主动脉窦瘤破裂的超声心动图诊断

目的评价主动脉窦瘤破裂(rupturedaorticsinusaneurysm,RASA)的超声心动图价值。方法复习文献,回顾性分析经手术证实的9例主动脉窦瘤的超声心动图特征。结果超声心动图可以准确显示窦瘤的形态、部位、破入心腔方向、血流动力学及并发症。结论超声心动图可于手术前及时、准确的诊断本病。     

先天性主动脉窦瘤破裂的影像诊断(附6例分析)

本文报道6例先天性主动脉窦瘤破裂病例，均经手术证实，窦瘤全部起于右冠状窦并破入右室。6例皆有普通X线照片，主动脉造影及超声心动图检查。本文对临床资料及各种检查方法进行了讨论，认为平片有明显的诊断价值，超声心动图作为无创检查不仅可明确提示诊断，而且能指出窦瘤的部位、破口大小及有无合并心内畸形。术前行胸主动脉造影能更详确的做出诊断。     

The combined approach to intracranial aneurysm treatment

Background

A consecutive series of patients with intracranial aneurysms in the practice of one neurovascular surgeon was retrospectively reviewed to illustrate that one physician can become proficient in microneurosurgery as well as endovascular surgery and achieve favorable outcomes in both disciplines. This supports one model of training for cerebrovascular surgeons that includes the complimentary practice of open microneurovascular surgery with endovascular surgery.

Methods

The senior author (HAR) treated 351 patients with 413 aneurysms between July 2001 and March 2007. Of these, 172 patients (216 aneurysms) were treated with open microneurosurgical techniques and 179 patients (197 aneurysms) were treated using endovascular techniques.

Results

Complete obliteration was attained in 94.3% of clipped aneurysms, and 61.9% and 65.9% of coiled aneurysms immediately and after at least 6 months of follow-up, respectively. At latest evaluation, 93% of endovascular patients and 90% of microneurosurgical patients had good clinical outcomes (GOS, 4 or 5; mean follow-up, 23 months; combines ruptured and unruptured cohorts). Procedure-related mortality included 1 surgical patient and 2 endovascular patients.

Conclusions

Because the fields of microvascular and endovascular surgeries are both technically complex, there has been concern that hybrid cerebrovascular surgeons cannot perform each technique with the skill necessary to achieve good outcomes. When compared to clipping and coiling reviews in the neurosurgical literature, we illustrate that one hybrid neurovascular surgeon is capable of attaining great facility in both techniques and that this type of physician will represent one practice model of cerebrovascular specialist in the future. This has potential implications for the training of hybrid cerebrovascular surgeons.     

颅内动脉瘤破裂的CT早期诊断进展

颅内动脉瘤是严重威胁人类生命健康的一种疾病,是造成自发性蛛网膜下腔出血(SAH)的首位原因。该病最大的特点是致残率、致死率高。如何尽早诊断和治疗,是减少动脉瘤再次破裂导致残疾和死亡的关键。近年来,随着CT技术进步成熟,临床诊断率已大大提高。现就动脉瘤破裂的早期CT诊断综述如下。     

腹主动脉瘤破裂的预后影响因素分析

目的 探讨影响腹主动脉瘤破裂的预后影响因素.方法 回顾性分析中山大学附属第一医院自1980年1月至2013年5月间收治的85例破裂型腹主动脉瘤患者的临床资料.从腹主动脉瘤破裂的疾病相关因素和手术相关因素两方面进行研究,采用单因素分析和Logistic多元回归分析了解影响腹主动脉瘤破裂患者的预后影响因素.结果 67例行手术治疗,术后30 d病死率为35.8％.围手术期病死率为47.6％,抢救成功率为52.4％.通过单因素分析可知在腹主动脉瘤破裂的疾病相关因素中,年龄(P=0.012)、从发病到就诊时间(P=0.023)、合并冠状动脉粥样硬化性心脏病(P=0.041)或慢性阻塞性肺疾病(P=0.018)、心搏骤停(P =0.036)、休克持续时间(P =0.007)和就诊时收缩压(P=0.015)在死亡组与存活组间差异有统计学意义;手术相关因素中,从就诊到手术开始时间(P=0.001)、手术时间(P =0.024)、失血量(P =0.039)及主动脉阻断时间(P=0.030)于两组间差异有统计学意义.通过多因素分析显示年龄(P=0.049)、合并冠状动脉粥样硬化性心脏病(P=0.016)、休克持续时间(P =0.007)、从就诊到手术开始时间(P =0.025)、手术时间(P=0.041)及失血量(P=0.021)于两组间差异有统计学意义.结论 腹主动脉瘤破裂病情进展迅猛,病死率高,临床上应力求早期诊断,及时手术治疗控制出血,才能提高其存活率.     

