急性脑梗塞动脉内溶栓治疗的临床疗效分析

目的 探讨急性脑梗塞动脉内溶栓治疗的临床疗效与影响因素。方法 288例脑梗死患者均在CT检查厦血管造影基础上接受选择性动脉溶栓治疗，其中在发病后6h以内溶栓者76例，6～24h溶栓者212例。统计两组患者的血管再通率和90天后预后情况。结果 脑血管造影发现血管闭塞245例，其中颈内动脉系统闭塞173例，椎基底动脉（VBA）闭塞72例；溶栓后再通分别为112例、38例。治疗后90天恢复良好者180倒，恢复差者108例。溶栓后颅内出血2例；6h内组和6～24h组患者治疗后90天预后良好率分别为80．35％和71．43％，血管再通率分别为67．86％和59．26％，血管再通中位时间分别为67min和73min。结论 局部动脉溶栓可以明显改善脑梗死患者的预后；仅以发病时间不超过6h作为动脉内溶栓治疗标准不够全面，应当根据病情适当放宽溶栓的时间窗。     

骨折术后急性下肢动脉血栓形成的溶栓治疗

目的探讨骨折后下肢动脉急性血栓形成的溶栓方法及治疗的临床意义。方法8例骨折术后下肢动脉急性血栓形成,均行骨折内固定术,其中1例骨折内固定并血管吻合术后形成,通过造影确定栓塞的程度、范围、部位后,在抗凝的同时用尿激酶溶栓,开通后常规口服抗凝剂3个月。结果8例急性形成的血栓均溶解,患肢远端血运明显改善或恢复正常,临床症状消失。结论骨折内固定术后急性形成的血栓通过造影明确栓塞的部位、程度、范围,然后采取急诊溶栓措施可有效地解除动脉闭塞。     

静脉溶栓治疗对椎基底动脉系统血栓形成的疗效

静脉溶栓治疗急性脑梗塞已被公认 ,各国溶栓治疗基本以颈内动脉系统缺血为主 ,对椎基底动脉系统缺血溶栓治疗较少。我们依据颈内动脉系统缺血溶栓治疗方案 ,试用在椎基底动脉缺血卒中的治疗中疗效显著。本组病人溶栓治疗结果显示死亡率为１０% ,疗效肯定。报告如下。一般资料 :     

急性脑梗塞动脉内溶栓的护理配合

目的探讨动脉内溶栓治疗急性脑梗塞的护理方法。方法在DSA引导下对288例急性脑梗塞患者进行动脉内灌注尿激酶(UrokinaseUK)25～75万U,对患者加强护理。结果288例患者均顺利度过了危险期,缩短了住院天数,提高了患者生存质量。结论动脉内溶栓是治疗急性脑梗死安全有效的方法,术前、中、后护理是重要环节,心理护理贯穿整个治疗过程。     

超早期动脉溶栓联合血管支架植入治疗急性颈内动脉闭塞

目的：探讨超早期动脉溶栓并联合血管支架植入治疗对颈动脉闭塞治疗的效果。方法回顾我科从2009年1月~2013年12月7例4.5 h内颈动脉闭塞患者,应用超早期动脉溶栓并联合血管支架植入治疗的并发症,注意事项,待解决的问题等。结果6例溶栓成功再通,1例未再通,无1例出现血管破裂。结论超早期动脉溶栓联合血管支架植入治疗急性缺血性卒中效果明显,后遗症少。     

支气管动脉栓塞术治疗大咯血的临床应用研究

目的探讨支气管动脉栓塞术（SBAE）治疗大咯血的安全性和疗效。方法30例大咯血患者行选择性支气管动脉栓塞术，术后随访6～24个月以评价疗效和安全性。结果即时止血成功率为86．6％，近期复发率为6．6％，中远期复发为0，并发症少而轻，对症治疗后缓解。结论选择性支气管动脉栓塞术安全、可靠，成功率高，适应证广，可避免开胸手术，是一种治疗大咯血的理想方法。     

