腹部枪伤瞬间血流动力学变化对脑损伤的作用

目的：从血流动力学方面探讨腹部枪伤时脑部远达效应发生的机制．方法：用５．５６ｍｍＭ１９３枪弹高速致伤狗腹部，用压力传感器分别测试腹主动脉、主动脉弓、颈总动脉起始端和末端的压力变化，并计算各动脉周向应力的变化．结果：枪击瞬间腹主动脉、主动脉弓、颈总动脉起始端和末端压力分别升高６．５６、４．３３、３．２８和２．３４倍，腹主动脉、主动脉弓、颈总动脉起始端周向应力分别增加８．０、５．３和３．６倍．结论：枪击瞬间各动脉内存在强大的压力，这些压力具有变化速度快、幅度大、正负压共存的特点．强大的压力使动脉管壁极度扩张而被致伤．从腹部至颈部动脉间存在着强大的压力差，这就促使大量的血液急速地向脑部冲击，造成脑组织损伤．     

彩色多普勒超声在颈动脉狭窄诊断中的临床应用

目的：研究彩色多普勒超声（Color Doppler Flow Imaging,CDFI）检查对颈部动脉狭窄的诊断价值。方法：分别对115例脑血管病患者和120例正常人进行颈部动脉CDFI检查,测量双侧颈总动脉分叉处及颈内动脉后壁内膜-中膜厚度（IMT）及斑块形成情况。结果：CDFI显示,与对照组相比,疑似颈动脉狭窄组中发现206支颈动脉内膜-中膜增厚,132支伴有斑块形成,收缩期峰值血流速度、舒张末期流速均显著性增高,对照组238支颈动脉各项指标均正常。结论：CDFI可作为检查颈动脉管壁病变的一种优良的观测手段,能准确地判定颈动脉狭窄程度及狭窄位置,为临床提供可靠诊断依据,也能用作治疗后随访手段。     

颈部放疗后与未行放疗鼻咽癌患者颈动脉彩色多普勒超声参数的对比评价

目的通过颈部放疗后与未行放疗鼻咽癌患者颈动脉彩色多普勒超声检查的对比以评价放疗对颈动脉的影响。方法对37例因鼻咽癌接受放疗后亦生存达5年以上的患者与32例新诊断为鼻咽癌而未行放疗的患者进行彩色多普勒超声检查,测量双侧颈总动脉及颈内外动脉的内中膜厚度、收缩期峰值流速、舒张末期流速及斑块形成情况等。结果经彩色多普勒超声检查发现在放疗组患者中有66支颈动脉内中膜增厚,31支伴有斑块形成,各项血流动力学指标均显著增高,而未放疗组中颈动脉各项指标均在正常范围。结论颈部放疗后生存5年以上的鼻咽癌患者常见颈动脉狭窄;彩色多普勒超声检查能准确判断鼻咽癌颈部放疗后颈动脉狭窄程度及位置,早期评估放疗后患者颈部大血管并发症。     

颈动脉球囊扩张再狭窄动物模型的建立

目的　探索再狭窄的发病机制进行干预研究 ,建立颈动脉再狭窄家兔动物模型。方法　取颈部正中切口 ,无菌暴露兔右颈动脉 ;在颈内动脉 (ICA)起始部及颈总动脉 (CCA)近心侧距动脉分叉2cm处用动脉夹临时夹闭 ;自颈外动脉 (ECA)远端结扎并由结扎近心侧穿刺进入导丝、球囊导管 ,撤除CCA动脉夹进行球囊扩张血管成形术 (PTA)。于PTA后不同时间进行组织学及形态学分析 (左侧颈总动脉作正常对照组 )。结果　PTA后早期CCA主要病理改变是血栓形成 ,中晚期为血管平滑肌细胞(VSMC)由中层移行之内膜并失控增殖伴有基质增多 ;第 15天管腔出现明显狭窄 (P <0 .0 1)内膜增厚(P <0 .0 1)。结论　家兔颈总动脉PTA模型模拟了临床过程 ,成功率高 ,为PTA之动脉阶段局部用药或转基因治疗实验首选模型     

