超选择性动脉溶栓治疗急性大脑中动脉脑梗死的疗效和安全性研究

目的研究超选择性动脉溶栓治疗急性大脑中动脉脑梗死的疗效和安全性。方法选取150例急性大脑中动脉脑梗死患者,按照随机数表法分成观察组和对照组,每组75例,对照组行常规的巴曲酶治疗,观察组行超选择性动脉溶栓治疗,对比两组患者治疗前后的神经功能缺损评分、治疗后血流动力学指标和治疗满意度情况。结果两组患者经治疗后,神经功能缺损评分与治疗前相比,均明显降低,而观察组患者治疗后的神经功能缺损评分显著低于对照组,差异均有统计学意义(P0.05),观察组患者治疗后的纤维蛋白原、全血高切黏度、全血低切黏度、血细胞比容、血浆黏度等血流动力学指标均低于对照组,差异均有统计学意义(P0.05),观察组患者的治疗满意度为94.67%,明显高于对照组的72.00%,差异有统计学意义(P0.05)。结论超选择性动脉溶栓治疗急性大脑中动脉脑梗死的疗效显著,治疗满意度较高,值得在临床上推广应用。     

7例羊水栓塞诊断与抢救的临床分析

目的 分析7例羊水栓塞的临床诊断与抢救,提供临床诊治羊水栓塞的参考,以提高抢救成功率。方法选取2011年1月～2019年10月于本院住院治疗的7例羊水栓塞的产妇临床资料、救治措施、预后及有无并发症进行回顾性分析。结果 7例羊水栓塞患者中,4例行剖宫产术,3例阴道分娩,经多学科合作积极抢救,4例抢救成功,1例有肺挫裂伤、胸骨、肋骨骨折,其余3例无并发症,1例植物人状态,2例死亡(死于严重的DIC、多器官功能衰竭)。结论 羊水栓塞起病急骤、表现不一、进展快,死亡率高,因此早期识别、积极治疗,多学科合作,必要时及时行子宫切除术,可提高抢救成功率,改善预后、减少并发症的发生。     

Management of post-traumatic arterial priapism in children: Presentation of a case and review of the literature

In this article, a 9-year-old boy with arterial priapism is presented. The patient was managed with the conservative measures including imipramine hydrochloride and a favorable outcome was achieved after 2 months of follow-up. The pathophysiology, diagnostic tools and treatment alternatives are discussed.     

Comparison of local and general anesthesia in tension-free (Lichtenstein) hernioplasty: a prospective randomized trial

To compare pulmonary effects, postoperative pain and fatigue, morbidity, patient satisfaction, and cost of different anesthetic techniques for inguinal hernia repair, 50 patients were randomized to local and general anesthesia groups (LA and GA). All patients received the same premedications and the same postoperative analgesic regimen. The standardized postoperative analgesic, intramuscular pyroxicam 20 mg, was given to all patients in the recovery room and an additional 20 mg on the same day was given as requested by each patient. Pulmonary function studies and arterial blood gas analysis were performed 1 h prior to the operation and at the postoperative 8th and 24th hours. All patients underwent Lichtenstein's tension-free hernioplasty. Postoperative pain and fatigue were registered 8 h and 24 h after the operation. A questionnaire was filled out by the patients, and they were asked to give grades for the general comfort of the anesthesia and the surgical procedure (1=worst, 10=best). Postoperative pulmonary function tests were significantly poorer in the GA group both on 8th- and 24th-hour measurements (P<0.05). Patients who underwent LA had significantly lower PCO₂ and higher PO₂ at the postoperative 8th hour (P<0.05). Mean postoperative pain and fatigue scores revealed a significant difference in favor of local anesthesia at only the 8th hour (P<0.05). There were two complications, one in each group (a hematoma in LA and a urinary retention in GA). Patient satisfaction grades were not different in the two groups. We conclude that LA in inguinal hernia repair does not adversely affect pulmonary functions, patients feel less pain, and patient satisfaction is comparable to that with GA. Electronic Publication     

