贵要静脉穿刺置管术的应用解剖

目的:为临床应用提供贵要静脉的解剖学资料。方法:对18具36侧经福尔马林灌注的成人尸体标本贵要静脉进行解剖观测。结果:测量了贵要静脉的长度和各部的外径,观察了贵要静脉的走行及贵要静脉与神经、动脉之间的关系。结论:(1)在肘部抽血时,如遇肘正中静脉缺如,以穿刺贵要静脉为宜;(2)如遇头静脉插管困难时,以选择贵要静脉为宜。     

光量子藻酸双酯钠载氧液体疗法对前部缺血性视神经病变和视网膜静脉阻塞患者高血黏度的治疗作用

目的观察光量子藻酸双酯钠液体载氧疗法对前部缺血性视神经病变和视网膜静脉阻塞高血黏度的改善作用。方法本院眼底病组住院患者159例,根据病史、眼底特征、视野检测和或日产Topcon50VT相机荧光素眼底血管造影确诊,将血流变检测异常者纳入,其中缺血性视神经病变患者73例,视网膜静脉阻塞患者86例,对照组采用藻酸双酯钠常规静脉给药观察,治疗组采用藻酸双酯钠光量子载氧两组治疗,仪器使用长春产CYZ-2型氧透射载体治疗仪,将静脉注射药物藻酸双酯钠加入5%葡萄糖250ml通过氧载体输液器在氧载体透照窗经过石英管进行紫外线照射后输入体内,强度为2.5×1000Uw,透照时间〉60min,每日一次,治疗10d后复查血液流变和血脂,对血流变和血脂指标进行统计学分析。结果依据异常血液变和血脂指标改善情况,藻酸双酯钠药物常规治疗和光量子载氧治疗后除均能降低患者高切黏度、低切黏度、胆固醇或甘油三酯;光量子载氧治疗后在高切黏度、低切黏度和胆固醇指标上疗效明显增加（p〈0.05）。结论藻酸双酯钠光量子载氧疗法对前部缺血性视神经病变和视网膜静脉阻塞患者高血黏度的恢复有明显效果,能显著增加药物的治疗作用无创伤,值得应用。     

Horseshoe-like macular tear following recurrent branch retinal vein occlusion

Background A macular hole can develop as a late complication secondary to a branch retinal vein occlusion (BRVO). We report about an atypical horseshoe-like tear occurring in the fovea after recurrent BRVO. Methods An interventional case report. Results In 1997, a 53-year-old man was seen with an occlusion of macular part of inferior temporal vein of the retina on the left eye. After experiencing several recurrent BRVO in this eye, 6 years later he presented with a horseshoe-like tear in the fovea. Visual acuity was 20/200. The patient underwent standard three-port vitrectomy and installation of C3F8 16%. Intraoperatively, massive traction of the vitreous was detected on the edges of the tear. Six months after the operation, the tear remained attached. The visual acuity was 20/200. Conclusions The uniqueness of the presented case is the occurrence of a macular tear following recurrent BRVO, its horseshoe-like shape and foveal location. To the best of our knowledge, this is the first report on a horseshoe-like tear seen in the fovea secondary to BRVO. We assume that chronic macular edema and retinal ischemia following BRVO were additional factors beside the vitreous traction, contributing to the formation of the macular tear. Anatomical closure of the tear and stabilisation of visual acuity can be achieved by vitreoretinal surgery. There is no financial interest to declare. No grant has been received in relation to this case. Presented as a poster at the 102nd meeting of the German Ophthalmologic Society, 2004 Berlin.     