二维及多普勒超声评估颈部动脉反流及病因学分析

目的探讨颈部动脉血流反流时血流动力学改变及病因分析。方法经超声检查发现颈部动脉血管反流患者16例,多普勒超声判别血流反向血管并测量收缩期峰值血流速度(PSV),二维灰阶超声探查引起病变的血管结构变化。结果 12例患者因动脉粥样硬化致锁骨下动脉盗血引起椎动脉发生反流,健侧椎动脉内径及PSV均大于反流侧(P0.01)。导致颈部动脉反流的原因并可见于大动脉炎致椎动脉反流、一侧颈总动脉及椎动脉发育不良致对侧椎动脉及锁骨下动脉反流、椎动脉闭塞后侧支循环建立致同侧局部椎间段反流、颈总动脉主干闭塞致颈外动脉反流等。结论超声能方便快捷地判断颈部动脉血流方向,依据动脉管腔内部结构变化为颈部动脉反流提供病因学诊断。     

132例中青年缺血性脑卒中颈动脉硬化危险因素分析

目的探讨中青年缺血性脑卒中颈部动脉硬化危险因素。方法对132例缺血性脑卒中患者行颈动脉彩色多普勒超声检查和危险因素进行回顾性分析,分别检查颈总动脉、颈总动脉窦部及颈内外动脉。结果 132例中有89例颈动脉检出粥样硬化斑块,检出率67.42%,颈动脉单纯内膜增厚41例,检出率46.06%。斑块形成48例,约占89例颈部动脉硬化53.93%。结论原发性高血压、脂肪肝、吸烟、血糖异常等是中青年缺血性脑卒中颈部动脉硬化得主要危险因素。     

新型犬颅脑爆炸伤模型的建立

目的 建立与爆炸性武器冲击波原发效应致伤机制近似的犬颅脑爆炸伤模型.方法 将1g TNT当量的球形爆炸源距致伤犬的右颞顶部9mm、13mm处引爆,记录致伤前后生理指标的变化、致伤后存活时间,观察致伤犬的动作改变及脑组织病理变化.结果 动物伤后均出现呼吸暂停、心率减慢、平均动脉压降低等脑干抑制现象.所有动物存活均超过6h.硬膜下血肿和蛛膜下腔出血较为明显.两致伤组颅脑伤情完全不同.结论 本实验所建立的动物模型可模拟冲击波原发效应,且重复性和稳定性好,安全易操作,适用于颅脑爆炸伤的实验研究.     

三维对比增强颈部动脉MRA动脉期及延迟期影像分析

目的：评价颈部动脉增强MRA动脉期及延迟期的临床应用价值。方法：对85例颈部3D CE-MRA图像显示的动脉形态进行分析,观察每例颈部动脉的6支血管即双侧颈总动脉、双侧颈内动脉和双侧椎动脉。扫描采用3.0TMR系统（Siemens,Trio）,使用高压注射器经肘静脉注射对比剂马根维显后动态扫描。结果：统计85例的双侧颈总动脉、颈内动脉及椎动脉共510支动脉,比较分析动脉期与延迟期就颈部动脉的形态,结果显示完全一致375支,占73.5%,不一致135支,占26.5%。增强MRA动脉期上,有95支颈动脉或椎动脉表现为轻度狭窄,占不一致135支的70.4%,而在延迟期表现为正常。表现在左侧颈总动脉起始部18支,右侧颈总动脉起始部5例,左侧椎动脉起始部38支,右侧椎动脉起始部7例,左侧颈内动脉虹吸段15支,右侧颈内动脉虹吸段12支。另有40支动脉在增强MRA动脉期图像表现为中—重度狭窄,在延迟期则表现为轻度狭窄,夸大了狭窄的程度,占不一致135支的29.6%。其中左侧颈总动脉起始部19支,右侧颈总动脉起始部2支,左侧椎动脉起始部16支,右侧椎动脉起始部3支。结论：3D CE-MRA动脉期易导致动脉的起始部及迂曲部位狭窄的假阳性或夸大狭窄程度,因此在进行3D CE-MRA时不应只进行动脉期扫描,还要进行延迟期的扫描。同时还应结合原始图像,这样才能准确评价动脉的狭窄程度。     

肢体爆炸伤海水浸泡后皮肤软组织的病理改变

目的探讨肢体爆炸伤海水浸泡后皮肤软组织的病理变化特点，为海战伤中采用组织移植等修复方法处理伤口提供理论依据。方法选用纸壳爆破雷管炸伤家兔后肢，将致伤家兔分别置于海水中浸泡30min和1h，并分别在浸泡后2、6、12h取材，肉眼、光镜观察组织形态变化，并与单纯爆炸伤和淡水浸泡组进行比较。结果肢体爆炸伤海水浸泡后皮肤损伤程度、范围以及炎症反应明显重于单纯火器伤组；浸泡时间越长，组织损伤越重；海水浸泡后嗜酸性粒细胞明显增多，与单纯火器伤组和淡水浸泡组有明显区别。结论爆炸伤后海水浸泡不但加重了皮肤组织的继发损伤，而且伤口全部基染，并司见大量嗜酸性粒细胞。本研究结果对海战中研究伤口修复的方法有一定的指导意义。     

