急性肠系膜动脉栓塞9例的诊断与治疗分析

目的　探讨肠系膜动脉栓塞易误诊的原因及早期诊断和治疗。方法　总结 1 985— 2 0 0 0年间收治的 9例急性肠系膜动脉栓塞的诊治经验。结果　就诊时明确诊断 1例。9例均行手术治疗 ,抢救成功 3例 ,死亡 6例。结论　该病诊断困难 ,预后较差。只有提高认识 ,早期诊断 ,及时正确施治 ,方能提高疗效     

经导管祛栓术治疗急性肺动脉栓塞

目的：探讨经导管栓子祛除术治疗急性肺动脉栓塞的临床疗效。方法：对24例急性肺动脉栓塞的病人，经肺动脉造影明确诊断，通过旋转猪尾导管碎栓、抽吸导管抽吸和局部溶栓来开通肺动脉。观察临床症状、动脉血氧分压（PaO2)、肺动脉平均压（PAPm）和肺动脉开通情况。结果：术后症状即刻缓解者23例，完全开通者20例，与术前相比PaO2明显升高（P＜0．05），PAPm明显降低（P＜0．05），并发脑出血1例，死亡2例，22例病人存活。结论：经导管栓子祛除术治疗急性肺动脉栓塞是安全有效的方法。     

螺旋CT肺动脉造影诊断肺小动脉血栓的实验研究

目的：评价螺旋CT肺动脉造影（spiral CT pulmonary angiography，CTPA）诊断犬肺小动脉血栓栓子（直径2.5-3.5mm）的应用价值。方法：23条实验犬行CTPA空白对照后，制成犬自体血块肺动脉栓塞模型，先后行CTPA与X线肺动脉造影（X-ray pulmonary angiography，XPA）检查，由2名医生在工作站上分析所获图像，并与犬肺病理解剖结果对照，评价CTPA与XPA对肺动脉血栓栓塞的诊断价值。结果：22条犬完成实验全过程，病理解剖发现肺动脉内栓子110个，与人工注入栓子数目相符，均位于肺动脉的段或亚段水平，其中107个位于扫描野内。CTPA发现栓子90个，诊断肺动脉内小血栓栓子的敏感度为84.1％，阳性预测值为93.8％；XPA发现栓子82个，敏感度为76.6％，阳性预测值为94.3％。结论：CTPA对实验性肺小动脉血栓栓子有较高的诊断价值。     

彩色超声引导下腔静脉滤器置入术30例临床分析

目的介绍超声引导下腔静脉滤器置入新方法及其对深静脉血栓形成后肺栓塞的预防作用。方法 2 0 0 2年 5月至 2 0 0 3年 7月对 30例下肢深静脉血栓形成 (其中 4例入院时出现肺栓塞 )患者在彩色超声引导下实施下腔静脉滤器置入术 ,其中 15例在滤器置入术后立即实施下肢深静脉取栓术 ,另外 15例行保守治疗。结果本组 30例均获成功 ,经 1～ 14个月平均 6个月的随访 ,除 1例出现滤器闭塞外 ,余无任何并发症及肺栓塞的发生 ,曾出现肺栓塞者滤器置入后未再发生肺栓塞。结论彩色超声引导下腔静脉滤器置入术可有效地预防深静脉血栓形成后肺栓塞的发生     

快速二期动脉转位术纠治新生儿完全型大动脉转位

目的总结快速二期动脉转位术的临床应用效果.方法 2002年9月至2003年5月,5例完全型大动脉转位患者行快速二期动脉转位术.手术平均年龄83.0±72.2 天,平均体重4.7±0.9 kg.由于求诊时已经超过最佳手术年龄,左心室退化,不能承受体循环压力,则先行肺动脉环缩和体肺动脉分流术,术后6～9天行第二期动脉转位术.结果一期手术中,1例术后32小时发生室上性心动过速,少尿,经腹膜透析和药物处理无效死亡;其余4例分别在术后6～9天行二期动脉转位术,无死亡.术后随访2～10个月,生长发育良好,超声心动图检查显示心内无残余分流,主动脉和肺动脉干吻合口通畅,左心室射血分数(EF)0.68～0.77,短轴缩短率(FS)0.24～0.37,1例主动脉瓣轻度反流.结论对失去最佳手术时间的新生儿完全型大动脉转位,行快速二期动脉转位术是最佳的选择.     

Management of upper limb arterial injury without angiography--Chennai experience

We present our experience and observations in the management of upper limb arterial injury in a tertiary trauma care centre of a University Hospital in a developing country from January 2000 to January 2002. In this retrospective study, we had treated 27 patients (identified from trauma register) with upper extremity vascular injuries. Clinical examination and Doppler pressure studies were our prime modalities of investigation. Angiography was not employed. Our immediate limb salvage rate was 100%. Two patients developed complications during a mean follow up of 70 days with one requiring amputation. We thereby emphasise the fact that good results can be obtained by thorough clinical examination and Doppler evaluation and prompt surgery without the need for angiography in upper limb vascular trauma.     

