多普勒超声对自血光量子疗法治疗兔脊髓损伤的肢体血液状态的研究

２４只家兔造成胸腰段脊髓损伤，用多普勒超声研究损伤平面上下的血流速度频谱，发现脊髓损伤后腋动脉血流峰值无变化，而股动脉明显减慢，自血光量子疗法能提高股动脉血流峰值，提示ＡＬＱ可以增加损伤平面以下的血流供应，改善脊髓缺血状况，有利于脊髓功能的恢复。     

大剂量甲强龙冲击治疗脊髓损伤的护理

脊髓损伤常由外伤引起，是颈、脊椎骨折脱位的严重并发症。脊髓损伤后，损伤平面以下人体感觉、运动及植物神经功能会遭到不同程度的损害，甚至引起四肢瘫痪。甲强龙(甲泼尼龙琥珀酸钠)是一种合成的糖皮质激素，高浓度的水溶液作用强、起效快，具有很强的抗炎、免疫抑制及抗过敏作用。早期大剂量应用甲强龙有利于脊髓冲动的发生，增加脊髓血流，减低脊髓脂质过氧化反应及组织退行性变，从而减轻脊髓神经组织的损伤。但大剂量冲击治疗可引起心律失常、循环性虚脱及心脏停搏等不良反应。我科采用甲强龙治疗脊髓损伤23例，均好转出院。为减少并发症，结合临床，现报告如下。     

彩色多普勒超声对糖尿病患者股动脉血流动力学的临床观察

目的应用彩色普勒超声研究糖尿病患者股动脉内—中膜厚度及血流动力学变化，以探讨糖尿病与股动脉硬化的关系。方法对28例糖尿病患者及13例正常人的股动脉行二维及彩色多普勒超声检查，观察股动脉内膜回声及有无粥样硬化斑块，测量内—中膜厚度和脉冲多普勒血流频谱参数，包括收缩期峰值速度、舒张早期峰值速度和阻力指数。结果（1）糖尿病患者股动脉内—中膜厚度明显大于对照组。（2）糖尿病合并高血压组动脉斑块发生率高于对照组。结论糖尿病患者股动脉内—中膜增厚；糠尿病合并高血压组粥样硬化斑块发生率增加。     

股动脉粥样硬化的彩色多普勒超声研究

目的：应用彩色多普勒超声研究不同程度的股动脉粥样硬化的超声表现。方法：测量股动脉血管后壁内膜中层复合体厚度（IMT）、收缩期峰值速度、加速度时间和频谱形态，来估测股动脉粥样硬化损伤的程度。结果：当内膜中层复合体厚度＞1mm，收缩期峰值速度＜0．55mm/s、股动脉三峡形态消失（单峰或双峰），即表明股动脉受损或远端动脉受损。受损的程度可以通过上述三个指标改变来评估。结论：通过超声测值及频谱形态变化，可以准确的估测股动脉及远端动脉的损伤程度。     

调制中频电对脊髓损伤患者下肢深静脉血流动力学的影响

目的:探究调制中频电对脊髓损伤患者下肢深静脉血流动力学的影响;比较调制中频电(modulated medium frequency current therapy,MMFCT)与间歇充气加压装置(intermittent pneumatic compression,IPC)在加速脊髓损伤患者下肢深静脉血流速度方面的作用差异。方法:纳入20例健康受试者及20例脊髓损伤患者。健康受试者左侧下肢分别用4种不同调制处方的中频电治疗刺激腓肠肌,然后使用多普勒超声测量腘静脉的收缩期峰值血流速度(PSV)、平均血流速度,筛选血流加速效果最好的处方。利用筛选的处方刺激脊髓损伤患者腓肠肌,测量股静脉PSV、刺激期平均血流速度、每分钟射血量,对比间歇充气加压装置治疗时股静脉的上述指标。结果:健康志愿者腘静脉基础PSV为9.5±3.3cm/s,基础平均血流速度为4.2±1.7cm/s,连续调制波刺激时腘静脉PSV加快了约250%,平均血流速度加快了200%。断续调制波相较于连续调制波,腘静脉PSV加快了约160%,平均血流速度加快了约140%,差异均有显著性意义(P0.05)。不同波形治疗的效果没有显著性差异(P0.05)。脊髓损伤患者静息时下肢股静脉基础峰值血流速度为6.5±2.7cm/s,基础平均血流速度为2.6±1.4cm/s,基础每分钟射血量为37.6±17.4ml/min。刺激时脊髓损伤患者股静脉的PSV、刺激期平均血流速度、单位时间射血量均明显升高,差异具有显著性意义(P0.05)。间歇充气加压装置治疗时的PSV、刺激期平均血流速度优于MMFCT,但MMFCT治疗时的单位时间射血量高于IPC,差异均具有显著性意义(P0.05)。结论:间歇调制波单次刺激加速血流的效果优于连续调制波,而不同波形之间治疗效果没有显著性差异。在脊髓损伤患者中,MMFCT能产生类似于IPC的加速下肢静脉血液回流的作用,推测其能用于下肢深静脉血栓的预防。IPC单次加速下肢静脉血流的效果优于MMFCT,但MMFCT治疗时的单位时间射血量高于IPC。     

