盐酸沙格雷酯治疗Bell麻痹的疗效

Bell麻痹是茎乳孔内面神经非特异性炎症所致的周围性面神经麻痹,属于常见的周围神经疾病之一.国内流行病学调查发现,该病发病率高达49.77万/年[1].治疗本病多采用激素、维生素等药物,但仍有部分患者恢复不佳.我科采用盐酸沙格雷酯治疗Bell麻痹,疗效较佳.1 资料与方法1.1 临床资料 选取在我院神经内科门诊就诊的患者,入选标准:①符合《The Massachusetts Jeneral Hospital Handbook of Neurology》 Bell麻痹诊断标准[2];②初次急性发病;③病程≤5d;④无中枢神经系统、后颅凹、耳的症状和体征;⑤排除糖尿病、自身免疫性疾病如GBS等.入组的59例患者随机分成对照组(30例)对治疗组(29例).两组在性别、年龄、病程及入组时面神经瘫痪程度等方面差异无统计学意义(P＞0.05).1.2 方法 对照组予泼尼松、维生素B1和弥可保口服.由带状疱疹引起者,加用阿昔洛韦抗病毒治疗,疗程28 d.治疗组:在对照组用药基础上加用盐酸沙格雷酯0.1,3次/d.     

下肢动脉硬化闭塞症支架置入后服用盐酸沙格雷酯的疗效观察

目的:探讨盐酸沙格雷酯治疗下肢动脉硬化闭塞症(arteriosclerotic obliterans,ASO)支架置入术后患者的疗效。方法:2008年6月至2009年10月,共52例因ASO而行下肢动脉支架置入术的患者,共57条患肢,随机分成两组,治疗组(26例,29条患肢)给予盐酸沙格雷酯100mg/次,3次/d,口服,对照组(26例,28条患肢)给予胰激肽原酶肠溶片120U,3次/d,口服。治疗6个月后从患者症状、跛行距离(distance of claudication,DOC)、踝肱指数(ankle/brachial index,ABI)、经皮氧分压(transcutaneousoxygen pressure,TcPO2)、支架再狭窄率、药物不良反应等方面判断治疗效果。结果:和对照组相比,治疗组术前ABI、TcPO2及DOC差异无统计学意义(P>0.05);术后2 w ABI、TcPO2差异无统计学意义(P>0.05);术后6个月ABI差异无统计学意义(P>0.05),TcPO2及DOC均改善,差异有统计学意义(P<0.05);治疗组主观感觉症状改善者25例,出现支架再狭窄1例,对照组主观感觉改善者22例,支架再狭窄3例,两者差异无统计学意义(P>0.05);治疗组支架两组术后用药未见明显不良反应。结论:盐酸沙格雷酯用于ASO支架置入术后治疗效果明确,安全、方便,值得推广。     

股腘动脉闭塞症的诊断和治疗中国专家共识

股腘动脉闭塞症是下肢动脉硬化闭塞症中最常见的疾病,表现为间歇性跛行、静息痛、肢体溃疡坏疽等症状,严重影响患者生活质量,甚至危及肢体及生命。随着腔内血管外科技术和器械的发展,其治疗理念和技术有了很大的改变,本共识根据国内近年来的临床实践经验,结合最新循证资料以及国外相关指南,提出适合中国人群特点的诊疗规范推荐意见,旨在为国内血管外科及相关领域医师提供最新的临床实践依据。     

盐酸沙格雷酯对糖尿病周围神经病变的疗效观察

目前治疗糖尿病周围神经病变的手段非常有限。盐酸沙格雷酯通过选择性拮抗5-羟色胺受体可抑制血小板凝集和血管平滑肌收缩。我们应用盐酸沙格雷酯对糖尿病周围神经病变患者进行治疗,观察其临床疗效,报告如下。对象和方法1.对象:2003~2004年在我科就诊的糖尿病患者103例,其中1型     