吲哚青绿血管造影联合广角接触镜观察涡状静脉

目的 应用吲哚青绿血管造影（ICGA）联合Staurenghi 230广角接触镜观察和分析人眼涡状静脉的形态及其分布特征。 方法 对28例32只眼进行广角接触镜联合ICGA检查。受检者中女性16例19只眼，男性12例13只眼；年龄28～84岁，平均年龄71岁。根据受检眼不同屈光度分为高度近视组和非高度近视组，前者15只眼，屈光度数≥－6.0 D；后者17只眼，屈光度数＜-6.0 D或正视。 结果 本组受检者中，共发现166支涡状静脉，其中，漩涡状118支，占71.1%；粗条纹状34支，占20.5%；不规则状14支，占8.4%。右眼发现涡状静脉71支，平均每一只眼有涡状静脉507支；左眼发现涡状静脉95支，平均每一只眼有涡状静脉5.28支。颞下、鼻下、颞上及鼻上象限发现的涡状静脉数分别为47、42、39、38支，平均每个象限1.34支，以颞下象限最多，每一只眼平均为1.在赤道部附近，距视盘约4~6 个视盘直径（DD），占964%；6支涡状静脉出巩膜点距离视盘较近约3～4 DD,占3.6%。123支涡状静脉可见明显壶腹，占74.1%，壶腹方向以平行或垂直于眼底水平线者多见。高度近视组和非高度近视组在涡状静脉数目、形态上差异无统计学意义。 结论 人眼涡状静脉形态呈漩涡状、粗条纹状、不规则状；高度近视眼与非高度近视眼涡状静脉分布特征基本一致，均以颞下象限最多，出巩膜点多在距视盘约4~6 DD处，多数可见明显壶腹。广角接触镜下ICGA检查视角广，能在一个视野内同时观察到几乎全部的涡状静脉。     

下肢深静脉瓣膜关闭功能不全的影像学诊断

目的研究下肢静脉瓣膜关闭功能不全影像学分型及对外科手术的意义。方法458条肢体均做下肢深静脉顺行造影,其中361条肢体行经皮腘静脉插管造影,并对14条单纯性大隐静脉曲张(正常瓣膜)肢体进行血液动力性观察。结果444条肢体诊断为下肢静脉关闭下全,14条肢体诊断为单纯型大隐静脉曲张,其中,Ⅰ型深静脉瓣膜脱垂致瓣膜关闭不全114例;Ⅱ型深浅静脉扩张致瓣膜相对关闭不全121例;Ⅲ型瓣膜脱垂加股静脉扩张125例;Ⅳ型先天性下肢深静瓣膜发育不全症4例;Ⅴ型深静脉血栓形成后完全再通瓣膜遭破坏71例;Ⅵ型先天性静脉畸形、组织肥大综合征(Klippel-Trenaunay,KTS)9例;14条单纯性大隐静脉瓣膜均完全正常,屏气时正常肢体股静脉第一对瓣膜、腘静脉瓣膜同时关闭,足背伸屈运动时腘静脉瓣膜开放程度显著大于股静脉第一对瓣膜(P＜0．01)。结论下肢深静脉瓣膜关闭功能不全分型能全面反映疾病的病理本质,较下肢深静脉瓣膜功能不全的概念更确切。     

多普勒超声定位在婴幼儿颈内静脉穿刺中的应用

目的 探讨多普勒超声定位在婴幼儿颈内静脉穿刺中应用的意义.方法 择期先心病手术患儿100例,随机分为解剖标志 多普勒超声定位组(Ⅰ组,n=50)和单纯解剖标志定位组(Ⅱ组,n=50),记录穿刺总成功率、一次穿刺成功率、穿刺次数、误穿颈总动脉率和穿刺时间(从选择穿刺点到放入导引钢丝)以及有无其它严重并发症.结果 解剖标志 多普勒超声定位组一次穿刺成功率显著高于单纯解剖标志定位组,前者的穿刺次数和穿刺时间明显低于后者.结论 解剖标志 多普勒超声定位应用于婴幼儿颈内静脉穿刺可提高穿刺成功率、减少穿刺次数和穿刺时间.     

加减清营汤对H2O2损伤的人脐静脉内皮细胞ECV304 VEGF表达的影响

目的:观察加减清营汤对H2O2损伤的人脐静脉内皮细胞(ECV304)VEGF表达的影响。方法:体外培养人脐静脉内皮细胞(ECV304),随机分成正常组、模型组、血清对照组、阳性药物对照组、加减清营汤含药血清组。加减清营汤含药血清组用加减清营汤含药血清进行干预。用380μmol/L H2O2损伤细胞,培养24h后收集细胞总蛋白,用Western-blotting法检测VEGF表达水平。结果:氧化应激状态下ECV304 VEGF的表达有所增加,加减清营汤含药血清则能显著提高VEGF的表达以有效应对氧化损伤。结论:加减清营汤能促进H2O2氧化损伤的血管内皮细胞的代偿性修复。     

