下肢静脉瓣膜功能不全的治疗现状及临床研究意见

下肢静脉曲张是人们熟知的外科常见病，在公元前1500年已有文字记载。随着下肢静脉系统解剖学知识的积累，尤其是关于下肢静脉及其瓣膜结构与功能、下肢静脉血流动力学的深入研究，检测技术的不断改进，最终形成了下肢慢性静脉功能不全（chronic venous insufficiency of the lower exfremifies，CVI）的概念。现今，CVI作为一组病症的总称，包含了先天性、原发性及继发性下肢静脉功能不全，造成下肢静脉血液逆流和（或）回流障碍，引起下肢静脉系统与微循环高压及相应的临床表现：浅静脉曲张、浮肿、色素沉着等皮肤改变，静脉性溃疡。下肢静脉瓣膜功能不全属于CVI范畴。本文就下肢静脉瓣膜功能不全的治疗变更、今后临床研究两个方面，简述如下。     

膝下动脉闭塞的腔内治疗

Objective To evaluate the results of endovascular intervention for infrapopliteal arterial occlusion in 40 patients. Methods There were 41 affected limbs in these 40 patients receiving 44 times of endovascular intervention for infrapopliteal arterial occlusion during Nov. 2006 and Dec. 2007. The average age was 76±6. The ABI(ankle brachial index)before intervention was 0.39±0.20 in anterior tibial artery and 0.39±0.23 in posterior tibial artery. CLI (critical limb ischemia) was 80.49% (33/41). Results The after intervention ABI increased by 0.43±0.22 (P<0.01) in anterior tibial artery and 0.43±0.25(P<0.01)in posterior tibial artery. 35 patients (36 limbs) were followed-up for (6±3) months. The limbs of Fontaine Ⅰ and Fontaine Ⅱ A were 28 (77.78%), CLI decreased to 19.44% (7/36) (P<0.01). At follow-up the ABI in anterior tibial artery was 0.63±0.22 and 0.56±0.22 in posterior tibial artery. The difference were all significant when compared with that before intervention and after intervention. The perioperative amputation rate was 0. The perioperative mortality rate was 2.5%. The total mortality rate was 15%. The limb salvage rate were 100%. Conclusion The effect of endovascular intervention for infrapopliteal arterial occlusion is satisfactory.     

下肢慢性静脉功能不全患者红细胞CD35和粒细胞CD11b的表达

目的探讨下肢慢性静脉功能不全（CVI）患者外周血红细胞CD35和中性粒细胞CD11b表达的意义.方法采用全血流式细胞技术分析42例患者和8例正常对照者在临床、病因、解剖和病理生理（CEAP）不同临床分级中红细胞CD35和中性粒细胞CD11b的表达.结果随着CVI临床表现的加重,C5-C6级患者CD11b表达与C2-C3级、C4级和正常对照组间差异有统计学意义（F=5.435,P＜0.05）;C2-C3级患者红细胞CD35表达与正常对照组间差异无统计学意义（F=2.506,P＞0.05）;C4级患者红细胞CD35表达与对照组、C5-C6级患者间差异有统计学意义（P＜0.05）.结论中性粒细胞CD11b和红细胞CD35可能参与了CVI的发病过程,并在一定程度上反映病变的程度.     

膝下动脉闭塞的腔内治疗

Objective To evaluate the results of endovascular intervention for infrapopliteal arterial occlusion in 40 patients. Methods There were 41 affected limbs in these 40 patients receiving 44 times of endovascular intervention for infrapopliteal arterial occlusion during Nov. 2006 and Dec. 2007. The average age was 76±6. The ABI(ankle brachial index)before intervention was 0.39±0.20 in anterior tibial artery and 0.39±0.23 in posterior tibial artery. CLI (critical limb ischemia) was 80.49% (33/41). Results The after intervention ABI increased by 0.43±0.22 (P<0.01) in anterior tibial artery and 0.43±0.25(P<0.01)in posterior tibial artery. 35 patients (36 limbs) were followed-up for (6±3) months. The limbs of Fontaine Ⅰ and Fontaine Ⅱ A were 28 (77.78%), CLI decreased to 19.44% (7/36) (P<0.01). At follow-up the ABI in anterior tibial artery was 0.63±0.22 and 0.56±0.22 in posterior tibial artery. The difference were all significant when compared with that before intervention and after intervention. The perioperative amputation rate was 0. The perioperative mortality rate was 2.5%. The total mortality rate was 15%. The limb salvage rate were 100%. Conclusion The effect of endovascular intervention for infrapopliteal arterial occlusion is satisfactory.     

