经皮氧分压评估下肢动脉硬化闭塞症经皮血管腔内成形术疗效的研究

目的 通过比较下肢动脉硬化闭塞症(ASO)经皮血管腔内成形术(PTA)前后的经皮氧分压(TcPO2)、踝肱指数(ABI)、趾肱指数(TBI)的变化,评价TcPO2在评估下肢ASO患者PTA疗效的临床价值.方法 ASO患者101例,下肢ASO患肢111例,行PTA术后2～9 d复查TcPO2、ABI及TBI.根据有无T2...     

自体骨髓干细胞移植联合胸腺肽α1治疗肝衰竭的临床研究

目的观察人自体骨髓干细胞移植联合胸腺肽α1治疗重型肝炎疗效。方法将80例重型肝炎患者随机分为三组,20例为对照,20例行单纯骨髓干细胞移植,40例行骨髓干细胞移植联合胸腺肽α1皮下注射治疗,观察其移植后肝功能、凝血功能等指标。结果治疗后4周,联合治疗组较单纯骨髓干细胞移植组及对照组间相比,ALT、TBiL均明显下降(P<0.05),ALB、PTA、CHE均明显上升(P<0.05),均有显著差异。结论人自体骨髓干细胞移植联合胸腺肽α1皮下注射治疗重型肝炎有较好疗效。     

人脐带间充质干细胞经外周静脉移植治疗失代偿期肝硬化的临床疗效

目的:探讨人脐带间充质干细胞经外周静脉移植治疗不同程度肝硬化的临床疗效及安全性.方法:选择乙型肝炎肝硬化失代偿期患者20例,其中Child-Pugh A级6例,B级8例,C级6例,在常规保肝的基础上给予人脐带间充质干细胞经外周静脉移植治疗,同期选择20例乙型肝炎肝硬化失代偿期患者作为对照组,其中Child-Pugh A级5例,B级9例,C级6例,给予常规保肝治疗.于术后2、4、12及24 wk观察不同程度肝硬化患者的肝功能和凝血功能的变化,并观察临床症状的改善以及不良反应的发生情况.结果:Child-Pugh A、B级患者:术后白蛋白(albumin,ALB)、胆碱酯酶(cholinesterase,CHE)升高,于12、24 wk较术前及对照组均有明显改善(P0.05),凝血酶原活动度(prothrombin activity,PTA)由术前平均62%±15%在24 wk上升至80%±17%,于4、12、24 wk较术前及对照组均有明显升高(P0.01),干细胞组与对照组谷丙转氨酶(alanine aminotransferase,ALT)、谷草转氨酶(aspartate aminotransferase,AST)、总胆红素(total bilirubin,TBIL)自第2周始均有下降趋势,但两组间比较差异无统计学意义(P0.05).Child-Pugh C级患者:术后ALT、AST、TBIL、ALB、CHE、PTA与术前及对照组比较差异均无统计学意义(P0.05).Child-Pugh A、B级患者术后临床症状明显改善,与对照组相比差异有统计学意义(P0.05),Child-Pugh C级患者临床症状改善程度两组间差异无统计学意义(P0.05).所有患者均未发生严重不良反应及并发症.结论:经外周静脉移植脐带间充质干细胞治疗失代偿期肝硬化具有较好的临床疗效和安全性.Child-Pugh A、B级患者的疗效优于Child-Pugh C级患者.     

