脑血管介入术后穿刺部位应用 Perclose ProGlid血管缝合器疗效观察及护理

目的：观察在脑血管介入治疗术中应用 Perclose ProGlide 血管缝合器止血的临床效果。方法200例行脑血管介入手术的患者,术后按器械说明书要求的标准使用方法应用 Perclose ProGlide 血管内缝合器缝合股动脉穿刺口,并给予介入术后护理,观察术后恢复情况。结果5例患者穿刺点皮肤有少量渗血,2例患者出现皮下血肿。结论脑血管介入术后穿刺处血管使用 Perclose ProGlid 血管缝合器效果较好,并发症少。     

血管缝合器的临床应用

目的：评价血管缝合器Perclose在冠脉介入治疗术（PCI）后止血的可靠性、安全性及临床应用价值。方法：120例经股动脉冠脉介入治疗术后，应用Perclose缝合器缝合止血，记录止血时间、下肢制动时间及血管并发症。结果：应用Perclose缝合止血成功率97．5％（95／120）。止血时间2．02？．1min，制动时间4．4？．8h。1例发生血肿。结论：在PCI术后应用血管缝合器Perclose缝合止血是可靠的、安全的，可明显缩短止血时间及下肢制动时间，并有助减少血管穿刺部位血肿等并发症的发生率。     

Perclose ProGlide血管缝合器系统在股动脉穿刺中的效果分析

目的评价Perclose Pro Glide血管缝合器系统在经股动脉穿刺治疗主动脉疾病中的安全性及有效性。方法 40例主动脉疾病患者全部接受经右股动脉穿刺行主动脉腔内修复术,于股动脉穿刺处交叉预埋两套Perclose Pro Glide血管缝合器系统并行主动脉腔内隔绝术,术后交叉缝合穿刺点,统计缝合成功率及并发症发生率。结果 40例患者均成功缝合股动脉穿刺点,术后止血成功率为100%;术后并发症发生率为7.5%(3/40),其中股动脉狭窄1例,局部血肿2例。无动静脉瘘及假性动脉瘤发生。结论行经股动脉穿刺腔内修复术时,使用两套Perclose Pro Glide血管缝合器系统交叉缝合股动脉穿刺点安全、有效,且创伤小,并发症少,值得临床推广。     

徒手压迫与Perclose缝合器对介入术后股动脉假性动脉瘤形成的比较

目的评价徒手压迫与Perclose血管缝合器处理对股动脉介入术后股动脉假性动脉瘤(PSA)发生率的影响。方法回顾性分析2000年3月至2006年7月共3 586例经股动脉介入患者的资料,根据术后处理穿刺伤口方法的不同分为徒手压迫组(3 060例)和Perclose血管缝合器组(526例)。比较两组患者术后形成股动脉假性动脉瘤(PSA)的概率及其预后。结果徒手压迫组的股动脉PSA发生率为1．3％(41／3 060例),Perclose血管缝合器组为0．8％(4／526例),两组的差异无统计学意义(P=0．20)。徒手压迫组41例股动脉PSA患者均采用改良超声引导下徒手压迫法,压迫30-150 min,成功闭合37例,总成功率为90．2％,均无复发;再压迫失败者中3例转外科行PSA修补术,1例拒绝手术出院随访。Perclose血管缝合器组4例股动脉PSA患者采用徒手压迫法均将PSA闭合,无复发。结论Perclose缝合器不能明显降低股动脉PSA的发生率,该器械尚有待于进一步改进,提高股动脉穿刺技术可能降低PSA的发生率。     