选择性血管造影对颈部肿块鉴别诊断的回顾分析

目的：探讨选择性动脉造影在颈部包块鉴别诊断中的价值。方法：20例患者经股动脉穿刺,颈总动脉造影术,6例直接颈总动脉穿刺。造影剂为60％泛影葡胺。部分行数字减影显示。结果：26例患者中颈动脉体瘤14例,颈动脉瘤4例,颈动静脉瘘2例,迷走体化学感受体瘤1例,颈神经鞘膜瘤2例,其它性质肿瘤3例。结论：选择性颈动脉造影对颈部尤其颈动脉三角区肿块的诊断及鉴别诊断很有价值。文本对此进行回归分析并报告了部分典型病例图片,为这一方法在口腔颌面外科应用提供了临床经验。     

异物创伤性动脉瘤犬模型构建的初步探讨

目的：建立异物创伤性动脉瘤的犬模型,为伴血管损伤软组织异物一站式介入治疗研究提供动物模型。 方法：随机选取2年龄的健康雄性比格犬7只,分为颈动脉瘤造模5只和未造模2只,造模于右侧颈动脉共5支血管为研究组,其左侧颈动脉及未造模2只犬两侧颈动脉共9支血管为对照组。研究组将长约15~20 mm的离断颈静脉剪开、缝合于同侧颈总动脉前璧上,以弯型断针穿破静脉片及动脉前壁,静脉片-动脉壁间腔搏动性充盈且无缝缘渗漏后,断针部分留存于该间腔甚或动脉腔内,逐层缝合手术区域组织。然后,经皮经股动脉插管选择性颈总动脉进行数字减影血管造影（DSA）。对照组颈动脉仅于其旁以缝针经皮扎伤软组织且无明显出血及血肿。术前、术后行颈部CT血管成像（CTA）和数字放射摄影（DR）检查与评估。 结果：研究组5支右侧颈动脉断针创伤性动脉瘤均成功造模,技术成功率100%;DSA清晰显示动脉破口、动脉瘤状动脉突起及断针异物,载瘤动脉局部轻度痉挛及狭窄,创伤性动脉瘤模型的瘤颈宽度为（2.1±1.3）mm,瘤体宽（9.7±1.1）mm,瘤体高（4.2±1.7）mm;CTA不如DSA显示效果佳。对照组9支颈动脉均正常。 结论：采用颈静脉片侧-侧吻合于同侧颈动脉前壁上并以断针穿破静、动脉壁且断针部分留置于其间的技术与方法,成功构建了异物创伤性动脉瘤犬模型。     

Occlusion of experimentally created fusiform aneurysms with porous metallic stents

BACKGROUND AND PURPOSE: Carotid fusiform aneurysms are most commonly treated with occlusion of the parent vessel. The purpose of our study was to assess the effectiveness of self-expanding, cobalt-alloy stents in the ablation of experimental fusiform aneurysms with preservation of the parent vessel in a carotid artery model. METHODS: Porous metallic stents were placed endovascularly along the lengths of experimentally created fusiform aneurysms in the carotid arteries of dogs; aneurysms were also created in the animals' opposite carotid arteries to serve as controls. RESULTS: Before stent placement, angiography of the carotid arteries showed large fusiform aneurysms along the lengths of the common carotid arteries and complex patterns of flow. Immediately after stent placement there was disruption of the usual flow patterns within the lumens of the fusiform aneurysms. The lumen between the wall of the aneurysm and stented carotid showed stasis of contrast material and blood. Near-complete ablation of all aneurysms was observed 8 weeks after stent placement. The stented carotid arteries remained widely patent; control aneurysms and carotid arteries were patent and unchanged. Histopathologic analysis revealed fibrotic reactive scar tissue filling the space between the stent wires and outer wall of the fusiform aneurysm. CONCLUSION: Changing blood flow dynamics within an aneurysm can promote thrombus formation. The stent promotes stasis and thrombus within the residual lumen between the stent wall and the outer wall of the aneurysm because its woven wire mesh interferes with usual blood flow patterns, which then promotes formation of thrombus and fibrosis within the residual aneurysmal lumen.     