自体外周血干细胞移植治疗急性心肌梗死对左心室功能的影响研究

目的探讨自体外周血干细胞(PBSCs)移植治疗急性心肌梗死(AMI)对左心室功能的影响。方法选择2003年11月至2005年9月辽宁省人民医院收治的69例AMI患者,分成干细胞移植组35例和对照组34例,两组均接受药物和冠状动脉内介入治疗,干细胞移植组在此基础上动员自体骨髓干细胞,进行外周血干细胞移植。两组均于治疗前、治疗后6个月进行超声心动图检查。结果6个月时干细胞移植组心脏收缩末容积(ESV)明显减小(P<0·05);舒张末容积(EDV)无显著性变化(P>0·05);左室射血分数(LVEF)显著增高(P<0·05);左室壁节段性运动积分指数(WMSI)明显减低(P<0·001);对照组于介入术前及术后6个月随访ESV、EDV、LVEF及WMSI差异均无显著性意义;术后6个月随访移植组与对照组比较ESV下降,LVEF升高,WMSI降低(P<0·05)。结论自体外周血干细胞治疗AMI可以在近期有效地缩小缺血梗死面积,减轻左室重构,改善心功能。     

自体外周血干细胞移植治疗失代偿期肝硬化

目的评价自体外周血干细胞移植治疗失代偿期肝硬化的效果。方法选择42例住院治疗的失代偿期肝硬化患者,分为干细胞移植组20例和对照组22例,两组均予以相同的内科综合治疗,干细胞移植组加行经肝动脉自体外周血干细胞移植术,观察患者术后乏力、纳差、腹胀等主要症状的变化,检测移植术后4、8、12、24周肝功能、凝血功能等指标的变化,同期检测对照组的变化。结果两组患者在治疗后观察期间的主要症状乏力、纳差、腹胀均有改善。20例干细胞移植组患者手术均成功,无特殊不良反应及并发症。术后8、12、24周干细胞移植组患者肝功白蛋白均较术前明显回升(P0.05),与对照组比较差异有统计学意义(P0.05)。术后12周、24周细胞移植组凝血酶原活动度以及术后24周细胞移植组凝血酶原时间较术前明显改善(P0.05),但组间比较无统计学差异。术后12周、24周Child评分较术前及对照组明显改善,差异有统计学意义(P0.01)。结论经肝动脉自体外周血干细胞移植治疗失代偿期肝硬化是一种安全、有效的微创治疗方法,可在一定程度上改善患者的低蛋白血症及凝血功能。     

PTA联合VSD治疗糖尿病足的近远期效果观察

目的观察血管腔内介入(PTA)联合负压封闭引流术(VSD)治疗糖尿病足的近远期疗效。方法采用随机数字表法将该院2015年4月—2017年3月接诊的50例糖尿病足患者分为实验组(PTA联合VSD治疗组)、对照组(PTA联合湿性换药治疗组),每组25例。比较两组患者治疗后6周时临床总有效率、术后恢复情况(换药总次数、愈合时间、住院时间)以及1年随访情况(重建血管通畅率、截肢率)。结果实验组患者总有效率高于对照组(P0.05);实验组患者换药总次数明显小于对照组(P0.05),且愈合时间、住院时间均短于对照组(P0.05)。术后随访1年,实验组患者重建血管的通畅率高于对照组,截肢率低于对照组(P0.05)。结论 PTA联合VSD治疗可加速糖尿病足患者创面愈合,缩短患者恢复时间和住院时间,降低术后复发率和截肢率。     

冠状动脉旁路移植术联合激光心肌血运重建和自体骨髓干细胞移植治疗心肌梗死的临床研究

目的 研究分析细胞移植联合激光心肌血运重建及冠状动脉旁路移植术治疗心肌梗死的安全性、可行性及疗效.方法 2004年1月至2005年9月,将同一手术团队在北京多家心脏中心进行冠心病搭桥的患者按照一定入选标准随机分为两组:接受冠状动脉旁路移植术联合同期自体骨髓干细胞移植的13例患者(以下称试验组)中,"干细胞移植组"(以下称2合1组)7例,"激光心肌血运重建联合干细胞移植组"(以下称3合1组)6例;同时随访研究作为对照组入选试验的常规冠脉搭桥术治疗患者10例.术前及术后3年均行同位素扫描,用以评价心脏功能和血流灌注及存活心肌情况,比较两组数据差异.结果 两组均无围术期死亡,围术期心梗、病理性心律失常及其他并发症发生率比较,差异均无统计学意义.同位素扫描显示,试验组总的低灌注心肌质量术后较术前明显减少,而对照组则有所增加.在这些低灌注心肌中,术后增加的存活心肌含量试验组较对照组明显.具体干细胞移植各亚组间比较,3合1组在总低灌注心肌及对梗死心肌比例缩小趋势上都明显优于2合1组,两组间左室射血分数的增加程度类似.结论 本研究进一步证实了自体骨髓干细胞移植治疗心肌梗死的安全性和有效性,初步证实了自体骨髓干细胞移植联合激光心肌血运重建及冠状动脉旁路移植3合1治疗作为一种新型联合治疗方式是安全可行的.     