主动脉夹层腔内隔绝术后Perclose ProGlide血管缝合器的临床应用

目的：评价经皮股动脉穿刺完成主动脉夹层（aortic dissection,AD）腔内隔绝术（endovascular graft exclusion,EVGE）后应用Perclose ProGlide（Abbott,USA）血管缝合器止血的安全性和可靠性。方法：2004-2012年我院收治的200例Stanford B 型AD患者,根据在局麻或者全麻下完成主动脉EVGE随机分组。100例为对照组,经外科纵行切开腹股沟区皮肤4.0～6.0 cm,暴露股动脉2.0～3.0 cm后穿刺建立股动脉建立入路完成手术。100例为观察组,经皮股动脉穿刺建立股动脉入路完成手术,术后常规使用2套装置缝合血管。结果：观察组使用两套缝合装置成功率95.0%（95/100）。对照组和观察组手术时间分别为（113.0±16.0） min和（90.0±12.1） min,差异具有统计学意义（P<0.01）。其中建立股动脉入路的时间分别为（14.0±1.3） min和（4.3±0.8） min,差异具有统计学意义（P<0.01）,退鞘后股动脉处理时间分别为（8.9±1.3） min和（3.0±0.7） min,差异具有统计学意义（P<0.01）,术后制动时间分别为（18.5±1.9） h和（7.7±2.3） h,差异具有统计学意义（P<0.01）,术后平均住院时间分别为（5.2±1.0） d和（3.3±0.8） d,差异有具有统计学意义（P<0.01）。并发症发生率分别为5.0%和4.0%,差异无统计学意义（P >0.05）,伤口不适感分别为36例（36.0%）和17例（17.0%）,差别有统计学意义（P<0.01）。结论：AD EVGE后应用Perclose ProGlide血管缝合器止血是一种安全、可靠的止血方法,可以缩短手术时间、建立股动脉入路的时间、术毕股动脉处理时间、术后制动时间、术后平均住院时间且并发症少,值得进一步推广。     

三种止血方法在股动脉穿刺部位止血中有效性和安全性的比较

目的:评价冠状动脉造影(CAG)和经皮冠状动脉介入治疗(PCI)后人工压迫止血法和两种动脉穿刺闭合器(Angi-oseal和Perclose)在股动脉径路止血中的安全性和有效性及其影响因素.方法:366例经股动脉行选择性冠状动脉造影或介入治疗的患者,分为人工压迫止血组128例、Angioseal组128例和Perclose组110例,观察3种止血方法的有效性、安全性,并分析其影响因素.结果:止血成功率各组间无明显差异;即刻止血率Angioseal组明显高于Perclose组(P＜0.01).下肢制动时间和止血时间Angioseal组和Perclose组均明显短于人工压迫组(P＜0.01).血管迷走神经反射和严重并发症仅发生在人工压迫组;局部并发症Angioseal组和人工压迫组均明显低于Perclose组(P＜0.01).影响因素:术后使用肝素者血肿发生率高(OR=4.382,P＜0.05);男性、PCI及术后使用氯吡格雷者渗血发生率高(P＜0.05或P＜0.01);年龄大及PCI者成功率低;术后使用低分子肝素和肝素者止血时间延长.结论:Angioseal、Perclose与人工压迫止血法均可有效用于心导管术后股动脉穿刺部位的止血.与Perclose相比,Angioseal止血时间更短、即刻止血率更高且局部并发症更少.     

PCI术后Angioseal血管闭合器的临床应用及并发症的防范

目的 评价PCI术后穿刺股动脉应用血管闭合器止血的安全性、可靠性及常见并发症的防范. 方法 495例经股动脉PCI术后患者,依照术后使用Angioseal闭合器与否,分成angioseal组(293例)和对照组(202例),记录两组患者下肢制动时间及血管并发症.结果 应用Angioseal闭合器成功率99.6%.两组术后制动时间分别为3.5±1.2和24±3.1小时,有显著性差异(P＜0.01).术后并发症两组间未见显著性差异.结论 Angioseal闭合器是一种安全、可靠的止血方法,可明显缩短制动时间,无明显的穿刺部位血管并发症.熟练操作可降低并发症的发生.     