Hospital Episode Statistics data analysis of postoperative venous thromboembolus in patients undergoing urological surgery: a review of 126,891 cases

Introduction

Current guidelines on venous thromboembolism (VTE) prevention do not reflect the potential varying risk for patients undergoing different urological procedures. Our study aimed to establish the procedure specific rate of postoperative VTE in patients undergoing urological surgery.

Methods

Hospital Episode Statistics were obtained for all patients undergoing common urological procedures between April 2009 and April 2010. This cohort was followed up to identify all patients reattending with either deep vein thrombosis (DVT) or pulmonary embolism (PE) within 12 months.

Results

A total of 126,891 individuals underwent urological surgery during the study period. This included 89,628 men (70.6%) and 37,236 women (29.3%) with a mean age of 65.2 years. At the 12-month follow-up, 839 patients (0.66%) were readmitted with VTE. Of these, 373 (0.29%) were admitted with DVT and 466 (0.37%) with PE. The procedure-specific rate of VTE varied significantly between 2.86% following cystectomy and 0.23% following urethral dilatation. Procedures performed in the lithotomy position carried a significantly lower risk of VTE than those performed in the supine position (0.60% vs 1.28%, p<0.0001). Furthermore, of all procedures performed in the lithotomy position, those performed on benign conditions carried a significantly lower risk than those performed on malignant disease (0.52% vs 0.79%, p<0.0001).

Conclusions

Procedure specific rates of postoperative VTE vary widely among patients undergoing urological procedures. These findings suggest the potential benefit of prolonging the use of thromboprophylaxis in high-risk patients but also exploring the apparent lack of need for routine thromboprophylaxis in patients undergoing low-risk procedures.     

伴右向左分流的隐源性缺血性卒中的临床和影像学特征

目的分析右向左分流相关隐源性缺血性卒中患者的临床特点及梗死灶影像特征。方法纳入隐源性缺血性卒中患者52例,根据经颅多普勒发泡试验结果分为伴右向左分流组(25例)及不伴右向左分流组(27例)。比较两组人群在人口学资料、脑血管病传统危险因素、梗死灶影像学等方面的差异。结果两组患者的年龄、性别比差异无统计学意义。伴右向左分流组患者无明确脑血管病传统危险因素的比例明显高于不伴右向左分流组(44%vs.14.8%,P=0.015),且其发生后循环梗死也更多见(56%vs.14.8%,P0.01),但两组患者的梗死灶大小无统计学差异(P0.05)。结论无明确脑血管病传统危险因素的后循环梗死患者,应注意排查是否存在右向左分流,以进一步明确卒中病因。     

The role and safety of the sitting position in instrumented cervical surgery

Placing patients who are undergoing neurosurgical procedures to the cervical spine in the sitting position offers significant advantages. These must be counterbalanced against the risk of venous and paradoxical air embolism. This study addresses the role and safety of the sitting position for instrumented cervical surgery. Twenty-five consecutive patients who underwent instrumented cervical surgery in the sitting position were recruited via retrospective analysis. Complications arising from the surgical procedure – specifically venous air embolism – were recorded, as well as pre- and post-operative haemoglobin levels. The incidence of venous air embolism was 0% (97.5% one-sided confidence interval: 0–13.7%). However, five other complications occurred (incidence rate of 20% with a 95% confidence interval of 6.8–40.7%). With appropriate precautions, screening and specific indications, the sitting position can be safely used in more complex instrumented cervical surgery.     

阿尔茨海默病与帕金森病痴呆病人的ASL脑灌注研究

目的 利用三维伪连续动脉自旋标记（3D pcASL）成像技术比较阿尔茨海默病（AD）和帕金森病痴呆（PDD）病人脑灌注的异同,并分析脑灌注改变与认知功能损害的相关性。 方法 前瞻性收集AD病人24例、PDD病人26例、正常对照（NC）36例,均行颅脑常规MRI及3D pcASL灌注MRI检查。采用基于Matlab的SPM12软件对3D pcASL序列扫描获得的脑血流（CBF）图进行预处理,通过单因素协方差分析及独立样本t检验进行组间比较。利用DPABI软件提取AD组与NC组、PDD组与NC组灌注存在差异脑区的相对脑血流量（rCBF）值,采用Pearson相关方法对rCBF值与简易精神状态量表（MMSE）及蒙特利尔认知评估量表（MoCA）评分做相关性分析。 结果 与NC组相比,AD组双侧大脑皮质的广泛区域灌注减低,双侧丘脑、基底节、海马及辅助运动区（SMA）灌注增高;PDD组表现为与AD组基本一致的灌注减低和增高的脑区,但是脑区变化范围缩小。与AD组相比,PDD组双侧壳核、左侧中央前回、右侧SMA灌注减低,右侧顶下小叶灌注增高。AD组左侧额中回及左侧颞中回的灌注值与MMSE评分（分别r=0.64,P<0.001;r=0.50,P=0.01）及MoCA评分（分别r=0.44,P=0.03;r=0.48,P=0.02）均呈正相关,PDD组相关脑区与认知评分未见显著相关性。 结论 3D pcASL成像技术能够直观地反映AD与PDD病人类似的脑血流灌注模式,同时显示两者的灌注差异。AD病人多个脑区灌注值与认知相关评分呈正相关,提示脑血流改变与认知损伤具有相关性。