骨髓动员与骨髓细胞移植对急性心肌梗死猪再灌注后心肌修复及血管再生作用的比较研究

目的比较骨髓间充质干细胞移植和骨髓动员对急性心肌梗死再通模型中心功能改善作用,并比较两者的心肌及血管再生作用.方法将模型分为3组,对照组(7头),骨髓动员组(5头),细胞移植组(8头).心梗再通模型制作后,骨髓动员组予G-CSF静脉注射1天,皮下注射连续6天,细胞移植组予骨髓间充质干细胞4～8×106经梗死相关冠脉注入.3周后观察以下指标1超声心动图检测心功能及局部室壁运动.2免疫组织化学染色,行不同区域血管计数,并观察增殖期内皮细胞数和新生心肌细胞数.结果(1)骨髓动员组和细胞移植组心功能及局部室壁运动均见明显改善.(2)细胞移植组在心梗周围区可见分散分布的BrdU标记移植细胞,骨髓动员组中未观察到处于增殖期的心肌细胞;细胞移植组和骨髓动员组均可见大量新生血管,但二者分布区域不同.结论骨髓动员及骨髓间充质干细胞移植均可明显改善心肌梗死后心功能,而骨髓间充质干细胞可通过补充可收缩细胞而使心功能改善更加明显,二者对不同区域的血管再生作用不同.     

下肢动脉球囊扩张成形术治疗高危糖尿病足的方法、效果及并发症分析

目的 观察下肢动脉球囊扩张成形术治疗高危糖尿病足的方法、效果及并发症。方法 选取2020年3月—2022年3月期间蚌埠市第五人民医院收治的80例高危糖尿病足患者为研究对象,以抽签法将其分为对照组和观察组,每组40例。对照组进行常规药物治疗,观察组进行下肢动脉球囊扩张成形术治疗。对比两组患者治疗后的血管再通率、溃疡愈合率、皮肤温度、TcPO2指数、各项疗效指标与总有效率。结果 治疗后,观察组的血管再通率与溃疡愈合率均高于对照组,差异有统计学意义(P<0.05)。观察组的皮肤温度与TcPO2指数均优于对照组,差异有统计学意义(P<0.05)。治疗后,观察组各项疗效指标及总有效率均优于对照组,差异有统计学意义(P<0.05)。结论 下肢动脉球囊扩张成形术治疗高危糖尿病足患者可以有效提升血管再通率、溃疡愈合率以及疗效。     

自体骨髓干细胞移植联合髓心减压治疗老年缺血性股骨头坏死临床疗效

目的 探讨髓心减压术联合自体骨髓干细胞移植治疗老年缺血性股骨头坏死(ONFH)的临床疗效.方法 老年缺血性ONFH患者70例,分为观察组46例(52髋)和对照组24例(27髋).对照组仅进行髓心减压松质骨植入,观察组在髓心减压的同时进行松质骨植入和自体骨髓干细胞移植.分别于术后3、6、12个月对比分析两组术后Harris功能评分、X线及磁共振成像(MRI)坏死面积.结果 与对照组相比,观察组治疗后6、12个月Harris功能评分明显增高(P＜0.01);治疗后3、6、12个月MRI坏死面积明显减小(P＜0.01).结论 髓心减压术联合自体骨髓移植治疗老年缺血性ONFH的临床疗效优于单纯采用髓心减压术.     