血管镜辅助下内膜切除术治疗长段股—腘动脉闭塞35例疗效观察

目的提高长段股—腘动脉闭塞性病变的治疗水平。方法对35例长段股—腘动脉闭塞性病变患者行血管镜辅助下半闭合式内膜切除术：依据术前影像学资料,在病变动脉远、近端纵形切开,切除动脉内膜。动脉腔内引入血管镜,检查残留斑块或内膜,用Fogarty取栓导管或内膜剥脱器进一步处理,缝合固定远端内膜断端。结果手术成功率100%,动脉内膜切除长度10～36（25±8）cm,手术时间85～250（160±70）min。其中5例同时行股深动脉扩大成形术,3例行髂动脉球囊扩张及支架植入术,1例行髂外动脉内膜切除术。术后出现切口并发症2例,足趾溃疡5例,均经换药后愈合。术后踝肱指数由术前0.45±0.13提高至0.95±0.18（P〈0.01）。术后2周经动脉置管造影证实股—腘动脉通畅率100%。随访1～24个月,累积通畅率85.7%,保肢率100%。结论血管镜辅助下半闭合式内膜切除术治疗长段股—腘动脉闭塞性病变安全有效,近期通畅率与旁路手术及腔内介入手术相近,远期通畅率有待进一步观察。     

盐酸沙格雷酯对糖尿病伴膝下动脉病变球囊扩张成形术后疗效的影响

目的:观察盐酸沙格雷酯对糖尿病膝下动脉病变,球囊扩张成形术(PTA)后再狭窄的疗效。方法:选择我科2007年4月至2011年8月收治2型糖尿病合并重症下肢缺血患者46例,男性21例,女性25例,年龄49～93岁,平均73.03岁。所有患者均为单纯膝下3支动脉病变。按随机数字表法将入选患者按1∶1的比例随机分为对照组(拜阿斯匹林)和治疗组(拜阿司匹林联合盐酸沙格雷酯),每组23例。PTA术后基础治疗两组一致,治疗组加用盐酸沙格雷酯片(安步乐克,100 mg,每日3次,日本三菱制药),治疗时间为6个月。疗效观察时间为PTA治疗前、治疗后3个月、6个月。观察项目为静息痛缓解、溃疡愈合、术后成功开通血管通畅及再狭窄的情况,将静息痛完全缓解,或者溃疡愈合评为疗效显著。结果:糖尿病性膝下动脉病变PTA术后,治疗组的症状改善及疗效优于对照组。结论:盐酸沙格雷酯对糖尿病膝下血管病变PTA治疗后,再狭窄的预防、缺血症状的改善有较好的作用。     

应用盐酸沙格雷酯治疗Buerger's病1例

<正>患者男性,31岁,因双侧下肢间歇性跛行11年,加重6个月,右足溃疡1个月入院。患者于11年前出现双下肢间歇性跛行、行走约100 m。入院前6个月,跛行距离缩短为50 m。入院前1个月出现静息痛、足部溃疡,右足先后3处皮肤破溃、迁延不愈,跛行距离缩短为10m。在外院住院查下肢动脉B超提示:双侧髂总、股总、股浅、腘动脉及足背动     

双导丝球囊治疗股腘动脉病变的前瞻性随机对照研究

目的:评价双导丝球囊治疗股腘动脉病变的近期临床效果及安全性。方法:选取我中心股腘动脉病患者67例,随机分为双导丝球囊组(35例)及普通球囊组(32例)分别进行介入治疗。两组患者间性别比例、年龄、术前踝肱指数(ABI)、Rutherford分级2/3/4/5、病变长度、吸烟比例、以及合并糖尿病、高血压、冠心病、心功能不全、肾功能不全、高脂血症比例,差异无统计学意义。比较两组患者支架置入率,术后ABI增加值、卢瑟福分级改善率、再狭窄率、LLL及TRL。结果:双导丝球囊组支架置入率为62.9%低于普通球囊组的84.4%;12个月随访结果显示,双导丝球囊组ABI增加值0.31(0.16,0.39)及卢瑟福分级改善率88.6%均高于普通球囊组,而再狭窄率17.1%、LLL 0.5(0.1,0.9)mm及TRL 11.4%均低于普通球囊组,差异有统计学意义;两组的截肢率及全因死亡率,差异无统计学意义。结论:双导丝球囊治疗股腘动脉病变临床效果显著且安全。     