异位妊娠破裂的临床观察和危险因素分析

目的：通过对异位妊娠的临床观察以及分析造成异位妊娠破裂的各种临床因素,为手术方法提供有力依据。方法回顾性分析广西水电医院收治的198例异位妊娠患者的临床资料,分析病理因素与发生破裂的关系。结果分析可知异位妊娠可能出现的症状有腹痛、腹部包块、阴道流血、盆腔出血,盆腔肿块位置,盆腔出血量,而异位妊娠破裂的危险因素主要包括受精卵着床部位异常等,盆腔出血量到达1000 ml、B超盆腔肿块直径＞4 cm时,高准确度提示异位妊娠破裂,临床B超检查多能准确判断。结论异位妊娠的临床表现多为腹痛、腹部出血等,输卵管峡部妊娠为异位妊娠破裂的危险因素,高度警惕破裂的发生。     

国产封堵器介入治疗主动脉窦瘤破裂四例

自从1840年Thumam报道了第1例主动脉窦瘤破裂（rupturedsinusofvalsalvaaneurysm,RSVA）以来,外科手术曾是治疗RSVA的主要方法。随着介入治疗的发展,一些RSVA也成功进行了介入封堵治疗。由于病例有限,RSVA介入封堵的适应证仍在探讨之中,远期疗效也有待于观察。我们近年来成功使用过程封堵器对4例伴或不伴室间隔缺损的RSVA患者成功进行介入封堵,现报告如下。     

An insider's view on person-centred rehabilitation: A case study

Purpose. The author, a rehabilitation specialist of more than 30 years, presents her observations of the medical and rehabilitation services her husband received after a ruptured abdominal aortic aneurysm. Building on the person-centred approach, she identified several problems and describes theory-based strategies how she and her husband (patient) addressed these problems. In addition, she provides insight in the complex role she fulfilled as family caregiver: liaison, advocate and as personal health manager (taking care of her own health).

Method. A qualitative analysis and interpretation based on personal observations and discussions with medical and rehabilitation professionals.

Results. The author argues that the culture of the institution (knowledge and compassion) and the role of the patient advocate have major implications on the outcome of a patient's functional gains. The International Classification of Functioning, Disability and Health can be a useful tool to enhance transparency within the patient-centred approach.

Conclusion. Although this case study is described from the perspective of one case, the information shared in this paper may stimulate further discussion and research in the concept and implementation of person-centred rehabilitation.     

主动脉窦瘤破裂术中主动脉瓣关闭不全的处理

目的：总结1989至2002年间31例主动脉窦瘤破裂(RASV)患者术中处理主动脉瓣的经验。方法：患者年龄为9-45(平均26．7)岁。超声心动图提示有主动脉瓣关闭不全(AR)27例。在全身麻醉体外循环下完成心内直视手术，窦瘤破口及合并室间隔缺损均在右心室面予以补片修补，窦瘤颈部予以荷包加固缝合。其中20例患者因瓣叶游离缘被拉长脱垂，致瓣口轻、中度关闭不全，采用瓣缘折叠法修复；11例瓣叶无法折叠修复者，实施主动脉瓣置换。结果：全组患者术后恢复顺利，无手术死亡；3例发生低心排血量，均痊愈出院。结论：RASV合并AR不单纯由主动脉瓣脱垂引起，往往合并有窦瘤引发的瓣叶退行性变，术前应做好换瓣准备，对较严重的AR应积极行主动脉瓣置换。     

颅内破裂动脉瘤术前再破裂的危险因素

目的探讨颅内破裂动脉瘤术前再次破裂出血的危险因素。方法回顾性分析2017年1月1日至2020年12月31日收治的873例颅内破裂动脉瘤的临床资料。采用多因素logistic回归分析方法分析术前再次破裂的危险因素。结果 873例中,术前动脉瘤再次破裂出血72例(8.25%),术前未破裂出血801例(91.75%)。多因素logistic回归分析结果显示:发病到入院时间>6 h(OR=7.338;95%CI 4.356～13.320;P<0.001)、动脉瘤最大径>10 mm(OR=2.476;95%CI 1.211～5.060;P=0.013)、入院收缩压≥160 mmHg(OR=3.058;95%CI 1.781～5.249;P<0.001)是颅内破裂动脉瘤术前再次破裂的独立危险因素。结论对于颅内破裂动脉瘤病人,如果发病至入院时间长、动脉瘤较大、术前血压控制不理想,应尽早治疗动脉瘤,可减少再破裂率。