大鼠脊髓急性损伤后血流动力学变化的光学监测

目的观察脊髓损伤后血流动力学的变化,探讨脊髓损伤的血流动力学机制。 方法雌性SD大鼠20只,分为对照组和损伤组,每组10只。Nystrom法制造大鼠脊髓（T10~11）中度压迫性损伤模型。利用激光散斑成像系统监测大鼠脊髓损伤后第10分钟、30分钟、1小时、2小时、3小时、6小时背部血管内的血流速度和血流量以及血管管径的变化。 结果对照组大鼠各时间点血管内的血流速度、血流量以及血管管径均较稳定,无明显波动。损伤组大鼠各项指标均低于对照组。 结论激光散斑成像技术可以用于监测脊髓血流动力学的变化;急性脊髓损伤后血流动力学的变化提示进行性的“创伤后缺血”,静脉回流受阻可能是引起创伤后缺血的一个重要因素。     

大鼠脊髓急性损伤后血流动力学变化的光学监测

目的 观察脊髓损伤后血流动力学的变化,探讨脊髓损伤的血流动力学机制.方法 雌性SD大鼠20只,分为对照组和损伤组,每组10只.Nystrom法制造大鼠脊髓(T10-11)中度压迫性损伤模型.利用激光散斑成像系统监测大鼠脊髓损伤后第10分钟、30分钟、1小时、2小时、3小时、6小时背部血管内的血流速度和血流量以及血管管径的变化.结果 对照组大鼠各时间点血管内的血流速度、血流量以及血管管径均较稳定,无明显波动.损伤组大鼠各项指标均低于对照组.结论 激光散斑成像技术可以用于监测脊髓血流动力学的变化;急性脊髓损伤后血流动力学的变化提示进行性的"创伤后缺血",静脉回流受阻可能是引起创伤后缺血的一个重要因素.     

颈髓损伤后四肢瘫运动功能训练

脊髓损伤患者的功能恢复情况与损伤平面密切相关。脊髓损伤平面不同,所残留的运动功能也不同。而脊髓损伤患者康复训练效果主要体现是运动功能的提高。126例完全性颈髓损伤不同平面的患者经运动疗法治疗后,其移乘和移动能力恢复情况均有不同程度改善。     

高位脊髓损伤患者大脑动脉血流检测分析

目的：检测高位脊髓损伤患者伤后不同时期大脑动脉血流速度变化特点。方法：对47例不同时期高位脊髓损伤患者进行彩色多普勒超声检查。结果：伤后3—6个月与6个月以上患者的舒张末期血流速度有显著差异。结论：脊髓损伤患者大脑动脉血流改变，对临床治疗有意义。     

1 例高位截瘫无自主呼吸病人的护理

高位截瘫患者，多数是因为脊髓损伤所造成的截瘫，是由外伤引起，常见于交通事故、工业事故或运动损伤等等。虽然，脊髓损伤所造成的受伤平面以下的运动、感觉的丧失，终身难以恢复，生活不能自理，需要有人照顾。但是，脊髓损伤后斯的护理也是同等重要的。     

自血光量子疗法和腹蛇抗栓酶联合治疗兔脊髓损伤

４８只兔造成脊髓损伤，分为四组：对照组、腹蛇抗栓酶（ＡＡ）治疗组、自血光量子疗法（ＡＬＱ）治疗组以及ＡＡ和ＡＬＱ联合治疗组．通过运动功能、脊髓诱发电位、光镜和电镜的对比研究，发现ＡＬＱ和ＡＡ联合应用的疗效优于ＡＬＱ或ＡＡ单独应用．认为ＡＬＱ和ＡＡ联合应用除了都能改变血液流变学性质外，ＡＬＱ可以提高组织供氧量和氧利用率，ＡＡ可以溶栓疏通微循环，因此具有促进脊髓功能恢复的协同疗效。     

Rapid vascular adaptations to training and detraining in persons with spinal cord injury