Successful Endovascular Treatment of a Left Common Carotid Artery Aneurysm Following Failed Surgery of a Right Common Carotid Artery Aneurysm

Aneurysm of the common carotid artery is a rare and serious disease requiring prompt treatment in order to avoid neurologic complications. A 39-year-old man presented with voice impairment and a pulsatile mass at the right side of his neck and was found by color Doppler examination to have bilateral common carotid artery aneurysms of unknown origin. The right-sided large aneurysm was treated with placement of an 8 mm interposition Gore-Tex graft between the right common and internal carotid arteries. The surgical graft thrombosed 7 days after the surgery but the left-sided aneurysm was successfully treated by a Jostent peripheral stent-graft. Color Doppler examination showed a patent stent and no filling of the aneurysm on his first and sixth-month follow-up. Bilateral common carotid artery aneurysm is an exceptionally unusual condition and endovascular treatment of carotid artery aneurysms with covered stents may become an effective treatment alternative for these lesions.     

Arterial saccular aneurysm model in the rabbit.

Saccular aneurysms arising from the common carotid artery in the neck at the origin of the internal carotid artery were created in male rabbits using the stump of a ligated external carotid artery. These stumps were intraluminally perfused with varying concentrations of porcine pancreatic elastase for 45 minutes via a microcatheter introduced into the femoral artery. The aneurysms were allowed to mature for 2 to 12 weeks. Gross examination and histologic studies confirmed the presence of an aneurysm in all 15 experiments. Ninety-two percent (12 of 13) of the aneurysms studied by postoperative angiography were shown to be angiographically patent: 40% of all aneurysms were noted to be patent at harvest; and the remainder showed evidence of intraluminal thrombus. On histologic examination, all aneurysms showed complete loss of elastic lamina without evidence of fibrosis or scarring.     

A Case of Habitual Neck Compression Induced Electroencephalogram Abnormalities: Differentiating from Epileptic Seizures Using a Tc-99m HMPAO SPECT

Self-induced hypoxia has been reported particularly in adolescents, and it can result in neurological injury. Here, we present a case of electroencephalogram (EEG) abnormalities induced by habitual neck compression differentiated from epileptic seizures by Tc-99m HMPAO SPECT. A 19-year-old male was admitted for evaluation of recurrent generalized tonic-clonic seizures. No interictal EEG abnormality was detected; however, abnormal slow delta waves were found immediately after habitual right neck compression. To differentiate EEG abnormalities due to a hemodynamic deficit induced by habitual neck compression from an epileptic seizure, Tc-99m HMPAO SPECT was performed immediately after right carotid artery compression. Abnormal delta waves were triggered, and cerebral hypoperfusion in the right internal carotid artery territory was detected on Tc-99m HMPAO SPECT. The slow delta wave detected on the EEG resulted from the cerebral hypoperfusion because of the habitual neck compression.     

血管内支架结合电解可脱卸弹簧圈治疗犬颈动脉宽颈动脉瘤的实验研究

目的 通过支架植入及结合电解可脱卸弹簧圈治疗犬颈动脉宽颈侧壁囊性动脉瘤实验研究评价动脉瘤栓塞后的血流动力学及组织学改变。方法 于6只健康犬双侧颈动脉分别建立宽颈侧壁动脉瘤,一侧单纯支架植入,对侧行支架植入结合弹簧圈栓塞。行血管超声和血管造影检查,并观察大体解剖及电镜检查：结果单纯支架植入的动脉瘤内无血栓形成,瘤颈处新生内膜生长较慢,而支架结合弹簧圈治疗的动脉瘤内很快形成血栓,新生内膜能完全覆盖动脉瘤颈。结论 血管内支架结合电解可脱卸弹簧圈治疗宽颈动脉瘤不但可以降低动脉瘤再破裂的风险,而且能达到动脉瘤解剖学治愈。     

Elastase-induced aneurysms in rabbits: effect of postconstruction geometry on final size