Transcutaneous oxygen tension monitoring after successful revascularization in diabetic patients with ischaemic foot ulcers.

OBJECTIVE: To monitor transcutaneous oxygen tension (TcPO2) after percutaneous transluminal angioplasty (PTA) in diabetic patients with ischaemic foot ulcers. RESEARCH DESIGN AND METHODS: Twenty-three diabetic patients with ischaemic foot ulcers who underwent successful revascularization by PTA (SR group) were retrospectively selected. Twenty diabetic patients who underwent unsuccessful revascularization (UR group) were also included. Transcutaneous oxygen tension was measured at the dorsum of the foot before and 1 (+/- 1), 7 (+/- 1), 14 (+/- 1), 21 (+/- 1) and 28 (+/- 1) days after the surgical procedure. RESULTS: After PTA, TcPO2 progressively improved in the SR group, reaching its peak 4 weeks after angioplasty. A concomitant decrease of cutaneous carbon dioxide tension (TcPCO2) was also observed immediately after PTA which reached the lowest levels 3 weeks later. In the UR group, TcPO2 showed a slight improvement immediately after PTA but remained stable throughout the observation, while TcPCO2 levels did not change. Finally, the percentage of SR patients with a TcPO2 > or = 30 mmHg was 38.5% 1 week after PTA, while it increased to 75% 3 weeks later. CONCLUSION: Transcutaneous oxygen tension monitoring showed that after successful revascularization it takes 3-4 weeks for cutaneous oxygenation to improve and reach the optimal levels for wound healing. Transcutaneous carbon dioxide tension monitoring may be more useful to identify the negative outcome of a revascularization procedure. Our findings suggest that, when the surgical approach can be delayed, the best timing to perform a more aggressive debridement or minor amputations is 3-4 weeks after successful revascularization.     

Extensive use of peripheral angioplasty,particularly infrapopliteal,in the treatment of ischaemic diabetic foot ulcers: clinical results of a multicentric study of 221 consecutive diabetic subjects

OBJECTIVE: To evaluate the feasibility, technical effectiveness and limb salvage potential of percutaneous transluminal angioplasty (PTA), particularly infrapopliteal, in diabetic subjects with ischaemic foot ulcer. DESIGN: Intervention study with PTA in consecutive series. SETTING: Six Diabetology Foot Centres and one Cardiovascular Catheterization Laboratory in Italy. SUBJECTS: Two hundred and twenty-one consecutive diabetic subjects hospitalized for ischaemic foot ulcer. INTERVENTION: Peripheral arterial occlusive disease (PAOD) was investigated by means of foot pulses assessment, ankle-brachial-index (ABI), transcutaneous oxygen tension (TcPO2) and duplex scanning. If non-invasive parameters suggested PAOD, angiography was performed and a PTA was carried out during the same session. MAIN OUTCOME MEASURES: PTA feasibility, improvement of ABI and TcPO2, limb salvage rate, clinical recurrence. RESULTS: On angiography, two patients had stenoses which were <50% of the vessel diameter. PTA was performed in 191 (85.3%) of the 219 subjects with stenoses >50%, even when longer than 10 cm and/or multiple/calcified. In 11 patients (5.8%) PTA was performed in the proximal axis exclusively, in 81 (42.4%) patients in the infrapopliteal axis exclusively and in 99 (51.8%) in both the femoropopliteal and infrapopliteal axis. Both ABI and TcPO2 improved significantly after PTA (P < 0.0001). Clinical recurrence occurred in 14 subjects: 10 of whom underwent a second successful PTA. Of the 191 patients who underwent PTA, 10 (5.2%) underwent an above-the-ankle amputation. CONCLUSIONS: PTA, including infrapopliteal, is feasible in most diabetic subjects with ischaemic foot ulcer and is effective for foot revascularization. Clinical recurrence was infrequent and the procedure could successfully be repeated in most cases. In subjects treated successfully with PTA the above-the-ankle amputation rate was low. PTA should be considered as the revascularization treatment of first choice in all diabetic subjects with foot ulcer and PAOD.     