PC预处理移植静脉免疫原性的实验研究

目的 评估经多聚环氧化合物(PC)处理的同种异体静脉的免疫原性。方法 根据处理犬静脉的不同方法分为新鲜组(n=7)、戊二醛(GA)组(n=5)和Pc组(n=6);匀浆液二次免疫BALB/c小鼠,小鼠血清与该犬淋巴细胞反应,以荧光标记的兔抗鼠IgG抗体染色被反应的淋巴细胞,计算染色淋巴细胞的百分率。结果 新鲜组的淋巴细胞染色率高于PC组和GA组(P0.05)。结论 PC与GA一样能明显有效地降低移植静脉的免疫原性。     

下肢ASO患者血管腔内治疗前后血浆NPY的动态变化

目的 研究下肢动脉硬化性闭塞症(ASO)患者血管腔内治疗前后血浆神经肽Y(NPY)水平的动态变化.方法 采用放射免疫法检测13例下肢ASO患者(ASO组)接受血管腔内治疗前和治疗后不同时间点(即刻和第1、3、5 d)的血浆NPY水平,以15名健康体检者作为正常对照(对照组).比较血管腔内治疗前与治疗后第3天时患肢踝/肱指数(ABI)和ASO临床分期.结果 ASO组治疗前血浆NPY水平显著高于对照组,为(250.67±88.27)pg/mL us(168.40±64.64)Pg/mL,两组间比较差异有统计学意义(P<0.05);ASO组治疗后即刻的血浆NPY水平升达峰值,为(307.21±103.75)pg/mL,随后逐渐降低.治疗后第3天患肢ABl较治疗前显著升高(0.81±0.19 us 0.45±0.17),差异有统计学意义(P<0.01),同时ASO临床分期明显改善.结论 ASO患者血浆NPY在严重缺血状态下释放增加,治疗后随着患肢缺血状态的纠正(ABI升高)及临床症状的好转,血浆NPY水平逐渐下降接近正常水平.     

大鼠局限性脑皮质损伤后海马CA－1区神经元损害及丹参的保护作用 

探讨海马神经元损害的机理及丹参的保护作用．方法：作者检测了大鼠局限性脑皮质损伤后海马ＣＡ－１区组织腺苷三磷酸（ＡＴＰ）酶活性，Ｎａ＋，Ｋ＋，Ｃａ＋离子含量，并观察了病理组织学的改变．结果：脑损伤后海马组织Ｎａ＋－Ｋ＋－ＡＴＰ酶、Ｃａ２＋－ＡＴＰ酶活性分别为０．４２５±０．０６６和０．４１９±０．０２０μｍｏｌＰｉ／（ｍｇ蛋白·ｈ），较正常对照组（Ｎａ＋－Ｋ＋－ＡＴＰ酶０．６３５±０．０４３，Ｃａ２＋－ＡＴＰ酶０．５２７±０．０１７）明显降低（Ｐ＜０．０１）；Ｎａ＋，Ｃａ２＋含量（Ｎａ＋２１５．７４±２４．３０，Ｃａ２＋４．５９±０．２５μｍｏｌ／ｇ干脑）较正常对照组（Ｎａ＋１４２．２５±１１．３９，Ｃａ２＋３．７３±０．３８）明显增高（Ｐ＜０．０１）．丹参治疗组大鼠海马组织ＡＴＰ酶活性抑制（Ｎａ＋－Ｋ＋－ＡＴＰ酶０．５９３±０．０２７，Ｃａ２＋－ＡＴＰ酶０．４６８±０．０４０）及Ｎａ＋，Ｃａ２＋聚积（Ｎａ＋１８１．７２±１９．６２，Ｃａ２＋４．０８±０．３８）程度较脑损伤组显著降低（Ｐ＜０．０１），电镜观察神经元损害也明显减轻．结论：提示丹参可能通过改善ＡＴＰ酶功能、抑制Ｎａ＋，Ｃａ２＋聚积而减轻脑损伤后海     

齐拉西酮与利培酮治疗精神分裂症对照研究

目的：探讨齐拉西酮与利培酮治疗精神分裂症的疗效和安全性。方法：将60例精神分裂症患者随机分为齐拉西酮组和利培酮组，每组30例。疗程8周，采用阳性与阴性症状量表（PANSS）和治疗中出现的症状量表（TESS）评定疗效和不良反应。结果：齐拉西酮组有效率83．3％，显效率70．0％，利培酮组有效率86．7％，显效率73．3％。结论：齐拉西酮治疗精神分裂症疗效较好与利培酮相当，不良反应少。     

综合康复方法治疗难治性面瘫

目前,对难治性面瘫的治疗方法和疗效各家报道不一,我们通过文献检索,获悉了该病的多种治疗方法,但未能获得循征治疗的金标准依据.根据多年的临床实践,同时结合患者的价值和愿望,我们从2000年开始,采用综合康复方法治疗难治性面瘫,并对临床疗效进行评价.     

乳房外Paget病行Mohs显微外科手术患者的护理

目的确定乳房外Paget病患者接受Moils显微外科手术前后的护理要点。方法总结分析6例乳房外Paget病患者,在接受Mohs显微外科手术前后的护理过程。结果让患者充分了解Paget病的预后、手术的具体方式和Mohs显微外科手术比较于传统方式的优点,消除了患者的恐惧焦虑情绪,提高了患者配合治疗的积极主动性。针对患者患病部位的特殊性制定术后生活指导,促进了患者身心的康复。结论Mohs显微外科手术是治愈乳房外Paget病优选方式,患者对疾病、手术方式、预后以及术后康复方式的了解非常必要。