分期静脉动脉化治疗肢体动脉广泛性闭塞的评价

目的：评价分期静脉动脉化治疗肢体动脉广泛性闭塞的疗效。方法：自1984年1月至2000年11月,共手术149例,164条下肢,ASO患肢33条,TAO130条,采用3种不同术式;（1）深组高位：在髂－股动脉与股浅静脉间建立AVR;（2）深组低位,在Guo动脉与胫腓干静脉间建立AVR;（3）清组：在Guo动脉与大隐静脉远侧段之间建立AVR。结果：152条患 肢随访4个月－16年,平均8年左右,除12条患肢外,140条患肢疗效满意或病情改善。结论：深组高位应慎重选择合适的病例,深组低位效果最好,浅组己不再采用,分期AVR为治疗肢体动脉广泛闭塞症开辟了一条新途径。     

The use of extended profundaplasty in limb salvage

Obstructive lesions of the profunda femoris artery extending beyond the lateral circumflex branch were repaired in sixty-two limbs with superficial femoral occlusion and profound ischemia. The operation relieved rest pain in all thirty-four limbs with this symptom. Of twenty-eight limbs with tissue loss, twenty-two were salvaged without further reconstructive surgery. This experience illustrates that in diffuse profunda disease, extended profundaplasty is a useful alternative to femoropopliteal bypass, particularly for the relief of rest pain, and does not preclude more distal arterial reconstruction.     

Limb salvage by extended profundaplasty of occluded deep femoral arteries

This report presents our experience with extended profundaplasty as an outflow procedure for limb salvage in patients with occluded common and profunda femoris arteries. During a 5 year period at Salem Hospital, 15 limbs in 11 patients were revascularized by a variety of inflow procedures combined with extended endarterectomy and patch grafting of an occluded profunda femoris artery. All patients presented with rest pain, ischemic ulcers, or gangrenous toes. Patients with acute embolic disease or thrombosis of a limb of a graft which required immediate reconstruction were excluded from this study. Preoperative arteriograms revealed no patent femoral or graftable popliteal vessels but did demonstrate collateral circulation, specifically portions of the circumflex femoral arteries and muscular branches of the profunda. Operation was undertaken to disobliterate the profunda and reinstitute direct perfusion of the collateral bed. In all cases it was possible to endarterectomize the profunda to eliminate distal spared vessel and to open most of the profunda branches.There was no operative mortality. Follow-up revealed 87 percent limb salvage and 80 percent patency at 1 year. At 2.5 years limb salvage was 77 percent and reconstruction has remained patent in 60 percent of the limbs.These results compare favorably with series that have reported reconstructions for profunda stenosis alone. These preliminary data suggest that endarterectomy and long patch grafting of the proximally occluded profunda may have merit in providing worthwhile palliation in a small subset of patients with advanced occlusive disease.     

An experimental study of tissue injury associated with reperfusion in ischemic limbs

Twenty adult mongrel dogs were divided into three groups. Group I: control (n = 7), group II: limb ischemia for 6 hours followed by reperfusion (n = 6), and group III: administration of alpha-tocopherol after 6 hours of ischemia, and reperfusion (n = 7). In group II, serum CPK and LPO increased after reperfusion with peak levels of 38,000 +/- 9,800 mU/ml and 20.4 +/- 3.7 nmol/ml respectively, which were significantly higher than those in group I. (CPK: p less than 0.02, LPO less than 0.03). In group III, the peak levels of serum CPK and LPO were regulated to the low level of 1,060 +/- 290 mU/ml and 9.2 +/- 4.5nmol/ml, respectively, which were significantly lower than those in group II. (CPK: p less than 0.02, LPO less than 0.04). Additional 13 dogs were divided into two groups in order to assess tissue LPO in the limb, liver, and kidney. Group A: control (n = 5), group B: reperfusion after 6 hours of ischemia (n = 8). Tissue LPO level of 1.89 +/- 0.74nmol/mg-protein in the gastrocnemius muscle in group B was significantly higher than that in group A (p less than 0.02), although there was no significant difference in the gracilis muscle, liver, and kidney. These results prove indirectly the participation of lipid peroxidative reaction by active oxygen in the mechanism of development of reperfusion injury, and suggest the preventive effect of alpha-tocopherol to reperfusion injury.     