前列地尔联合胰激肽原酶治疗早期糖尿病足的疗效观察

目的 探究前列地尔联合注射用胰激肽原酶治疗早期糖尿病足的临床疗效.方法 120例早期糖尿病足患者按照随机数字表法分成3组,每组40例.A组给予前列地尔10 μg+生理盐水20 ml静脉推注,B组给予注射用水1.5 ml+注射用胰激肽原酶40 IU肌肉注射,C组予前列地尔10 μg和胰激肽原酶40 IU联合应用,3组治疗均为1次/d,连续给药4周后比较3组的临床疗效并记录3组患者治疗前、后踝肱指数及足背动脉流速数据.结果 治疗后C组总有效率(95％)显著高于A组(77.5％)和B组(75％)(x2=6.580,P＜0.05),且踝肱指数和足背动脉流速亦高于A组和B组(x2=24.59,95.99,P均＜0.05).结论 前列地尔联合胰激肽原酶是治疗早期糖尿病足较为理想的配伍方案.     

社区老年糖尿病患者足背经皮氧分压现况研究

目的观察分析社区2型糖尿病(T2DM)患者足背经皮氧分压(TcPO2)水平。方法选择在北京市方庄和望京社区卫生服务中心就诊的T2DM且无糖尿病足患者270例,分别测量入选患者左、右侧足背TcPO2,并且以TcPO260mm Hg(1mm Hg=0.133kPa)为界,将至少一侧足背TcPO2<60 mm Hg为降低组214例(79.3%),其余为正常组56例。收集2组患者相关资料,进行二分类logistic回归分析。结果与正常组比较,降低组女性(61.2%vs 35.7%,P=0.001)和双下肢感觉异常(35.0%vs 17.9%,P=0.014)比例更高、高血压病程[(15.8±11.7)年vs(11.2±7.6)年,P=0.029]和血脂异常时间[(9.9±7.4)年vs(7.7±5.1)年,P=0.048]更长,差异有统计学意义。二分类logistic回归分析显示,女性(OR=2.831,95%CI:1.517~5.285,P=0.001)和双下肢感觉异常(OR=2.229,95%CI:1.047~4.748,P=0.038)为患者TcPO2降低的影响因素。结论社区老年T2DM无糖尿病足患者的足背TcPO2降低发生率高,TcPO2可能发现患者亚临床的足部组织灌注改变状况。     

经皮氧分压检测在糖尿病足截肢手术中的应用

目的评价经皮氧分压（TcPO2）检测在糖尿病足截肢手术中的临床应用价值。方法对68例2型糖尿足截肢手术患者进行回顾性分析。其中32例（A组）运用经皮氧分压检测方法确定氧分压40 mmHg以上的部位为截肢平面,36例（B组）根据术者临床经验判断截肢平面进行截肢手术。将两组患者的切口愈合情况及术后并发症发生情况进行统计分析和比较。结果 A组术后切口愈合情况明显优于B组（P〈0.01）,截肢术后并发症发生率低于B组（P〈0.01）。结论经皮氧分压检测是一种经济、可靠、重复性好、操作简单、无创性、对选择截肢平面有指导作用的可靠指标。     

The Prostacyclin Analogue Iloprost as an Early Predictor of Successful Revascularization in Diabetic Patients Affected by Critical Limb Ischemia and Foot Ulcers