药物涂层球囊在股腘动脉狭窄闭塞疾病中的临床应用

正由于腔内治疗的良好疗效及微创可重复的特点,腔内手术已经成为治疗周围动脉疾病的首选方法。经皮球囊扩张术(percutaneous transluminal angioplasty,PTA)是腔内治疗的首选技术之一,利用PTA开通血管技术的成功率超过95%,但再狭窄率高达20%~65%~([1])。再狭窄发生率高及远期疗效不佳,已成为现阶段周围动脉腔内治疗领域亟待解决的主要问题。药物涂层球囊(drug-coated balloon,DCB)是在标准     

Viabahn覆膜支架与裸支架治疗股腘动脉硬化闭塞症疗效分析

目的分析Viabahn覆膜支架与裸支架治疗股腘动脉硬化闭塞症的临床疗效。方法回顾性分析2016-01~2017-01采用腔内手术治疗的75例(75条患肢)股腘动脉硬化闭塞症患者的临床资料。Viabahn覆膜支架治疗组患者35例,裸支架治疗组患者40例,比较两组患者血管再通情况并分析影响一期通畅率的因素。结果 75例患者(75条患肢)手术均获得成功,随访时间24个月。Viabahn支架组术后3、6、12、24个月一期通畅率分别为97. 14%、91. 43%、80. 00%、68. 57%,二期通畅率分别为100. 00%、97. 14%、91. 43%、85. 71%;裸支架组术后3、6、12、24个月一期通畅率分别为90. 00%、75. 00%、52. 50%、42. 50%,二期通畅率分别为97. 50%、92. 50%、87. 50%、80. 00%。Log-rank检验提示两组一期通畅率差异有统计学意义(χ2=5. 318,P=0. 021),二期通畅率差异无统计学意义(χ2=0. 536,P=0. 464)。吸烟、高血脂、糖尿病是影响一期通畅率的独立危险因素(P=0. 007、0. 003、0. 063)。结论 Viabahn覆膜支架相较裸支架治疗股腘动脉硬化闭塞症疗效更确切。     

Prolonged urokinase infusion for chronic total native coronary occlusions: Clinical,angiographic, and treatment observations

Prolonged intravascular infusion of urokinase has proven beneficial in reestablishing patency of chronically occluded peripheral arteries and saphenous vein grafts. This study was performed to assess the efficacy and safety of prolonged urokinase infusions as a prelude to angioplasty in chronically occluded native coronary arteries, that had failed standard angioplasty techniques. Twenty-five patients with objective evidence for ischemia in the distribution of a chronic coronary occlusion were referred for percutaneous intervention. Patients were assessed for any potential exclusions from lytic therapy. Urokinase infusion through both a SOS wire and a stable guiding catheter was continued at 100,00–240,000 units/hr for 8–25 hr; patents then underwent attempted balloon angioplasty. Mean duration of urokinase infusion was 20.6 ± 7.7 hr (total dose 163,000 ± 52,447 units/hr). Fibrinogen levels dropped slightly with this (300 ± 129 to 203 ± 81 mg/dl, P = 0.02). Angiography posturokinase showed improvement in 7 (28%) with regard to coronary flow (± 1 TIMI-grade). Angioplasty was successful in 13 (52%), with final angiographic result revealing thrombus in 5 (20%), or dissection 8 (32%). The infusions were well-tolerated with a low incidence of chest pain, 2 (8%); or ischemic ECG response, 2 (8%); myocardial infarction, 2 (8%); or significant bleeding 2 (8%). All patients survived the procedure, with a length-of-hospital stay = 5.1 ± 4 days. Use of prolonged preangioplasty intracoronary urokinase infusion can be done safely with success in roughly one-half of patients with chronic total native coronary occlusions who have failed prior attempts at percutaneous intervention. A larger more rigorously designed protocol is required to make specific recommendations about technique, cost, and long-term follow-up.     

