妊娠合并多发性大动脉炎行剖宫产术的麻醉一例

患者 ,女 ,2 3岁 ,体重 72kg ,因足月妊娠、头盆不称 ,全身大动脉炎入院行剖宫产术。患者于孕期 3、7月时分别常规查体 ,双上肢均未测及血压及脉搏 ,但无异常不适 ,未行任何治疗措施 ,否认家族及个人有重大疾病及遗传病史。术前检查 :T 36 5℃ ,P双侧桡动脉测不到 ,HR 89次 /分 ,RR 2 2次 /分 ,BP双侧肱动脉测不到。查体 :双下肢足背动脉搏动尚好 ,心肺功能正常 ,颈部可闻及血管杂音 ;二维超声所见 :双颈总动脉、锁骨下动脉、腋动脉及头臂干内膜均明显增厚 ,左颈总动脉面积狭窄率 5 0 % ,右颈总动脉面积狭窄率 6 0 % ,流速分别为 2 0 …     

大动脉炎的外科治疗：附85例报告

大动脉炎的外科治疗（附８５例报告）北京邮电医院血管外科研究所（１０００３２）汪忠镐谷涌泉大动脉炎是一种主动脉及其分支的多发性、全层动脉的非化脓性炎症性疾病，常引起动脉狭窄或闭塞，偶尔引起动脉瘤样改变。我院自１９９２年６月至１９９６年６月共收治８５例，...     

妊娠合并胰腺炎7例报告

摘要：回顾性分析7例妊娠合并急性胰腺炎（AP）的临床资料。经B超、血淀粉酶、血脂检查各6例， 其中3例合并胆道结石，6例有高脂血症，4例血淀粉酶增高。及时诊断6例，延误诊断1例。非手术治疗5例并继续妊娠，母婴均存活。手术治疗2例，同时终止妊娠，2例患者及1例胎儿存活，1例胎儿死亡。提示胆道结石和高脂血症是妊娠合并AP的重要诱因。酶学及影像学检查是重要的诊断方法。治疗应遵循“个体化”原则。     

脑缺血型大动脉炎的外科治疗：附45例报告

大动脉炎作为一种危害性极大的主动脉及其分支的多发性、全层动脉的非化脓性炎性疾病，尤其是脑缺血型大动脉炎危害性更大，致残率、病死率均高，处理也甚棘手。我院于１９９２年６月至１９９７年６月共手术治疗４５例脑缺血型大动脉炎的病人。其中不少为颈部四动脉病变病...     

大动脉炎患者的生育力和妊娠风险

大动脉炎(Takayasu arteritis, TA)是指主动脉及其主要分支的慢性进行性非特异性炎症引起的不同部位动脉狭窄或闭塞,少数可引起动脉扩张或动脉瘤,出现相应部位缺血。TA属于免疫性疾病,常用糖皮质激素和环磷酰胺等药物治疗。无论是可能存在的自身免疫反应还是药物的影响,均可能造成不同程度的卵巢储备功能下降乃至生育力下降。另外,由于血管性病变的特点,TA患者妊娠可出现妊娠期高血压疾病、胎儿生长受限、早产以及心脑血管意外等并发症,但发病率通常仅是轻度升高,与对照组相比并不具有显著差异,整体预后良好。TA患者孕前需充分评估病情,病情稳定方可妊娠。孕前基础血压高、病变累及腹主动脉或合并肾动脉狭窄者,孕期出现母胎并发症风险更高。本文通过回顾性分析合并TA的不孕和妊娠病例各1例,系统复习TA与生殖的相关内容,有助于开拓临床视野。     

妊娠合并急性胰腺炎的诊断与治疗（附5例报告）

目的　提高对妊娠合并急性胰腺炎的认识和警惕性 ,降低孕产妇的病死率。方法　对本院 1992年 3月～ 2 0 0 2年 3月收治的妊娠合并急性胰腺炎的 5例进行回顾性分析。结果　本组病例大多发病于妊娠晚期 ,且多为重症急性胰腺炎 ;误诊 2例 ,误诊孕产妇病死率显著增高 ;中止妊娠不能降低孕产妇病死率。结论　妊娠合并急性胰腺炎的早期诊断与治疗是改善病人预后的基础 ,其治疗应遵循“个体化”原则 ,并协同妇产科医生妥善进行胎儿的处置     