PurposeThe aim of this study is to evaluate the role of Iloprost as an early predictor of successful revascularization in patients affected by ischemic diabetic foot ulcers (DFUs).MethodsConsecutive patients with ischemic DFUs with persistent low TcPO2 (<30mmHg) one day after a technical successful Percutaneous Transluminal Angioplasty (PTA) have been included.All patients underwent Iloprost infusion and TcPO2 has been recorded at days 3, 14 and 30.According to the TcPO2 reported at day 3, patients were divided into two groups: group A (patients with TcPO2 ≥30mmHg) and group B (patients with TcPO2 <30mmHg). Baseline TcPO2 values at days 3, 14 and 30 after Iloprost infusion and needing of re-intervention (re-PTA) have been evaluated.ResultsTwenty-five patients have been included, 12/25 (48%) in Group A and 13/25 (52%) in Group B.There were no significant differences at the baseline and one day after PTA between the two groups while TcPO2 values recorded in Group A at days 3, 14 and 30 after Iloprost infusion were significant higher in comparison to the Group B (χ = 0.005).The rate of re-PTA were respectively 33,3% (Group A) and 53,8% (Group B) (p = 0.03).ConclusionsIloprost may be an early predictor of successful revascularization in patients affected by critical limb ischemia (CLI) and DFUs.     

When is a technically successful peripheral angioplasty effective in preventing above‐the‐ankle amputation in diabetic patients with critical limb ischaemia?

AIM: To determine parameters predictive of avoidance of major (above-the-ankle) amputation after a technically successful peripheral angioplasty (PTA) in patients with diabetes with critical limb ischaemia. METHODS: From January 1999 to December 2003, 420 consecutive patients with diabetes admitted to hospital because of critical limb ischaemia underwent peripheral angiography and concomitant technically successful PTA. Transcutaneous oxygen tension (TcPO(2)) was measured before and after PTA. Major amputation at 30 days was recorded. RESULTS: After PTA, the iliac-femoral-popliteal axis was patent in all patients. In 67 patients, all three crural arteries were patent, in 143 patients 2 crural arteries were patent, and in 186 patients one crural artery was patent (104 peroneal, 62 anterior tibial, 20 posterior tibial). In 24 patients, all three crural arteries were occluded. Twenty-two major amputations were performed. Of these, 15 were performed in the 24 patients with occlusion of all the infrapopliteal arteries. Seven of the 186 patients in whom only the peroneal artery was patent required amputation. In patients not requiring amputation, TcPO(2) increased from 15.5 +/- 11.9 to 45.0 +/- 12.0 mmHg (P = 0.000), while in those requiring amputation, TcPO(2) increased from 9.6 +/- 7.7 to 18.6 +/- 8.1 mmHg (P < 0.082). Multivariate analysis indicated an independent role of occlusion of infrapopliteal arteries after PTA (OR 8.20 for every crural obstructed artery, P = 0.022, CI 1.35-49.6) and TcPO(2) after PTA (OR 0.80 for increase of 1 mmHg, P < 0.001, CI 0.74-0.88). CONCLUSIONS: In patients with diabetes, PTA is effective in avoiding major amputation, provided recanalization occurs in at least one tibial artery down to the foot. In a few patients, re-canalization of the peroneal artery alone is not sufficient to avoid major amputation.     

自体外周血干细胞移植治疗62例缺血性下肢血管病的临床研究

目的　观察自体外周血干细胞(PBSC)移植治疗缺血性下肢血管病的临床疗效及相关影响因素。方法　62例自愿接受自体PBSC移植的患者中糖尿病足34例,动脉硬化闭塞症22例,血栓闭塞性脉管炎4例,结节性多动脉炎1例,雷诺病1例。发生足部溃疡或坏疽38例,合并感染14例。累及双下肢病变52例,其中3例患者移植前已行一侧肢体截肢术;单肢病变10例,共移植111条下肢。全部患者均给予重组人粒细胞集落刺激因子450~600μg/d,皮下注射,行PBSC动员5d,第6天用血细胞分离机采集单个核细胞(MNC),总量82~148ml,MNC数量(7182~2246)×109/L。将MNC悬液按3cm×3cm距离进行缺血肢体移植术,术后第1天至6个月定期观察各项指标综合评估。结果　PBSC移植后7~30d54例(871%)疼痛有不同程度的缓解,7~30d56例(903%)患肢冷感明显改善,4~16周16例(400%)溃疡或足趾坏疽好转,感染得到控制;踝肱指数12例(343%)有不同程度的改善,26例(423%)经皮氧分压改善,5例数字减影下肢动脉造影结果显示新侧支血管形成明显增加。2例糖尿病足合并脑梗死患者在干细胞动员期间症状加重,经治疗好转,其余患者未出现并发症和明显不良反应。结论　自体PBSC治疗缺血性下肢血管病是一种安全、有效的手段,尤其对于下肢动脉没有流出道的患者有特殊意义,可使一部分患者免除截     