Temporary vena cava filters in the prevention of pulmonary embolism during total hip arthroplasty

Thromboembolism constitutes one of the most dangerous complications during the immediate postoperative period of prosthetic surgery. Pharmacological prophylaxis and mechanical vascular compression are not always sufficient to protect from this surgical complication. In patients at greatest risk for thromboembolism, often with a positive history for pulmonary embolism, temporary vena cava filters may be used to reduce the incidence of vascular and pulmonary complications. However useful, these filters cannot be routinely used in orthopedic surgery. We present our results with the use of Filcard RFO2 vena cava filters in an open, randomized study of 30 patients. Received: 5 November 2001/Accepted: 30 November 2001     

Clinical observation of tempofilter Ⅱ inferior vena cava filter in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis

Objective The aim of this study was to evaluate our experience with the retrievable Tempofilter Ⅱ inferior vena cava (IVC ) filter with regard to insertion, efficiency, ease of retrieval, and any associated complications. Methods A retrospective review was performed of 112 patients (44 female,64 male,mean age 52. 3 years) who underwent Tempofilter Ⅱ IVC filter insertion. Filter insertion was successful in all patients. The filter was placed in via the jugular vein of 112 cases with acute deep vein thrombosis (DVT) and (or) PE;after drug treatment, it was observed whether there existed PE symptoms and if the change of the filter location occurred and associated complications. Results All the inferior vena cana filters were successfully emplaced,and DVT responded well to the filters;no clinical relevant pulmonary embolism occurred;The mean dwell time of successfully retrieved filters was 19. 3 days ( range 8-69 days). The thrombus was trapped in 54 cases (48. 2% ). One vena cana filter was escaped. Conclusion Tempofilter Ⅱ vena cana filter is of exact curative effect in the p revention of PE and high value of clinical application.     

复合术式治疗复杂型下肢动脉硬化闭塞症疗效分析及其影响因素的研究

目的探讨复合术式(球囊扩张、支架植入联合内膜剥脱及取栓)治疗复杂型下肢动脉硬化闭塞症(ASO)的远期疗效及其相关影响因素。方法回顾性分析2005年1月至2009年11月间,复合术式(球囊扩张+支架置入、内膜剥脱+介入、导管取栓+介入)治疗318例ASO患者的临床资料,其中糖尿病性下肢动脉硬化闭塞症(DASO)198例(61例为双侧病变)259侧肢体,非糖尿病性下肢动脉硬化闭塞症(NDASO)120例(41例为双侧病变)161侧肢体。随访6～36个月,分析患者腘动脉以下血管及股浅动脉的通畅率及其相关影响因素。结果 318例患者中首次治疗成功率分别为DASO腘动脉以下血管90%,股浅动脉血管92%,NDASO腘动脉以下血管91%,股浅动脉血管94%,随访6～36个月,DASO腘动脉以下血管通畅率明显低于NDASO腘动脉以下血管通畅率。DASO腘动脉以下血管累积二次通畅率为89%～67%,股浅动脉血管累积二次通畅率为93%～73%。支架植入组的狭窄率显著低于非支架植入组(P0.05)。DASO的血管的通畅率减低与吸烟史、高血压、血糖控制不稳等因素有关。无围术期死亡及严重并发症发生。结论复合术式治疗下肢动脉硬化闭塞症适应范围广泛,疗法肯定。控制相关影响因素,可有效提高疗效。     

脑膜瘤的术前栓塞

目的 通过对16例脑膜瘤栓塞，探索脑膜瘤的术前栓塞效果。方法 选择性全脑血管造影了解脑膜瘤血供．证实无颈内、外动脉“危险吻合”存在后，用明胶海绵颗粒栓塞脑膜瘤颈外供血动脉。结果 本组16例脑膜瘤DSA表现典型，栓塞术后除5例局部头皮痛外无严重并发症发生。术后3～4d均手术顺利切除。术中出血明显减少，与未行栓塞者对比平均每例减少出血约300ml，以Ⅱ型明显。结论 脑膜瘤术前供血动脉栓塞能明显减少术中出血，安全有效。     