OBJECTIVE: To assess the time course of arterial adaptations during 6 weeks of functional electric stimulation (FES) training and 6 weeks of detraining in subjects with spinal cord injury (SCI). DESIGN: Intervention study (before-after trial). SETTING: University medical center. PARTICIPANTS: Volunteer sample of 9 subjects with SCI. INTERVENTIONS: Six weeks of twice weekly FES cycling and 6 weeks of detraining. MAIN OUTCOME MEASURES: Vascular characteristics were measured by plethysmography (baseline and peak blood flow of the thigh) and echo Doppler (diameter of the femoral artery and flow-mediated dilation [FMD]). RESULTS: After 2 weeks of FES training, arterial characteristics changed significantly; there was an increase in baseline and peak blood flow, an increase in femoral artery diameter, and a decrease in FMD of the femoral artery. Detraining reversed baseline and peak thigh blood flow, vascular resistance, and femoral diameter toward pretraining values within 1 week. However, detraining did not restore the FMD of the femoral artery, even after 6 weeks. CONCLUSIONS: Two weeks of hybrid FES training (4 exercise bouts) is sufficient to improve peak leg blood flow and arterial diameter, and to normalize FMD. In addition, detraining results in rapidly reversed vascular characteristics within 1 week.     

颈髓损务呼吸功能不全时压力支持通气的应用

目的 总结颈髓损伤呼吸功能不全患者使用压力支持通气（PSV）的经验。方法 观察不同水平压力支持通气时间吸频率（RR）、潮气量（ VT）、每分通气量（VE）、吸气峰压（PIP）、肺动态顺应性（Cdyn)等数值变化和血气分析变化。结果 观测指标与PSV水平两者呈相关性变化。结论 通过调节PSV水平可使有关呼吸监测指标均改善,使患者处于较为合理的呼吸状态。     

组织多普勒成像技术评价2型糖尿病患者股动脉远端血流阻断下股动脉壁弹性的价值

目的探讨组织多普勒成像技术评估2型糖尿病（T2DM）患者股动脉远端血流阻断下股动脉壁弹性的价值。 方法2012年12月至2014年2月绍兴第二医院收治T2DM患者64例,其中34例股动脉内膜中层厚度（IMT）<1.0 mm,30例股动脉IMT≥1.0 mm,同时选取同期30名健康体检者作为健康对照组。高频超声观察股动脉结构并测量股动脉IMT,应用脉冲多普勒（PW）技术测量股动脉血流频谱。使用血压机阻断股动脉远端血流后,应用PW及组织速度成像（TVI）技术测得股动脉后壁组织运动曲线,测量第一、二峰持续时间。采用t检验分别比较T2DM股动脉IMT<1.0 mm组患者、T2DM股动脉IMT≥1.0 mm组患者与健康对照组受试者IMT差异;采用秩和检验分别比较3组受试者股动脉远端血流阻断下股动脉后壁组织运动曲线第一、二峰持续时间差异。 结果健康对照组受试者、T2DM股动脉IMT<1.0 mm组患者、T2DM股动脉IMT≥1.0 mm组患者IMT分别为（0.80±0.09）、（0.82±0.08）、（1.26±0.19）mm。T2DM股动脉IMT<1.0 mm组患者与健康对照组受试者IMT差异无统计学意义（t=1.67,P=0.10）,T2DM股动脉IMT≥1.0 mm组患者IMT大于健康对照组受试者,且差异有统计学意义（t=16.88,P=0.00）。3组受试者股动脉远端血流阻断前股动脉血流频谱均为一高二低三相波型,股动脉远端血流阻断后股动脉血流频谱也均为二高二低四相波型。股动脉远端血流阻断下,健康对照组受试者、T2DM股动脉IMT<1.0 mm组患者、T2DM股动脉IMT≥1.0 mm组患者股动脉后壁组织运动曲线第一峰持续时间分别为（220.77±59.07）、（250.96±42.62）、（246.55±52.41）ms,3组间差异无统计学意义（u=3.258,P=0.196）;第二峰持续时间分别为（209.18±42.99）、（272.27±39.98）、（344.71±43.96）ms,3组间差异有统计学意义（u=74.150,P=0.000）。 结论股动脉后壁组织运动曲线第二峰持续时间可作为T2DM患者股动脉壁IMT改变前评价股动脉弹性的一个有效指标。     

Hemodynamic effects of intermittent intra-arterial infusion treatment with prostaglandin E1 in peripheral arterial occlusive disease

