部溶栓治疗效果显著。     

介入溶栓联合取栓术治疗肠系膜上动脉血栓20例

探讨介入溶栓联合取栓术治疗肠系膜上动脉血栓疗效。20例肠系膜上动脉血栓患者采用经皮肠系膜上动脉插管溶栓+8 F导引导管或导管鞘取栓+留置导管微量泵溶栓治疗。血管开通18例,治愈率90%;2例治疗失败,转为外科手术。介入溶栓联合取栓术治疗肠系膜上动脉血栓疗效肯定,早期发现并及早治疗能够获得较好疗效。     

下肢深静脉血栓的介入治疗

目的探讨下肢深静脉血栓（LEDVT）介入治疗的效果。方法237例LEDVT患者接受下肢静脉造影和介入性治疗,其中102例植入永久下腔静脉滤器（IVCF）,11例植入临时IVCF;151例血管内留置导管溶栓;86例导管血栓碎吸基础上导管溶栓;26例股、髂静脉单纯PTA,37例并支架植入。结果介入治疗有效率97.89%,肺栓塞（PE）13例,经介入溶栓均抢救成功。结论经皮经腔介入治疗LEDVT疗效较好。使用插管溶栓、机械性血栓碎吸等个体化组合应用可提高成功率、降低并发症率。     

肢体军训伤后继发动脉血栓形成的导管接触性溶栓治疗

目的探讨应用导管接触性溶栓(CDT)治疗肢体军训伤后继发动脉血栓形成的临床效果。方法回顾性分析2005年3月至2013年3月收治的43例肢体军训伤后继发动脉血栓形成患者应用CDT治疗的临床资料。根据Rutherford分级:Ⅰ级1例,Ⅱa级23例,Ⅱb级15例,Ⅲ级4例。单纯应用CDT 22例,CDT+腔内球囊扩张成形(PTA)17例,CDT+PTA+支架植入4例。结果本组导管溶栓时间为1~7天,平均(3±2)天。治愈32例(74.4%),Ⅰ级1例,Ⅱa级21例,Ⅱb级9例,Ⅲ级1例;其中单纯CDT 22例,CDT+PTA 6例,CDT+PTA+支架植入4例。有效11例(25.6%),Ⅱa级2例,Ⅱb级6例,Ⅲ级3例;均施行CDT+PTA治疗。2例(4.7%)溶栓过程中发生二次栓塞予调整导管位置后继续溶栓,5例(11.6%)溶栓过程中发生小腿骨筋膜室综合征行骨筋膜室切开减压术,均保趾、保肢成功。43例均获得随访,随访时间12~108个月,平均(48±19)个月。患者均无症状加重或复发。结论 CDT治疗四肢外伤后继发动脉血栓形成是一种安全、有效、微创的方法。     

大腔导管抽吸联合溶栓治疗巴德-吉亚利综合征合并下腔静脉血栓

目的观察大腔导管抽吸术联合置管溶栓及血管成形术治疗巴德-吉亚利综合征(BCS)合并下腔静脉(IVC)血栓的安全性及有效性。方法将74例BCS合并IVC新鲜或以新鲜血栓为主的混合血栓患者分为血栓抽吸组(32例)和单纯溶栓组(42例)。血栓抽吸组接受大腔导管抽吸联合经导管溶栓及血管腔内成形术,单纯溶栓接受行经导管溶栓及血管腔内成形术,比较2组血栓清除效果、溶栓时间、溶栓药用量及并发症。结果2组技术成功率均为100%。血栓抽吸组平均溶栓时间、尿激酶平均用量少于单纯溶栓组(P均<0.05)。血栓抽吸组Ⅲ级血栓清除12例、Ⅱ级19例、Ⅰ级1例,单纯溶栓组分别为17、20及5例,2组差异无统计学意义(P=0.33)。血栓抽吸组2例(2/32,6.25%)、单纯溶栓组3例(3/42,7.14%)出现并发症,组间差异无统计学意义(P=1.00)。结论大腔导管抽吸联合溶栓及血管成形术治疗BCS合并IVC血栓可缩短溶栓时间,减少溶栓药用量,且安全性较好。     