Angioseal及Perclose两种血管闭合装置疗效的对比研究

目的观察Angioseal及Perclose两种血管闭合装置的安全性、有效性及临床应用价值。方法回顾性分析我院心内科2001年1月~2011年4月,经皮冠状动脉造影及介入治疗后使用Perclose和Angioseal血管闭合器患者997例,分别比较两种止血装置的止血时间、制时间、即刻成功率及并发症发生情况。结果 1.止血时间:Perclose组为(10.8±4.8)min,Angioseal组为(3.0±0.9)min,Perclose血管闭合器止血时间显著长于Angioseal闭合器,两组相比有显著性差异(P<0.001);2.下肢制动时间:Perclose和Angioseal组患者下肢制动时间分别为(6.4±1.2)h及(6.3±0.7)h,两组相比无统计学差异(P>0.05);3.大、小血管并发症发生率:Perclose组并发症发生率为4.5%,Angioseal组并发症发生率为3.7%,两组均无局部血栓形成、下肢动脉栓塞等并发症发生,血管并发症两组比较无统计学差异(P>0.05),4.即刻止血成功率:Perclose组即刻成功率为97.8%,Angioseal组即刻成功率为98.6%,两组成功率比较无统计学差异(P>0.05),个别止血器操作失败系为人为操作不当及器械因素所致。结论 Angioseal和Perclose两种血管闭合装置大、小血管并发症率发生少,止血时间短,均能有效止血,可做为介入治疗后动脉止血的优先选择。Angioseal血管闭合器与Perclose血管闭合器相比,具有更易操作,止血时间短及并发症发生率有减少趋势等优点。     

三种止血干预措施在冠状动脉介入术中的应用比较

目的:探讨经桡动脉冠状动脉介入造影及治疗过程中三种常用止血干预措施的临床效果、安全性和成本。方法:选择286例患者接受经挠动脉冠状动脉造影或介入术治疗,其中男155例,女131例,平均年龄(59.8±9.4)岁。介入术中桡动脉穿刺点,109例患者接受压迫止血(A组),76例患者接受Per-close血管缝合器止血治疗(B组),101例患者接受Boomerang血管封阻器止血治疗(C组)。观察与记录三组的止血时间、制动时间、末梢血氧饱和度变化、血管并发症并计算止血成功率。结果:三组止血时间和制动时间比较均有显著性差异(P<0.05),其中以A组时间最长分别为(13.5±3.1)min和(15.8±4.7)h(CAG),以及(21.0±5.7)min和(21.9±4.1)h(PIC),B组最短分别为(4.8±0.8)min和(4.4±0.6)h(CAG),以及(7.0±1.4)min和(5.7±1.0)h(PIC);三组止血成功率间差异不显著(P>0.05),三组止血治疗后较治疗前,以及三组末梢血氧饱和度无统计学差异(P>0.05);A组共24例患者术后出现并发症(22.0%),显著高于其他两组(P<0.05),B和C组并发症发生率分别为5.3%和5.0%;止血费用以A组最低,B组最高,三组间差异显著(P<0.01)。结论:三种干预措施在冠状动脉介入术后穿刺点止血应用中各具特色,其中Perclose血管缝合器法和Boomerang血管封阻器法具有止血快速、安全优势,但费用较高;人工压迫止血费用低廉、操作简便,但术后恢复较慢,且并发症较高。临床上应根据具体情况合理选择。     

血管闭合装置在急诊PCI术后应用的比较

经股动脉途径是冠脉造影术和介入治疗的最重要血管路径,与其他血管路径相比,更有利于冠脉复杂病变的处理,并且在急诊经皮冠状动脉成型术（percutaneous transluminal coronary intervention,PCI）中,有其不可替代的优势,但术后拔管需要人工压迫止血及较长时间的卧床,给患者带来了痛苦、不适和一些相关的并发症。本研究比较了Perclose血管缝合器、Angio—seal血管闭合器在介入治疗术后应用的效果及安全性。     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.