下肢静脉血栓形成应用尿激酶溶栓的疗效观察

本组54例下肢静脉血栓形成病人应用大、小两种剂量尿激酶溶栓治疗。大剂量组为25u/h持续静滴4小时，然后以2-4万u/h维持24小时；小剂量组以2万u/h维持24小时静滴，疗效观察：大剂量组有效16.0%，部分有效72.0%小剂量组分别为17.2%，72.4%，两组差异无统计学意义。在溶栓并发症发生率上，大剂量组轻度出血12.0%，重度出血8.0%，致命出血4.0%，肺栓塞4.0%，截肢4.0%；而小剂量组轻度出血13.8%，重度出血3.5%，致命出血0%，肺栓塞3.5%，截肢3.5%，两者在重度及致命出血发生率上存在差异，大剂量组高于小剂量组，所以本组研究结果显示小剂量尿激酶在溶栓疗效上与大剂量组无差异，而在减少溶栓并发症发生上优于大剂量组。建议临床应用小剂量尿激酶进行下肢静脉血栓形成溶栓治疗。     

胃左动脉的放射线解剖

用X线与解剖相结合的方法,研究了32例成人尸体的胃左动脉。对其起源、长度 直径、夹角和变异进行了观察和测量.胃左动脉弓是在X线下识别胃左动脉的主要标志,该动脉弓位于脊柱左侧,78％密集于T12椎体高度及其左缘25mm范围内。本文还对该动脉的有关临床问题作了简要讨论。     

急性卒中静脉内rt-PA后动脉内溶栓治疗安全

美国德克萨斯大学健康科学中心的James C．Grotta博士于1月的《卒中》（Stroke，2007；38：80—84．）杂志上报告，在全剂量静脉内重组组织型纤维蛋白酶原激活剂（IVrt-PA）后使用动脉内血栓溶解，对急性缺血性卒中患者安全，并且可导致较高的血管再通率和良好的结果。     

动脉导管溶栓治疗急性肢体动脉栓塞14例分析

目的 探讨动脉导管溶栓治疗急性肢体动脉栓塞的方法和疗效。方法回顾性分析14例肢体动脉栓塞的诊断方法和介入手术治疗方案。结果治愈11例，治愈率78．6％(11／14)；2例好转。无患肢缺血坏死或截肢，无术后因肾功能衰竭死亡。结论动脉导管溶栓是治疗急性肢体动脉栓塞有效的方法，值得进一步开展和探索。     

四肢主干动脉损伤的治疗分析

目的：探讨四肢主干动脉损伤的有效治疗方法。方法：回顾性分析2007年1月～2012年1月47例四肢主干动脉损伤患者的治疗临床资料。外科手术42例,其中单纯动脉破裂修补术11例,直接吻合11例,大隐静脉移植术17例,人工血管移植术3例;另外5例行腔内治疗,其中覆膜支架植入3例,裸支架植入2例。结果：44例肢体成活,截肢3例。40例患者获门诊随访,为35例手术患者和5例腔内治疗病例,截肢患者均未随访。随访时间为3个月一3a,平均随访时间15个月。在接受随访的35例手术患者中有5例吻合口处血管轻度狭窄,3例移植血管内重度狭窄,l例移植血管内闭塞;腔内治疗5例无明显异常发现。结论：外科手术及腔内治疗是四肢主干动脉损伤的有效治疗方法;选择合适的治疗方法,早期诊断和治疗,是保全肢体的关键。     

Hemodilution (HD) in patients with ischemic skin ulcers

Summary In 25 patients with arterial occlusive disease in the clinical stage IV according to Fontaine a hemodilution down to an average hematocrit value of 0.31±0.02 was performed. Eighteen patients had peripheral ulcers of the lower limbs and 3 patients had ulcers of the upper ones. Four patients had tissular lesions both at the level of the feet and toes and hand and fingers. The average age of the patients was 43. Hemodilution was achieved by repeated withdrawals of approx. 500 ml blood, followed by reinfusion of the autologous plasma associated with infusion of substitutive solutions of low-molecular weight dextran to avoid hypovolemia. In all patients with peripheral ulcers of the upper limbs, with no exception, a good to a very good clinical effect was obtained ranging from an extended to complete healing. The healing tendency of lesions in the feet and toe region was on the whole less marked and depended basically on the total number of vascular impediments found in one patient. The rheological and hemodynamic mechanism of the therapeutic effect of hemodilution, the preliminary criteria for indicating this therapy and its observed complications are discussed.Supported by Verein zur Bekämpfung der Gefäßerkrankungen e.V. Engelskirchen, Federal Republic of Germany     