延长的指动脉逆行岛状皮瓣的临床研究

目的　探讨延长切取指动脉逆行岛状皮瓣的可行性和临床效果。方法　 2 0 0 1年以来 ,延长切取指动脉逆行岛状皮瓣修复指腹缺损 7例。结果　皮瓣全部成活 ,经随访 ,修复后指腹两点辨别觉为 6～ 9mm(平均为 7 6mm) ,外形满意 ,患者均恢复原工作。结论　延长切取指动脉逆行岛状皮瓣安全可行 ,是一种修复指腹大范围缺损的较理想方法。     

向颈、肩、背扩展的胸三角皮瓣的解剖学研究与临床应用

在３０例成人新鲜尸体上，采用手术显微镜下解剖、钼耙Ｘ线照像、碳素墨汁动脉灌注等方法，调直向颈、肩、背扩展的胸三角皮瓣的皮动脉来源及其分支的外径、长度、走行方向，及该皮瓣各皮动脉之间吻合支的外径、数目。并通过临床实践，讨论了该皮瓣的实用价值及推广前景。     

向颈、肩、背扩展的胸三角皮瓣的解剖学研究与临床应用

在30例成人新鲜尸体上,采用手术显微镜下解剖、钼钯 X 线照像、碳素墨汁动脉灌注等方法,调查向颈、肩、背扩展的胸三角皮瓣的皮动脉来源及其分支的外径、长度、走行方向,及该皮瓣各皮动脉之间吻合支的外径、数目。并通过临床实践,讨论了该皮瓣的实用价值及推广前景。     

下肢缺血预处理对未成熟心肌的保护作用及其机制

目的　探讨下肢缺血预处理对未成熟心肌保护作用的机制。方法　采用双下肢缺血预处理 (DLIP)大白兔Langendorff离体心脏灌注模型。分为 4组 ,每组大白兔 6只 :E1组 ,动物麻醉后反复 3次阻断双下肢血流 5min ,松开 5min ,建立模型 ,灌注 15min转为工作心 15min ,全心停灌 45min ,恢复灌注 15min改为工作心 3 0min ;E2组 ,双下肢缺血预处理前静脉注射超氧化物歧化酶至双下肢缺血预处理完毕 ,重复E1组方法 ;E3组 ,静脉注射蛋白激酶C(PKC)阻滞剂多粘菌素B(PMB) ,时间 10min ,重复E1组方法 ;E4组 ,静脉注射ATP敏感性钾通道 (mitoKATP)阻滞剂(5 HD) ,时间 10min ,重复E1组方法。以左室功能恢复、心肌含水量、血清肌酸激酶 (CK )和乳酸脱氢酶 (LDH)漏出率、心肌组织ATP和丙二醛 (MDA)含量、超氧化物歧化酶 (SOD)活性、心肌细胞内Ca2 含量、心肌线粒体钙依赖性ATP酶 (Ca2 ATPase)活性及其Ca2 含量、心肌线粒体合成ATP能力 [ATP] m、超氧阴离子自由基 (O2 -)作为观察指标。结果　E1组左心室功能恢复优于其他各组 (P <0 .0 5 ) ,心肌ATP含量、SOD活性、Ca2 ATPase活性、[ATP] m 均优于其他各组 (P <0 .0 1) ,心肌含水量低于其他各组 (P <0 .0 5 ) ,MDA含量、CK、LDH漏出率、心肌细胞内Ca2 含量、心肌     

A prospective clinical study on the pathogenesis of multiple organ failure in severely burned patients.

This study has shown that multiple organ failure (MOF) is one of the major causes of death in patients with severe burns. Both the plasma and visceral levels of TXB2 and the TXB2/6-keto-PGF1 alpha ratio were significantly increased. The changed plasma levels of TXB2 and the TXB2/6-keto-PGF1 alpha ratio paralleled the deterioration of the general condition in MOF patients. The circulatory platelet aggregation ratios (CPAR) in the MOF patients initially declined then dropped profoundly at 5-7 days postburn, indicating more microaggregate formation. CPK, LDH and GOT had increased markedly by 1 day, were elevated further at 2-3 days, and remained at supranormal levels for the first 7 days postburn. Degeneration, destruction, oedema, haemorrhage and thrombosis were observed in tissues from patients who died due to heart, lung, renal and hepatic failure. Clinically, 13 of the 16 MOF cases developed organ failure and 11 died between 3 and 7 days postburn. These findings confirmed that the increases of TXA2 and the TXA2/PGI2 ratio in plasma and visceral tissues can be an important factor in the genesis and development of postburn MOF.     

Reperfusion of ischemic lower limbs increases pulmonary microvascular permeability

Lower torso ischemia and reperfusion has been shown to stimulate the generation of thromboxane (Tx)A2, leading to transient pulmonary hypertension and later to polymorphonuclear leukocyte accumulations in the lungs. This study investigated whether hind limb ischemia leads to increased pulmonary microvascular permeability. Anesthetized sheep (n = 6) previously prepared with a lung lymph fistula underwent 2 hr of tourniquet ischemia of both lower limbs. One minute following tourniquet release mean pulmonary arterial pressure (MPAP) rose from 14 +/- 1 to 36 +/- 4 mm Hg (p less than 0.05) and returned to baseline within 30 min. The pulmonary arterial wedge pressure of 4 +/- 1 mm Hg was unchanged. Plasma TxB2 levels rose from 211 +/- 21 to 304 +/- 52 pg/ml (p less than 0.05) 10 min after tourniquet release and were back to baseline at 30 min. Lymph flow (QL) rose from 4.3 +/- 0.6 ml/30 min to 8.3 +/- 1.8 ml/30 min (p less than 0.05); the lymph/plasma (L/P) protein ratio rose slightly but not significantly. In three sheep, inflation of a left atrial balloon increased left atrial pressure from 3 to 16 mm Hg. MPAP rose from 14 to 24 mm Hg. There was an increase in QL from 3.6 to 17 ml/30 min; the L/P protein ratio declined from 0.63 to 0.41. These results indicate that reperfusion following 2 hr of bilateral hind limb ischemia results in increased pulmonary microvascular permeability.     