Paclitaxel-eluting stents for the treatment of chronic total coronary occlusions: a strategy of extensive lesion coverage with drug-eluting stents.

The recanalization of a chronic total coronary occlusion (CTO) is hampered by a high rate of lesion recurrence. The goal of the present study is to assess the effect of paclitaxel-eluting stents in CTOs in a strategy of extensive stent coverage and the optional use of additional bare metal stents (BMSs). In 82 consecutive patients, a CTO (duration > 2 weeks) was successfully recanalized with implantation of one or more Taxus stents. These patients underwent a repeat angiography after 5.0 +/- 1.5 months and were assessed by quantitative angiography. The patients were compared with 82 clinically and lesion-matched patients from a consecutive series of 148 patients with CTOs treated by BMS in the preceding time period. In 21 of the 82 patients, additional lesions in the target artery not directly related to the original occlusion site were treated with BMSs (hybrid approach). The history of diabetes, extent of coronary artery disease, clinical symptoms, and angiographic features were similar in the Taxus and BMS group. Periprocedural adverse events were 3.3% with Taxus and 3.3% with BMS, but 12 months MACE was significantly lower in the group with exclusive use of Taxus (13.3% vs. 56.7%; P < 0.001), mainly due to a lower target lesion revascularization of 10.0% as compared to 53.4% (P < 0.001). There was only one late reocclusion with Taxus (1.7%) as compared to 21.7% with BMS (P < 0.05). However, in the hybrid group, the MACE rate was considerably higher, with 33.3%. Our data of a 80% reduction of target vessel failure as compared to BMS, with a lower risk of late reocclusions without increased acute adverse events, demonstrate the benefit of paclitaxel-eluting stents in CTOs. However, diffuse atherosclerosis in CTOs should be covered completely by the drug-eluting stents.     

Traditional antegrade approach versus combined antegrade and retrograde approach in the percutaneous treatment of coronary chronic total occlusions

Objectives : The goal of this study was to compare the antegrade‐approach and bilateral‐approach strategies for chronic total occlusion (CTO). Background: The retrograde approach has been reported for difficult CTO lesions. Methods : This study assessed 96 consecutive patients with 119 CTO lesions. The lesions were treated with either an antegrade approach (A group) or a combined bilateral antegrade and retrograde approach (B group). The specific intervention techniques, in‐hospital success rate, and major adverse cardiac and cerebrovascular events (MACCE) were compared. Results : Lesions with well‐developed septal collaterals with nontortuous microchannels were preferentially chosen for the B group versus A group (P < 0.001 and 0.008, respectively). Compared with the A group, there were more CTO lesions located in the right coronary artery in the B group (P < 0.001). In the B group, the CTO lesions had a longer length and needed stiffer wires for crossing than in the A group (P = 0.001 and 0.046, respectively). The technical success rate was 94% and 86% for the A group and the B group, respectively (P = 0.127). In‐hospital complications were not different between the two groups. The B group needed a higher radiation exposure dose and a greater exposure time than the A group (P < 0.001). In the B group, use of the retrograde method significantly increased the final success rate. Conclusions: These results suggest that all CTO lesions should first be managed with an antegrade approach. When there is difficulty crossing the lesion, switching to a bilateral approach is an option for lesions with well‐developed collaterals. © 2009 Wiley‐Liss, Inc.     