BACKGROUND AND PURPOSE: Elastase-induced aneurysms in rabbits have become an accepted model to study endovascular treatment. The size and shape of the resulting aneurysms may vary widely. Our goal was to predict the final aneurysm morphology on the basis of immediate postinduction geometry. METHODS: Thirty New Zealand white rabbits were used. Aneurysms were created at the origin of the right common carotid artery (CCA). Intraluminal incubation of elastase was applied to the origin of CCA with proximal balloon occlusion of the artery. The aneurysms were allowed to mature for 3 weeks and evaluated by digital subtraction angiography. We retrospectively measured neck diameter, dome height, and aneurysm diameter, as well as the angle between the parent artery and the main axis of the aneurysm neck. We performed correlation analysis with immediate postinduction geometry. RESULTS: The diameter of the origin of the CCA measured immediately after elastase incubation correlated positively to the mature aneurysm neck (P < .01). Moreover, the aneurysm neck both after the aneurysm creation and at 3-week follow-up had a positive correlation with the final dome height (P < .05). Finally, the dome height was related to the angle between the centerline of the innominate artery and axis of the aneurysm neck for dome diameter-to-neck ratio of <1.5 (P < .05). CONCLUSION: These results indicate that neck width immediately after creation and the curvature of the parent artery are linked to the final aneurysm dimensions, and we may be able to predict the size of aneurysm on the day of creation.     

爆炸冲击伤的诊断

爆炸冲击伤是爆炸后冲击波超压直接作用机体,因释放能量而产生的各种损伤,属原发性爆炸伤。爆炸冲击伤表现外轻内重,多发伤、复合伤多见,脏器挫伤重,伤情发展迅速,诊断难度大。本文详细介绍了爆炸伤的分类及爆炸冲击伤的致伤机制,肺、胃肠道和耳爆炸冲击伤的临床表现,X线片、CT和超声检查,动脉血气以及耳镜及电耳镜、听功能和前庭功能等检查手段,并阐述了常见爆炸冲击伤的诊断要点。     

Abciximab for thrombolysis during intracranial aneurysm coiling

Introduction  Thrombotic events are a common and severe complication of endovascular aneurysm treatment with significant impact on patients’ outcome. This study evaluates risk factors for thrombus formation and assesses the efficacy and safety of abciximab for clot dissolution. Materials and methods  All patients treated with abciximab during (41 patients) or shortly after (22 patients) intracranial aneurysm coil embolisation were retrieved from the institutional database (2000 to 2007, 1,250 patients). Sixty-three patients (mean age, 55.3 years, ±12.8) had received either intra-arterial or intravenous abciximab. Risk factors for clot formation were assessed and the angiographic and clinical outcome evaluated. Results  No aneurysm rupture occurred during or after abciximab application. The intra-procedural rate of total recanalisation was 68.3%. Thromboembolic complications were frequently found in aneurysms of the Acom complex and of the basilar artery, whilst internal carotid artery aneurysms were underrepresented. Two patients died of treatment-related intracranial haemorrhages into preexisting cerebral infarcts. Two patients developed a symptomatic groin haematoma. Conclusions  Abciximab is efficacious and safe for thrombolysis during and after endovascular intracranial aneurysm treatment in the absence of preexisting ischaemic stroke.     

1999 ARRS Executive Council Award. Creation of saccular aneurysms in the rabbit: a model suitable for testing endovascular devices. American Roentgen Ray Society

OBJECTIVE: This study developed an animal model of intracranial aneurysms suitable for evaluating emerging endovascular devices for aneurysmal therapy. We characterized the short-, medium-, and long-term attributes of this endovascular technique for saccular aneurysmal creation in the rabbit. MATERIALS AND METHODS: The right common carotid artery was surgically exposed in nine New Zealand white rabbits. Using endovascular techniques, we occluded the origin of the right common carotid artery with a pliable balloon. Elastase was incubated endoluminally in the proximal common carotid artery above the balloon. The common carotid artery was ligated distally. Animals were studied angiographically and sacrificed at 2 weeks (n = 3), 10 weeks (n = 3), and 24 weeks (n = 3) after aneurysm creation. Histology was obtained. RESULTS: Saccular aneurysms formed in eight of the nine rabbits. The aneurysm projected from the apex of an approximately 90 degree curve of the parent vessel, the brachiocephalic artery. Mean aneurysm diameter was 4.5 mm (SD, 1.2 mm), and mean height was 7.5 mm (SD, 1.6 mm). All samples showed thinned elastic lamina and no evidence of inflammation. In four of eight aneurysms, unorganized thrombus was present in the dome of the aneurysm. CONCLUSION: Arterial aneurysms with intact endothelium and deficient elastic lamina were reliably created in an area of high shear stress in New Zealand white rabbits. Three of these aneurysms remained patent for at least 6 months. We found a simple procedure that can be readily applied to the testing of new endovascular devices for a reliable creation of aneurysms in rabbits.