深静脉血栓形成的介入治疗

目的 探讨对深静脉血栓形成（DVT）的患者进行介入溶栓治疗的选择原则和并发症的预防。方法 38例DVT患者放置下腔静脉滤器后进行血管腔内治疗，包括静脉腔内插管溶栓术38例、球囊扩张术14例和支架放置术2例。48h照腹平片观察滤器的位置．1周后行彩色多普勒检查了解下腔静脉和病变深静脉的通畅度。出院后定期复查滤器位置和患肢情况。结果 髂静脉、锁骨下静脉和肱静脉DVT的完全缓解率为100％，股静脉DVT完全缓解率为93．3％，小腿静脉DVT为68．4％；其余为部分缓解。滤器放置成功率为100％，溶栓过程中及追踪复查均未发生肺动脉栓塞。结论 深静脉血栓形成的患者进行介入溶栓治疗结合下腔静脉滤器放置术有效而安全，有较高的临床应用价值。     

A brief history of interventional radiology in Singapore and its current status

X-ray services were first established in Singapore in 1898. With the opening of the General Hospital in 1926, there was subsequent increase in workload. However, a radiology department was not formed until the 1950s. Angiography was introduced in the same decade initially for diagnosis. By the 1960s and 1970s, both vascular and non-vascular interventions were performed. Subsequently, interventional radiology experienced exponential growth, with newer technology and better facilities established over the past 3 decades. With more trained interventional radiologists, the service is currently available in all public hospitals and in most private hospitals in Singapore today. It is envisaged that structured training and formal credentialing will be established, eventually leading to recognition of interventional radiology as a specialty in its own right.     

下腔静脉滤器预防肺动脉栓塞的应用价值

目的 讨论下腔静脉滤器放置术在下肢静脉血栓形成(DET)患者进行溶栓治疗中预防肺动脉栓塞(PE)的应用价值．方法 37例DET形成患者放置Greenfield下腔静脉滤器22个、Simon滤器12个、Bird—nestle滤器3个，放置后进行下肢静脉溶栓治疗，48h腹平片观察滤器的位置，1周后行彩色多普勒检查了解下腔静脉通畅度，出院后定期复查滤器位置．结果 滤器放置成功率为100％，溶栓过程中及追踪复查均未发生PE．结论 下腔静脉滤器放置术对PE的预防有较高的临床价值，下肢DET成患者行溶栓治疗前，作为常规应用可确保安全．     

腔静脉滤器置入联合胫后静脉置管溶栓治疗急性下肢深静脉血栓形成

目的：探讨腔静脉滤器置入联合胫后静脉途径置管直接溶栓治疗急性下肢深静脉血栓形成的临床应用价值。方法：18例急性下肢深静脉血栓形成患者,先行患肢血管造影明确诊断后,在下腔静脉滤器置入的基础上采用胫后静脉置管微泵持续推注尿激酶直接溶栓治疗,对其中髂静脉狭窄5例和闭塞1例患者在拔除溶栓导管后实施髂静脉球囊扩张成形术。结果：18例患者置管溶栓治疗后症状均得到明显改善,1例术前合并肺动脉栓塞者症状消失。溶栓后的健、患侧大腿周径差及小腿周径差比治疗前明显减小,差异均有统计学意义（P〈0．001）。治疗期间,无一例围手术期死亡,无肺动脉栓塞发生,无置管处渗血或血肿形成、神经损伤等置管相关并发症发生。术后17例获随访,随访时间1～12个月,平均5个月。15例肢体肿胀基本消退、肌张力减低、恢复正常劳动力;2例活动后肢体出现轻微肿胀伴沉重感,能进行正常家务劳动;17例均未出现患肢浅静脉曲张及静脉营养性障碍。结论：腔静脉滤器置入联合胫后静脉置管直接溶栓治疗急性下肢深静脉血栓形成具有疗效好、创伤小、安全性高、适应证宽,便于护理等优点,是一种安全、有效的治疗方法。     