玻璃体腔注射曲安奈德治疗视网膜静脉阻塞黄斑水肿

目的：比较玻璃体腔注射曲安奈德和传统方法治疗视网膜静脉阻塞黄斑水肿的疗效。方法：共有21例因视网膜静脉阻塞导致黄斑水肿的患者纳入此项临床研究。接受治疗前所有的患者均进行了全面的眼科检查，并随机分为两组。实验组9例患者进行玻璃体腔注射4mg曲安奈德治疗；对照组12例患者接受传统方法治疗。结果：治疗前，对照组视力（logMAR）为1．20±0．38，而实验组为1．64±0．31。治疗后1mo，对照组的视力改善到0．98±0．54（logMAR），而曲安奈德治疗组改善到0．87±0．61（logMAR）。实验组和对照组之间视力改善有显著差异（P〈0．01）。结论：研究结果显示，尽管实验组和对照组的患者视力均有改善，但治疗视网膜静脉阻塞黄斑水肿，玻璃体腔注射曲安奈德比传统方法更有效。     

Changes of aqueous vascular endothelial growth factor and interleukin‐6 after intravitreal triamcinolone for branch retinal vein occlusion

Background: To investigate sequential changes of aqueous vascular endothelial growth factor (VEGF) and interleukin (IL)‐6 in macular oedema secondary to branch retinal vein occlusion after single intravitreal injection of triamcinolone acetonide (IVTA). Methods: We recruited 10 healthy controls and 30 patients at Chonnam National University Hospital, Gwangju, Korea. Aqueous and plasma levels of VEGF and IL‐6 were measured by enzyme‐linked immunosorbent assay at the time of IVTA and 3 months later. Non‐response to IVTA was defined as showing persistent macular oedema based on a reduction of central macular thickness by less than 20% from baseline measurements by optical coherence tomography and vision improvement by less than 0.3 logMAR. Fluorescein angiography was performed 6 months after IVTA. We compared aqueous levels of VEGF and IL‐6 between responders and non‐responders. Results: The aqueous levels of VEGF and IL‐6 were significantly higher in 12 non‐responders than in 18 responders at baseline measurements (511 ± 245 pg/mL vs. 230 ± 108 pg/mL, P < 0.001; 38 ± 31 pg/mL vs. 16 ± 13 pg/mL, P < 0.001, respectively). Aqueous levels of VEGF were still higher in non‐responders (312 ± 64 pg/mL) 3 months after IVTA, and aqueous levels of VEGF in responders returned to normal (86 ± 21 pg/mL, P < 0.001). Aqueous levels of IL‐6 normalized in all patients 3 months after IVTA. Fluorescein angiography revealed that non‐responders showed higher frequencies of macular ischaemia and ischaemic branch retinal vein occlusion. Conclusions: IL‐6‐independent VEGF secretion may contribute to persistent macular oedema associated with ischaemic BRVO after IVTA.     

Sheathotomy in complicated cases of branch retinal vein occlusion

Purpose: To report the clinical experience and results of using a microsurgical technique to decompress the arteriovenous connection in complicated branch retinal vein occlusion (BRVO) combined with haemorrhage, oedema and ischaemia. Methods: We carried out a retrospective, non‐randomized, interventional case study of the surgical sheathotomy decompression procedure. We enrolled 12 patients (seven women, five men; median age 64 years) with BRVO and decreased visual acuity (VA) caused by haemorrhage, oedema and ischaemia. The mean duration of thrombosis was 7 months (2–15 months). The patients were examined for pre‐ and postoperative best corrected VA (BCVA), intraocular pressure (IOP) and fundus photography. Ten patients were examined with fluorescein angiography and eight with ocular coherence tomography (OCT). Postoperative progression of cataract was recorded, as were other complications. The mean follow‐up time was 20 months (8–39 months). Results: Best corrected VA had improved in nine patients, was unchanged in one patient and had deteriorated in two patients at the last follow‐up. Noted complications were venous haemorrhage at surgery in five patients, retinal detachment in one patient and progression of cataract in four patients. Conclusions: Microsurgical treatment with sheathotomy of BRVO is a technically feasible procedure with few complications. Postoperative increased reperfusion could explain the resolution of macular haemorrhage, oedema and ischaemia, and may improve visual function in patients with this common vascular eye disease.