下肢深静脉血栓滤器置人及溶栓治疗的围手术期护理

目的：总结对行下腔静脉血栓滤器置入术及溶栓治疗的患者实施围术期护理的方法。方法：对46例下肢深静脉血栓（DVT）患者放置下腔静脉血栓滤器及溶栓治疗同时,术前认真做好术前准备,加强对患者的健康宣教;术中积极配合护理;术后观察患肢病情及溶栓时护理干预。结果：所有患者手术顺利,均未发生肺栓塞及滤器移位等并发症及不良反应,提高了患者的生存质量。结论：对DVT患者应用下腔静脉滤器置入及溶栓治疗的同时实施围手术期护理,能有效预防肺栓塞,有效地减少不良反应及并发症的发生,提高整体护理质量。     

溶栓治疗和TOAST、OCSP分型对急性缺血性脑卒中患者短期预后的影响

目的:探讨急性缺血性卒中的患者应用阿替普酶溶栓后的短期预后以及TOAST、OCSP两种分型与急性缺血性脑卒中患者预后的关系。方法:回顾性分析2019年1月至2020年6月中山大学孙逸仙纪念医院急诊科来诊的急性缺血性脑卒中住院患者193例[其中男性158例,女性85例,年龄(69.46±13.02)岁],其中应用阿替普酶...     

Evolution of thrombolytic therapy in patients with HeartWare ventricular assist device thrombosis: a single-institutional experience

Open in a separate window OBJECTIVESPump thrombosis remains a major challenge in heart failure patients with left ventricular HeartWare assist device. Current International Society for Heart and Lung Transplantation recommendations favour surgical pump exchange over lysis because safety and efficacy of lysis has been controversially reported. This study summarizes our experience on our HeartWare thrombosis prevention strategy as well as thrombolysis through implementation of our institutional standardized HeartWare assist device protocol.METHODSOutcomes of all HeartWare thrombosis patients admitted between 2010 and 2020 were analysed. Thrombolysis therapy using tissue plasminogen activator was used as the first-line therapy in this study and thrombolysis therapy efficacy was defined as freedom from stroke, bleeding, recurrent HeartWare assist device thrombosis or surgical device exchange within 30 days after lysis application.RESULTSA total of 507 patients have been included in this study and 66 patients (13%) collectively developed a first HeartWare-thrombosis after a median of 12 months (8–22 months) after HeartWare implantation. Forty patients were treated with unstandardized lysis, of whom 7 patients had thrombolysis associated complications, such as incomplete thrombus resolution requiring surgical pump exchange in 4 patients, but also intracranial haemorrhage occurring in 3 patients. Three patients died in the non-protocol group. Eight device thrombosis patients were treated according to our protocol, showing no lysis-associated complication.CONCLUSIONSDespite current recommendations, preferring surgical HeartWare pump exchange in thrombosis, thrombolysis therapy for first HeartWare thrombosis can be safe and effective in a standardized protocol setting, including anticoagulation adjustment and intensified blood pressure control management.     

超选择性动脉溶栓治疗急性脑梗死的临床研究

目的 探讨尿激酶超选择性动脉溶栓治疗急性脑梗死的安全性和有效性。方法 前瞻性收集急性脑梗死病人217例,先行全脑血管造影明确责任血管部位,然后用导引导管或微导管按1万U/min的速度向责任血管泵入尿激酶,每注射10万U即重复血管造影,如果造影显示堵塞血管已经再通则停止溶栓治疗,在治疗2 h、 24 h、7 d、14 d按我国第四届脑血管病学术会议通过的脑卒中患者临床神经功能缺损程度评分标准评定疗效。结果 溶栓后,血管再通率为65.90%（143/217）,溶栓2 h、24 h、7 d和14 d的有效率分别为70.05%、70.97%、76.96%和79.26%。结论 对于急性脑梗死患者,超早期溶栓能恢复血流灌注,阻断脑梗死病理过程,避免脑细胞坏死,明显提高治愈率,降低致残率。     