Coronary septal collaterals as an access for the retrograde approach in the percutaneous treatment of coronary chronic total occlusions.

OBJECTIVES: To investigate the feasibility and safety of the percutaneous dilatation of coronary septal collaterals and to allow its use as an access for retrograde approach to percutaneous coronary intervention (PCI) of coronary chronic total occlusions (CTOs). BACKGROUND: Despite improvements in percutaneous techniques and materials, CTO recanalization success rate is still suboptimal. The retrograde approach allows to significantly increase this success rate. However, its application via a bypass graft or epicardial collateral can potentially result in severe complications. A safer retrograde access is desired and would allow broadening the application of the retrograde approach in the percutaneous treatment of CTOs. METHODS: After a failed antegrade CTO recanalization attempt, a retrograde approach via septal collaterals was tried in 21 patients (19 males, 2 females). The septal collateral was accessed via the contralateral patent coronary artery and was crossed with a hydrophilic floppy wire. After successful wire crossing of the septal collateral, sequential low pressure dilatation was performed with a 1.25 or 1.5 mm balloon to allow the delivery of a balloon catheter up to the distal CTO site. RESULTS: Successful wire crossing and balloon dilatation of septal collaterals was achieved in 19 cases and in 17 cases, respectively. Postdilatation septal collateral diameter increased significantly reaching a mean diameter of 1.46 +/- 0.38 mm. Retrograde CTO recanalization was successfully performed in 71% of the cases. No major complications occurred. CONCLUSIONS: Coronary septal collaterals can be used as an access for the retrograde approach in the percutaneous treatment of CTOs.     

Usefulness of waveform analysis of popliteal artery in Type II diabetic patients using gated magnetic resonance 2D-cine-PC imaging and 31P spectroscopy

Abstract Aims/hypothesis. We studied 76 patients with Type II (non-insulin-dependent) diabetes mellitus and 16 age-matched non-diabetic subjects (control group) to clarify qualitative and quantitative abnormalities of waveform and flow volume of the popliteal artery. Methods. The 76 diabetic patients comprised 16 patients with occlusive arterial disease in the lower extremities [arteriosclerosis obliterans (ASO) group] and 60 patients free from this disease (non-ASO group). We flow analysed the popliteal artery and measured the phosphocreatine to inorganic phosphate ratio of resting plantar muscles to identify risk factors for foot lesions using gated magnetic resonance two-dimensional cine-mode phase-contrast imaging and ³¹P spectroscopy. Results. The control and non-ASO groups had a triphasic waveform with systolic, early and late diastolic components. All ASO patients had an abnormal monophasic waveform and a lower ankle brachial index than that of the control and non-ASO groups. To clarify the mechanism of reduced flow volume of lower extremities, we assigned the 60 patients of the non-ASO group to the three subgroups based on their levels of total flow volume of the popliteal artery. The lowest group showed an abnormal triphasic waveform with lower amplitudes of systolic and late diastolic components and flow velocities in foot arteries than those of the highest group although ABI was similar. From stepwise multiple regression analysis, late diastolic flow volume was identified as an independent determinant for the phosphocreatine to inorganic phosphate ratio (r ² = 0.484, p < 0.001). Conclusion/interpretation. Waveform analysis of popliteal artery provides a powerful tool for identifying impaired peripheral circulation caused by either occlusive arterial disease or increased arterial resistance in diabetic patients. [Diabetologia (2000) 43: 1031–1038] Received: 24 January 2000 and in revised form: 31 March 2000     

Efficacy and safety of riociguat in the treatment of chronic thromboembolic pulmonary arterial hypertension: A meta-analysis