导管接触性溶栓治疗在肝移植术后早期肝动脉血栓形成中的应用

目的探讨肝移植术后早期肝动脉血栓形成(EHAT)的导管接触性溶栓(CDT)治疗的有效性和安全性。方法 2009年1月～2019年11月接受CDT治疗的肝移植术后EHAT病人23例。结果本组均接受CDT治疗,放置CDT导管手术操作平均时间(78±24)分钟,溶栓治疗平均时间(87.4±22.8)小时,尿激酶平均用量(344.5±62.3)万U,经CDT治疗,19例肝动脉内血栓完全溶解,CDT治疗有效率为82.6%(19/23)。溶栓过程中,腹腔轻微出血(100 ml)2例,无其他相关并发症发生。平均随访时间(60.4±3.7)个月,19例肝动脉血栓完全溶解病人术后1年、2年、5年肝动脉通畅率分别为94.7%(18/19)、89.5%(17/19)、79%(15/19)。结论 CDT是一种安全、有效、微创的治疗方式,在肝移植术后EHAT病人的治疗及预后过程中发挥了重要作用。     

下肢动脉栓塞症的腔内治疗

目的 探讨腔内介入治疗下肢动脉栓塞(lower extremity arteries embolism,LEAE)的方法、疗效及安全性.方法 回顾性分析29例LEAE患者的临床及影像资料.结果 29例均经导管抽吸出血栓.其中股、腘、胫前动脉及胫腓干栓塞分别为23、2、3、1例.单纯导管抽栓治疗17例,导管抽栓+尿激酶溶栓治疗9例,导管抽栓+球囊扩张治疗2例,导管抽栓+支架治疗1例.29例患者均顺利开通栓塞动脉,但9例抽栓后破碎的小栓子脱落栓塞远端血管或远端血管血栓形成,采用抽栓联合尿激酶溶栓治疗后,4例完全开通栓塞的远端血管,3例部分开通栓塞远端血管,2例溶栓后远端血管仍不能开通,但侧支循环较前明显增多.随访(18±4)个月,23例患者下肢缺血症状完全消失,5例患者栓塞侧足部皮温降低、肤色苍白、末梢血运差,1例截肢治疗.结论 腔内介入治疗下肢动脉栓塞具有微创、安全的特点,在行造影的同时,可进行腔内介入治疗,可降低患肢缺血、坏死的发生率.     

急性脑梗死动脉内溶栓治疗致靶血管早期再闭塞的若干问题探讨

目的探讨局部动脉内溶栓治疗急性缺血性脑梗死致靶血管早期再闭塞的可能性、时间及其相应处理措施。方法217例急性缺血性脑梗死患者应用尿激酶或爱通立(rt-PA)行局部动脉内溶栓治疗,发生靶血管早期再闭塞3例(1.38%)。结果颈内动脉末端、大脑中动脉、基底动脉各1例;重度伤残1例,死亡2例。结论急性脑梗死动脉内溶栓治疗过程中可并发靶血管的早期再闭塞,可能与溶栓后破碎栓子、斑块随血流移位栓塞远端的血管及局部的血栓再形成有关,靶血管早期再闭塞有较高的死亡率。     

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.     

A comparison of the inhibitory effects of four volatile anaesthetics on the metabolism of chlorzoxazone, a substrate for CYP2E1, in rabbits

Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.     

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.     

Systemic analgesia adapted to the children's condition

A concept of balanced analgesia using nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol (acetaminophen), opioids, and corticosteroids can also be used in patients with pre-existing illnesses. NSAIDs are the most effective treatment for acute pain of moderate intensity in children; however, these drugs should be avoided in patients at increased risk for serious side effects, e.g. patients with renal impairment, bleeding tendency, or extreme prematurity. NSAIDs can be given with minimal risks to the younger child with mild to moderate asthma, and, in these patients, the use of steroids can be encouraged; in addition to their antiemetic and analgesic action, a beneficial effect on asthma symptoms can be expected. In the non-intubated child with cerebral trauma, exaggerated sedation caused by opioids and increased bleeding tendency caused by NSAIDs must be avoided. In neonates and small infants, the oral administration of sucrose or glucose is helpful to minimize pain reaction during short uncomfortable interventions.