妊娠合并急性阑尾炎的早期诊断和外科治疗（附26例报告）

目的总结妊娠合并急性阑尾炎的临床特点及手术效果。方法妊娠合并急性阑尾炎26例,平均发病时间28.2（4-72）h。术前明确诊断23例,术前疑诊3例。均行阑尾切除术,入院至手术平均时间4.7（1.8-44）h。结果术后2例切口感染,1例应患者要求行药物流产,余无流产、早产、胎儿宫内窘迫及死胎发生。所有病例均获随访,平均10.5（9-12）个月,1例术后4月发生轻度粘连性肠梗阻,保守治愈。结论妊娠合并急性阑尾炎临床特点不典型,但根据病史、体检,结合B超检查作出早期诊断亦不困难,一旦确诊应尽早手术,以保证母婴安全。     

输尿管镜术治疗妊娠合并肾绞痛（附12例报告）

妊娠合并肾绞痛不仅给孕妇带来痛苦,而且常因处理不当危及胎儿健康。目前可供选择的诊断、治疗手段较少,确诊和治疗均较困难。2003年1月～2008年1月,我们对12例妊娠合并肾绞痛者采用输尿管镜手术治疗,均取得满意疗效,现报道如下。     

输尿管镜弹道碎石术治疗妊娠合并输尿管结石（附52例报告）

目的 探讨妊娠合并输尿管结石的诊断和处理方法。方法 回顾分析我院2008年1月～2013年12月采用输尿管硬镜弹道碎石术治疗妊娠合并输尿管结石共52例患者临床资料。结果 52例患者中,上段结石18例,8例一次性碎石取石成功（44.4%）,10例因输尿管推移、息肉、狭窄等仅放置双J管（55.6%）;下段结石34例均一次性碎石取石成功（100%）。手术时间10～40min,平均时间23min。术后所有患者腰腹痛、发热等症状消失。1例术后出现先兆早产（1.9%）,经处理后缓解。结论 输尿管镜弹道碎石术治疗妊娠合并输尿管结石安全,损伤小,对输尿管下段结石碎石取石率高,是治疗妊娠期输尿管结石的有效方法之一。     

中西医结合治疗多发性大动脉炎60例报告

多发性大动脉炎是累及主动脉及其主要分支的慢性、进行性、非特异性炎症 ,属中医“脉痹”、“血痹”等范畴。本病病因尚不明确 ,缺乏根治方法。我们自 1985年以来用中西医结合方法治疗 6 0例 ,取得较满意疗效 ,现分析报告如下。1　临床资料1 1　一般资料　本组 6 0例 ,年龄 12～ 50岁 ,平均2 2岁。男性 8例 ,女性 52例 ,男女比例为 1∶6 5。病程最长 2 0年 ,最短 2个月 ,其中 1年以内者 14例 ,1～ 5年者 2 2例 ,6～ 10年者 13例 ,11年以上者 11例。1 2　病变类型　头臂动脉型 2 0例 ,主 -肾动脉型14例 ,广泛型 2 6例。中医辨证阴虚内热…     

Anaesthetic management in a parturient with Takayasu arteritis

We report the anaesthetic management of a parturient suffering from Takayasu's arteritis scheduled for elective caesarean section. A full term 29-year-old female weighing 50 kg, height 152 cm, gravida3, para 1 with previous lower segment caesarean section (LSCS) was scheduled for elective LSCS. Patient had suffered a right sided frontoparietal infarct 14 years back for which she underwent treatment in the form of medication from some higher centre She was advised tablet aspirin 75 mg and prednisolone 40 mg once a day. Digital subtraction angiography showed complete occlusion of origin of both subclavian and carotids and reformation of collaterals. Echocardiography revealed mild concentric left ventricular hypertrophy, trivial AR and normal left ventricular systolic function. Caesarean section was planned under regional anaesthesia with monitoring gadgets placed on lower limb. Subarachnoid block (SAB) was administered with 7.5 mg hyperbaric bupivacaine along with 25 μg fentanyl at lumbar 4–5 interspace, using a 25-G Quincke Babcock needle. Intra-operative period was uneventful with minimal fall in blood pressure which was managed accordingly. Parturient was stable in the postoperative period and was moved to a ward after being monitored for 24 h in ICU.     

Endovascular stenting of mid-aortic syndrome due to Takayasu arteritis

Introduction–patients: Takayasu arteritis may involve various parts of the aorta and its major branches. It leads to occlusive or aneurysmal disease of the vessel. It can be treated either with surgery or percutaneous intervention. We report a successful endovascular treatment of stenosis of the descending thoracic and abdominal aorta in a 19-year-old female.