A study of neovascularization in the rat ischemic hindlimb using Araldite casting and Spalteholtz tissue clearing

INTRODUCTION: Understanding neovascularization is an important prerequisite for therapeutic advances aimed at the salvation of ischemic tissues. We explored an alternative strategy to corrosion casting for visualizing neovascularization in a rat hindlimb ischemia model. METHODS: Rats were subjected to hindlimb ischemia by femoral artery ligation. Directly after femoral artery occlusion and at 7, 14, 21 and 28 days postsurgery, rats were sacrificed, and neovascularization was evaluated by vascular casting with Araldite plastic and subsequent Spalteholtz tissue clearing. RESULTS: Semitransparent preparations were obtained, in which the casted arteries could be directly and three-dimensionally visualized in detail and in relation to the surrounding tissue. In the vascular casts, collateral formation and recanalization of previously thrombosed arteries were demonstrated. CONCLUSIONS: We describe an alternative approach to study neovascularization in animal models. This method, which combines Araldite plastic vascular casting with Spalteholtz tissue clearing, preserves all vasculature as well as the surrounding tissue. In a small time series in rat ischemic hindlimbs, we show that restoration of blood flow after ischemia not only involves newly formed collaterals, but also recanalization of previously thrombosed arterial segments.     

血流动力学的医学应用与发展

血流动力学是指血液在血管系统中流动的力学,主要研究血流量、血流阻力、血压、切应力、扰动流等,以及它们之间的相互关系,对人类生命健康具有重要的影响。血流动力学在血管的弯曲、狭窄、堵塞、分叉以及肿瘤的治疗等方面具有重要的临床研究意义。目前,血流动力学在动脉血管搭桥、冠状动脉狭窄、腹主动脉瘤、动脉粥样硬化、脑动脉肿瘤以及旋动流等方面引起广泛研究。伴随着血流动力学的深入研究,心脑血管的手术规划、介入治疗等得到快速发展,基于血流动力学的临床检测和治疗仪器也越来越多。血流动力学因素,如血管压力、血管阻力、血流量、壁面切应力、血液黏度、流动分离、湍流、涡流等对常见血管疾病以及术后并发症的影响机理正在逐步深入探索之中,并已经取得了一定成果。     

Arterial Occlusive Disease Complicating Radiation Therapy of Cervical Cancer

Radiation-induced arterial disease is caused by significant atherosclerosis in the circumjacent vessels being irradiated. Even though this has been recognized as survival of cancer patients treated with radiotherapy improves, it is a problem that is often under-reported. We present a case of chronic thromboembolic occlusion of right common iliac artery in a 53-year-old woman who was treated with radiation therapy for cervical cancer 13 years ago. We initially performed percutaneous transluminal angioplasty with thrombolytic therapy, but had to cease thrombolytic therapy due to upper gastrointestinal bleeding of Dieulafoy''s lesion, nevertheless, achieved good results after revascularization by Fogarty embolectomy.     

心理干预对冠心病介入治疗患者的影响

目的 探讨心理干预对冠心病介入治疗患者的影响.方法 对68例冠心病介入治疗患者,随机分为两组,干预组34例,对照组34例,在手术前后对干预组进行综合心理干预,并采用SDS和SAS评定两组患者的情绪变化.结果 术前两组患者SDS和SAS评分无显著性差异,心理干预后干预组的抑郁焦虑较对照组明显改善(P＜0.01),且并发症明显少于对照组.结论 心理干预可明显的减轻冠心病介入治疗患者的抑郁焦虑,并且可显著减少术后并发症的发生,对保证手术的顺利进行具有重要意义.