Background:Riociguat is a novel soluble guanylate cyclase stimulator, and has been widely used for the treatment of pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension (CTEPH). Some studies found that riociguat had better effects on CTEPH and proved to be safe, but the results were not utterly consistent. Therefore, the purpose of this study was to comprehensively evaluate the efficacy and safety of riociguat in the treatment of CTEPH.Methods:Randomized controlled trials on riociguat for the treatment of CTEPH were searched through such electronic databases as PubMed, Embase, Cochrane Library, Web of Science, China national knowledge internet, and Wanfang. The outcomes included exercise capacity, pulmonary hemodynamics, and side effects. The fixed-effects or random-effects models were used to analyze the pooled data, and heterogeneity was assessed by the I² test.Results:Four studies involving 520 patients were included in this meta-analysis. Compared with the placebo group, riociguat significantly improved the hemodynamic indexes and increased 6-min walking distance (P < .0001, standardized mean difference (SMD) = −0.24, 95%CI −0.35 to −0.12; P < .00001, SMD = 0.52, 95%CI 0.33 to 0.71), and decreased the Borg dyspnea score (P = .002, SMD = −0.31, 95%CI −0.51 to −0.12). In addition, riociguat could also significantly reduce the living with pulmonary hypertension scores and increase the EQ-5D scores (P = .01, SMD=−0.23, 95%CI −0.42 to −0.05; P < .00001, SMD = 0.47, 95%CI 0.27 to 0.66), but there was no significant difference in the change level of N-terminal pro-hormone B-type natriuretic peptide in patients with riociguat (P = .20, SMD = −0.24, 95%CI −0.61 to −0.13). The common adverse events of riociguat were dyspepsia and peripheral edema, and no other serious adverse reactions were observed.Conclusions:We confirmed that riociguat had better therapeutic effects in improving the hemodynamic parameters and exercise capacity in patients with CTEPH without inducing serious adverse events. This will provide a reasonable medication regimen for the treatment of CTEPH.     

Rapid onset of peripheral artery disease in a chronic myeloid leukemia patient without prior arterial disorder: direct relationship with nilotinib exposure and clinical outcome

The second‐generation tyrosine kinase inhibitor (TKI) of the BCR‐ABL1 oncoprotein nilotinib used in patients with chronic myeloid leukemia is suspected to increase the risk of arterial occlusion, especially in patients with pre‐existing cardiovascular risk factors or established cardiovascular diseases. Here, we describe a case of unexpected and rapid onset of symptomatic peripheral artery disease (PAD) associated with silent stenosis of digestive and renal arteries in a nilotinib‐treated patient devoid of significant cardiovascular diseases (CVD) risk factor, prior atherosclerotic disease, or other cause of arterial damage. This is the first report to establish a direct relationship between nilotinib exposure and PAD and to reveal that arterial damage is irreversible despite rapid drug withdrawal. However, functional outcome was favorable upon rapid TKI replacement, specific cardiovascular disease management, and development of collateral arterial network.     

586例冠状动脉慢性完全闭塞患者经皮冠状动脉介入治疗疗效及相关因素分析

目的:评估经皮冠状动脉介入治疗(PCI)对冠状动脉慢性完全闭塞(CTO)患者的治疗效果,并探讨影响介入治疗效果的相关因素。方法:回顾性分析586例经PCI治疗的CTO患者的临床资料,分析CTO患者行PCI治疗的疗效及相关影响因素。结果:CTO患者PCI的成功率为80%。术中并发症7.7%,分别是冠状动脉穿孔8例,心包压塞5例,支架血栓形成4例,严重心律失常(房扑、房颤、室性心动过速及室颤)22例,手术相关心绞痛6例。影响PCI治疗成功的患者自身因素有年龄(P=0.034)、高血压史(P=0.041)、糖尿病史(P=0.032)、发病至治疗的时间(P=0.008);病变相关因素有冠脉闭塞部位(P0.05)、冠脉分支迂曲程度(P=0.015)、闭塞血管远端缺如(P=0.044)及合并钙化(P=0.007)。结论:CTO患者进行PCI治疗的效果良好。患者的个人病史、病变特点及治疗是否及时是决定介入治疗成功的关键因素。