Methods–results–conclusions: Self-expandable nitinol stent was deployed and adequate opening of the aorta was obtained in this patient. Long-term durability of endovascular approach is a matter of debate. We also reviewed the sufficiency of endovascular treatment versus surgery.     

Takayasu arteritis: clinical features and management: report of 272 cases

BACKGROUND: Takayasu's arteritis is a condition of unknown aetiology with an unpredictable natural history. Most of the literature available has originated from Asia, with a few contributions from Africa where the pattern of the disease may be different. This is a single institution's experience review. METHODS: Data were obtained retrospectively from the angiographic and medical records of patients treated at Groote Schuur Hospital over the period 1952-2002. The criteria for inclusion were those proposed by the Aortitis Syndrome Research Committee of Japan and the American College of Rheumatology. RESULTS: Two hundred and seventy-two patients were identified. The mean age at presentation was 25 years (range 14-66 years) and 75% were female. Only 8% were Caucasian. Hypertension was the most common presentation (77%) and was usually a consequence of renal artery stenosis or aortic coarctation. Cardiac failure was the most common problem. Cerebrovascular symptoms were recorded in 20%. Convincing evidence of tuberculosis was present in 20%. The entire aorta was involved in 70% of cases. Thirty per cent had aortic bifurcation involvement. Occlusions were noted in 93% and aneurysms in 46%. Vascular reconstruction was performed on 115 occasions in 99 patients, with an operative mortality of 4%. Cardiac failure was the usual cause of death. One hundred and six patients (39%) were followed for a minimum of 5 years. No further progression of disease was noted in 70 patients. CONCLUSION: The natural history and prognosis of Takayasu's arteritis still remain poorly defined.     

螺旋CT三维血管成像诊断大动脉炎

目的探讨螺旋CT血管三维成像检查多发性大动脉炎的诊断价值。方法回顾性分析56例大动脉炎患者的螺旋CT三维血管成像特点。结果56例大动脉炎病变血管清晰显像,共发现受累血管175支,其中累及最多的为锁骨下动脉（36.00%,63/175）,且左锁骨下动脉所占比率较高（24.00%,42/175）,其次是颈总动脉（29.71%,52/175）,肾动脉（10.86%,19/175）;受累动脉管壁不同程度地向心性或偏心性增厚,管腔狭窄或闭塞。结论多层螺旋CT三维血管成像可明确多发性大动脉炎的诊断及病变范围、程度和性质,值得临床推广应用。     

Imaging diagnosis and interventional radiology in systemic vasculitis with particular emphasis on Takayasu arteritis: Part 1

This is a review article describing some new and interesting aspects in the diagnosis and treatment in systemic vaseulitis and demonstrating several cases that we have encountered. Particular emphasis will be put on Takayasu arteritis(also known as aortitis syndrome) most commonly observed in Japan and other oriental countries. CT and MRI better demonstrate the vessel wall abnormality of Takayasu arteritis than angiography. Importance of plain chest radiograph should also be kept in mind;it could provide a clue in the diagnosis of Takayasu arteritis in its early stage.     

A girl with Takayasu arteritis associated with possible systemic lupus erythematosus

Takayasu arteritis is an inflammatory disease that affects the aorta and its main branches. Its etiology is obscure. Its association with systemic lupus erythematosus has been reported in the English literature in about 20 cases worldwide, and a relationship with a positive tuberculin test, either with or without tuberculosis, has also been mentioned. We report a pediatric patient who presented with renovascular hypertension secondary to Takayasu arteritis associated with a strongly positive tuberculin test and who subsequently developed possible systemic lupus erythematosus 8 months later.     

基于临床和CT血管造影特征分析儿童多发性大动脉炎并发心功能不全危险因素

目的 基于临床和CT血管造影(CTA)特征分析儿童多发性大动脉炎(TA)并发心功能不全(CD)的危险因素。方法 回顾性分析39例TA患儿,男9例、女30例,年龄1个月～15岁、中位年龄8岁。39例中,7例伴CD(CD组),均为女性,年龄2～15岁、中位年龄13岁;32例无CD(无CD组),男9例、女23例,年龄1个月～14岁、中位年龄7岁;对比分析2组患儿性别、年龄及主动脉受累部位等。结果 2组患儿年龄分布范围差异有统计学意义(P<0.05)。高血压、升主动脉受累是TA患儿伴发CD的独立危险因素(P均<0.05),高血压及升主动脉受累TA患儿发生CD的概率分别为非高血压及无升主动脉受累者的14.493和13.889倍。结论 高血压及升主动脉受累均为TA患儿伴发CD的独立危险因素,应积极予以干预。