14 femoral arteries of twelve patients with peripheral arterial occlusive disease (Fontaine stage II: n = 4, stage III/IV: n = 10) were investigated before, immediately after a series of 26 (ten to 52) intraarterial infusions with prostaglandin E1, and 30 weeks later. Using combined B-mode and pulsed Doppler (duplex) ultrasound blood flow measurements were performed in the common femoral, the superficial femoral, and the deep femoral artery. There was a significant decrease of resting blood flow volume in the common femoral artery after therapy (418.5----362.2 [p less than 0.01]----324.5 ml/min [p less than 0.05]) in the group of patients treated successfully. The peak flow (maximum value of blood flow volume during reactive hyperaemia) in the common femoral artery increased significantly after therapy (597.3----779.1 [p less than 0.05]----843.7 ml/min). The increase of peak flow correlated well with clinical improvement. Other parameters (blood flow velocities, pulse rise time, pulse decrease time, pulsatility index) changed without correlation to clinical outcome. The increase of peak flow after therapy might be caused by an improved collateral circulation, and the decrease of resting blood flow might be due to metabolic effects of prostaglandin E1 (improved oxygen utilization).     

Blood flow in the gluteus maximus of seated individuals during electrical muscle stimulation

Blood flow was measured under the ischial tuberosites of seated individuals during electrical stimulation of the gluteus maximus muscles. Eight able-bodied and six spinal cord injured subjects were studied. Muscle blood flow was measured via radioactive tracer (133xenon) clearance. Retention of xenon in adipose tissue prevented accurate measurement of blood flow in cutaneous and subcutaneous tissue. Average muscle blood flow for both subject groups was increased during stimulation as compared to rest. All subjects showed an increase in muscle blood flow during stimulation. The statistical significance from a paired student t-test was greater for able-bodied subjects (p less than .05) than for spinal cord injured subjects (p = .12). The increase in muscle blood flow produced by electrical muscle stimulation in seated individuals supports the hypothesis that electrical muscle stimulation can help prevent pressure sores.     

Burns after spinal cord injury

The problem of burns after spinal cord injury is described. Chart review was performed on thirty-five known cases. All burns occurred below the level of the lesion (p less than .001). Causes included bathing and showering, food and beverage, and therapeutic and environmental heating devices. We conclude that spinal cord injured patients should be educated about the risk of burn injury and the situations in which burns can occur.     

Acrocyanosis in a spinal cord injured patient--effects of computer-controlled neuromuscular electrical stimulation: a case report

This case report documents the treatment of a spinal cord injured patient with acrocyanosis of both feet. The 37-year-old white male patient sustained a traumatic spinal cord injury at the age of 16 years, which resulted in an incomplete vertebral fracture of the C5-C6 level. He was treated with computerized neuro-muscular electrical stimulation (NMES) of the quadriceps femoris muscle with weights applied to the ankles an average of two times per week for six weeks. Improvements in the color of the patient's skin and toe ulcers, stronger pedal pulses bilaterally, decreased swelling bilaterally, and subjective reports of less discomfort were noted. The empirical findings of this case report suggest that computerized NMES may be effective for improving circulation in the spinal cord injured individual with acrocyanosis. Further study, however, is needed to determine whether a relationship may exist between blood flow and computerized NMES.     

股动脉断裂显微外科修复24例分析

目的探讨股动脉断裂显微外科修复的治疗方法。方法2005年1月至2009年12月,对24例因股动脉断裂采用端端吻合、大隐静脉移植修复方法行急诊手术治疗。结果术后肢体均存活,患肢足背动脉搏动恢复,肤色、皮温及毛细血管反应正常。术后3个月行彩色多普勒检查,吻合口血管通畅,无血栓形成及吻合口狭窄,下肢行走功能恢复。结论急诊抢救休克以及尽早修复重建血管是治疗股动脉断裂的关键。     

Ischemic myelopathy: a review of spinal vasculature and related clinical syndromes.

This article provides a comprehensive review of spinal vascular anatomy (arterial and venous) and clinical syndromes that result from the disruption of blood flow to or from the spinal cord. Blood is supplied to the spinal cord through three longitudinal channels: one anterior and two posterior spinal arteries. These vessels, which originate as branches of the vertebral arteries and run caudally along the spinal cord, are augmented by a variable number of medullary arteries. A vascular ring, or vasa coronae, surrounds the cord and connects these longitudinal channels. Central arteries from the anterior spinal artery and penetrating vessels from the vasa coronae provide blood directly to the cord. Venous flow from the spinal cord is also accomplished through a system of anterior and posterior spinal vessels draining through a variable number of medullary veins and an extensive valveless vertebral venous plexus. The disruption of blood flow to or from the spinal cord can result in infarction, with permanent neurologic loss and physical impairment. The clinical presentation in cases of ischemic myelopathy can be variable. Discrete syndromes based on the occlusion of specific vessels are reported and include venous infarction, anterior and posterior spinal artery syndrome, and central infarction.