川芎嗪对肢体缺血再灌注损伤影响的临床实验研究

目的 了解川芎嗪 对肢体组织缺血再灌注损伤的影响。方法 病例选取四肢骨折手术,止血带时间需要1－1.5h的36例,分为A一（川芎嗪组）15例和B组（空白对照组）21例,另设立C组为腰椎或髋部手术病例15例,分别于术前,术后24小时测定血清SOD活性,LPO,GSH和血流流变学指标。结果 A组各项指标相对稳定,术后B组SOD酶活性短暂下降,LPO和GSH升高（P＜0．05）,还原粘度明显升高（P＜0．01）,C组则显示血液流变学指标的降低（P＜0．05）。结论 川芎嗪对肢体组织缺血再灌注损伤有保护作用,其作用机理与川芎嗪活血,化瘀,抗凝,抗癌,改善血液流学特征性,拮抗氧自由基损伤有关。     

血液稀释联合潘通预防肢体缺血再灌注损伤

目的探讨静脉血液稀释疗法和潘通对肢体缺血再灌注损伤（I／R）预防作用。方法复制家兔左下肢缺血／再灌注损伤模型,分别在阻断左下肢前、阻断4h灌注1h和再灌注24h采集假手术组、I／R组、潘通组、血液稀释组和联合治疗组静脉血,测定血浆丙二醛（malondialdehyde,MDA）、超氧化物歧化酶（erythrocuprein,SOD）、血栓素B2（TXB2）含量,应用SAS8．1对实验数据进行均数问双因素方差分析,两两比较用SNK-q检验。结果潘通组、血液稀释组和联合治疗组血浆MDA、TXB2含量较I／R组显著降低,SOD显著升高,而联合治疗组与潘通组、血液稀释组相比也有显著性差异（P值均〈0．05）。结论静脉血液稀释和潘通可有效缓解肢体缺血再灌注损伤,而联用静脉血液稀释和潘通可取得更好的效果,两者具有良好的协同效应。     

Thromboxane release after reperfusion of chronically ischemic limbs in patients

We hypothesized that chronic ischemia of peripheral vascular disease would lead to increased thromboxane A2 (TxA2) and decreased prostacyclin (PGI2) production and surgical correction of the ischemia would stabilize TxA2 and PGI2 at normal levels. TxA2 and PGI2 concentrations were determined in 22 patients before, during, and after arterial reconstruction for limb salvage and in 10 control subjects. Control samples and preoperative patient samples had no detectable TxA2 or PGI2 (less than 26 pg/ml). Five minutes after reperfusion TxA2 increased (TxA2 = 76.27 +/- 48.9 pg/ml, mean +/- SEM) and persisted at 1 day (TxA2 = 190.1 +/- 80.1 pg/ml), 2 days (TxA2 = 224.7 +/- 131.7 pg/ml), 5 days (TxA2 = 334.8 +/- 272.8 pg/ml), and 7 days postoperatively (TxA2 = 256.6 +/- 149.0 pg/ml). Elevated TxA2 production was not associated with chronic ischemia of peripheral vascular disease. Reperfusion of the severely ischemic limb caused significant TxA2 release.     

步行锻炼治疗下肢缺血症

目的:评估步行锻炼治疗下肢缺血性间歇性跛行(IC)的疗效.方法:选择IC患者16例(26条患肢),作步行锻炼(每周在步行机上行走锻炼2次,辅以相应的药物治疗)3个月.结果:治疗3个月后,除1条患肢外,所有患肢的缺血表现均有改善或消失,无痛行走距离(PWD)和最大行走距离(MWD)分别提高263.1%和292.7%.结论:步行锻炼是治疗IC有效的方法.     

The role of isolated profundaplasty for the treatment of rest pain

This study was undertaken to determine the efficacy and durability of profundaplasty and define preoperative factors predictive of success. The hospital charts, vascular laboratory data, and arteriograms of 20 patients having 21 isolated profundaplasties for ischemic rest pain between 1979 and 1987 were reviewed. Follow-up extended to 72 months (mean, 26 months). Early success was achieved in 12 extremities (57%) and life-table analysis showed continued success to six years in 11 extremities (55%). Of the multiple preoperative factors assessed, only a low-thigh/ankle gradient pressure index (TAGI) of less than 0.55 was predictive of success. Life-table analysis for limbs with a TAGI of less than 0.55 showed an 89% success rate at six years compared with only a 32% success rate for limbs with a TAGI of more than 0.55. Isolated profundaplasty for the treatment of ischemic rest pain can be an efficacious and durable procedure when patients are selected based on objective hemodynamic measurements.