术前筛查下肢血栓对防止肺栓塞的意义

目的：探讨术前彩色多普勒超声（CDFI）筛查骨折患者下肢静脉血栓对防止肺栓塞的意义。方法：回顾性分析2010年1月至12月,因创伤致下肢骨折入院,拟行切开复位术的2000例患者,男1140例,女860例;年龄18～94岁,平均（54.78±21.45）岁。所有患者入院时伤肢肿胀明显,均经外敷和口服中药治疗,伤肢肿胀好转后（3～14d）,行骨折复位术,手术前1d筛查骨折患者下肢血栓,并对其临床资料（性别、年龄、骨折部位、病程）进行回顾性分析。结果：①2000例创伤骨折患者术前经CDFI筛查,证实并发深静脉血栓（deepveinthrombosis,DVT）共128例（6.4%）。血栓类型：髂-股静脉血栓52例,腘-胫静脉血栓20例,小腿肌肉静脉血栓56例。对胫静脉以上DVT72例采取溶栓治疗或放置下腔静脉滤网,溶栓有效20例,放置下腔静脉滤网17例,溶栓失败和未放置腔静脉滤网患者28例,这65例均实施了骨折复位术,另外7例采取保守治疗。1例术中发生肺栓塞,经及时溶栓治疗获得成功。小腿肌肉静脉血栓56例中51例未行特殊处理,实施了复位术;另5例行保守治疗。②DVT发生与性别无关;血栓发生最小年龄22岁,41岁以上组血栓发生率高于40岁以下年龄组;多发骨折、股骨骨折高于胫骨、腓骨骨折;血栓发生病程最短3d,病程越长,血栓发生率越高。结论：创伤骨折患者无论是否存在形成DVT的高危因素,骨折复位手术前均应常规行CDFI筛查DVT,对降低麻醉、手术风险,防止致命性肺栓塞有重要意义。     

Midterm follow-up of arterial switch operation for transposition of the great arteries with intact ventricular septum and left-ventricular outflow tract obstruction

Objective: We report the mid-term follow-up of patients, who underwent arterial switch operation (ASO) for transposition of the great arteries (TGA) with intact ventricular septum and left-ventricular outflow tract obstruction (LVOTO) over a 10-year period from 2000 to 2009. Methods: Thirteen TGA patients (3.9% of our ASO cohort) with intact ventricular septum and LVOTO underwent ASO. LVOTO was defined as pulmonary valve z-score ≤ −2.0 (n = 3) or peak LVOT gradient ≥40 mmHg with (n = 7) or without (n = 3) anatomic subvalvar stenosis on echocardiography. Median age and weight were 14 days (range, 7–130 days) and 3.2 kg (range, 2.1–4.6 kg). The LVOT abnormalities included fibromuscular narrowing (n = 5) and atrioventricular valve-related findings (n = 5). LVOT clearance was achieved by resection of accessory mitral tissue (n = 2) only. Results: Follow-up was 100% complete. There were no early or late deaths. Freedom from re-operation for neo-aortic valve regurgitation and/or LVOTO was 100% at a median follow-up of 38 months (range, 6–115 months). All patients had functional status appropriate for their age. Three patients had mild aortic regurgitation. The median Doppler estimated LVOT systolic gradient was 12 mmHg (range, 0–18 mmHg) for the entire cohort at the latest follow-up. Conclusions: Mid-term outcomes of ASO for a highly selected group of patients with pulmonary valve annulus z-score ≤ −2.0 ≥ −0.4, resectable organic LVOTO, and dynamic peak LVOT gradient ≥40 mmHg remain satisfactory, with a need for long-term follow-up.