超声指导下介入治疗动静脉内瘘狭窄的应用

目的 探讨在超声指导下对动静脉内瘘（arterio-venous fistulas,AVF）狭窄的维持血液透析（hemodialysis,HD）患者进行经皮腔内血管成形术（percutaneous transluminal angioplasty,PTA）对手术即刻及远期疗效的影响.方法 选择2011年1月至2013年1月在广州市第一人民医院因AVF狭窄或闭塞住院并接受PTA介入治疗的慢性肾功能衰竭HD患者62例,分为对照组32例及超声组30例.对照组患者实施常规PTA,超声组患者则在超声指导下进行PTA.PTA术后对患者随访1年,记录随访期间AVF主要心血管事件（包括急性、亚急性血栓形成;扩张部位再狭窄、闭塞需再次PTA或外科造瘘;新发生的AVF狭窄致HD不充分）.结果 与对照组相比,超声组穿刺时间、PTA手术时间显著减少,差异有统计学意义[（5.41±1.92）min vs.（8.40±5.61）min,P＜0.01;（62.83±13.43）min vs.（71.56±17.98）min,P＜0.01].超声组穿刺并发症发生率降低且手术即时成功率有高于对照组趋势,但差异无统计学意义（3.3％ vs.15.6％,P＞0.05;96.6％ vs.87.5％,P＞0.05）.超声组术后超声多普勒AVF瘘口血流量显著高于对照组,差异有统计学意义[（537.62±33.09） mL/min vs.（519.25±35.06） mL/min,P＜0.01].Kaplan-Meier曲线分析结果显示,超声组随访期间无AVF主要心血管事件发生,其生存率显著高于对照组,差异有统计学意义（90.0％ vs.65.6％,Log rank=4.706,P=0.030）.结论 应用超声指导PTA处理AVF狭窄方便、安全,缩短手术操作时间并能改善手术即刻及远期疗效,具有一定的临床推广应用价值.     

纯化自体骨髓干细胞经肝动脉移植治疗失代偿期肝硬化的疗效及安全性分析

目的 探讨纯化自体骨髓干细胞经肝动脉移植治疗失代偿期肝硬化的疗效及安全性.方法 对120例失代偿期肝硬化患者实施纯化自体骨髓干细胞经肝动脉移植,采用多点穿刺的方法采集180 ～200 ml骨髓,加入125 U/ml肝素进行抗凝处理.对本组患者手术前后不同时间点肝功能各项指标（包括血清ALB、TBIL、PTA、临床症状变化及并发症发生情况等）进行观察.结果 （1）手术前后临床症状评分相比,差异均具有显著统计学意义（P＜0.01）;（2）术后血清ALB含量显著高于术前,差异具有统计学意义（P＜0.05）;（3） Child A、B级患者手术前后PTA差异均具有统计学意义（P＜0.05）,但Child C级患者手术前后PTA差异均无统计学意义（P＞0.05）;（4）手术前后Child A、B、C级患者TBIL水平差异均无统计学意义（P＞0.05）;（5）上消化道出血、肝性脑病、感染及原发性肝癌发生率分别为12.50％、17.50％、12.50％及5.00％.结论 纯化自体骨髓干细胞经肝动脉移植治疗失代偿期肝硬化的疗效显著,安全性高,值得在临床上推广应用.