多模式MRI对急性缺血性脑卒中静脉溶栓治疗指导的临床价值

目的探讨多模式MRI对急性缺血性脑卒中(ACIS)静脉溶栓治疗指导的临床价值。方法回顾性分析2017年01月~2018年01月我院收治的70例ACIS患者的临床资料,根据治疗方法的不同分为对照组(n=35)和观察组(n=35),对照组给予常规抗血栓治疗,观察组给予多模式MRI指导下静脉溶栓治疗,比较两组临床疗效、神经功能缺损(NIHSS)评分、日常生活能力(Barthel指数)评分、血清CRP水平及安全性。结果治疗后观察组总有效率91.43%、血管再通率94.29%,显著高于对照组的71.43%和74.28%(P<0.05);治疗后观察组NIHSS评分和血清CRP水平均低于对照组,Barthel指数评分高于对照组(P<0.05);两组总不良反应发生率无显著差异(P>0.05)。结论多在模式MRI指导下静脉溶栓治疗ACIS的疗效显著,可有效改善神经功能,提高日常生活能力,且安全性较高。     

“翻山鞘”联合大腔导管抽吸技术在下肢深静脉血栓中的应用

目的：探讨“翻山鞘”联合大腔导管抽吸技术治疗下肢深静脉血栓方法与疗效。方法回顾分析28例下肢深静脉血栓患者先行下腔静脉滤器植入,而后采取“翻山鞘”联合大腔导管抽吸治疗下肢深静脉血栓,配合导管溶栓及抗凝。结果28例患者“翻山鞘”全部跨越髂静脉分叉,进入患侧髂外静脉。本组显效16例;有效10例,无效2例,术后无并发症出现。结论下肢深静脉血栓通过“翻山鞘”联合大腔导管抽吸技术治疗取得了满意的疗效,节约手术时间,降低手术风险。     

微导管溶栓在处理急诊PTCA术后无复流现象中的初步应用

目的：探讨微导管溶栓在治疗急性心肌梗塞急诊PTCA及支架术后无复流现象中的应用。方法：对我院76例急性心梗病人施行急诊PTCA及支架术,对8例术后出现无复流现象的病人给予冠脉内推注药物,并对其中的5例病人采用梗塞相关冠状动脉内留置微导管滴注溶栓药治疗,并于10h后复查冠脉造影及定期随访。结果：5例轻微导管溶栓治疗者较药物治疗者血流改善,心功能改善。结论：微导管溶栓对于急诊PTCA及支架术后无复流的急性心梗病人能较有效地恢复血流,改善心功能,可作为临床处理无复流的一种方法手段。     

不同溶栓效果患者纤维蛋白原及D-二聚体的动态变化研究

目的 探讨不同溶栓效果的急性脑梗死患者纤维蛋白原（FIB）及D-二聚体DD）动态变化.方法 根据治疗24 h后的神经功能缺损评分（NIHSS）减分率比较溶栓组33例与未溶栓组20例的疗效,采集溶栓组溶栓前,溶栓后2h、6h、12h、24 h及l周的血液检查FIB、DD水平,用重复测量方差分析其动态变化.结果 溶栓患者24 h后NIHSS减分率较未溶栓患者差异有统计学意义（x2=4.7026,P＜0.05）.溶栓效果好组FIB在12h达到低点,明显低于溶栓效果差组（￡=4.47,P＜0.01）,DD在6h达到高点,明显高于溶栓效果差组（t=6.374,P＜0.01）,其差异均有统计学意义.结论 溶栓效果好的患者FIB下降明显,DD上升明显,为临床观察病情转归,预测预后提供依据.     

急性心肌梗死合并2型糖尿病优化介入治疗与直接经皮冠状动脉介入治疗的临床对比研究

目的 探讨经皮冠状动脉介入治疗（PCI）联合尿激酶静脉溶栓（即优化介入治疗）与直接经皮冠状动脉介入术治疗急性心肌梗死（AMI）合并2型糖尿病（DM）的有效性和安全性。方法 78例发病时间≤12h的首次AMI患者随机分为溶栓治疗＋PCI组（45例）和直接PCI组（33例），对2组患者介入治疗前梗死相关血管（IRA）通畅率、介入治疗成功率、出血并发症发生率、住院期间急性心脏缺血事件发生率及出院前左心室功能（LVEF）进行比较。结果 冠状动脉介入治疗前溶栓治疗＋PCI组IRA通畅率（53．3％）显著高于直接PCI组（24．3％）（P〈0．05），前者介入治疗成功率98．0％；2组开通率分别为91．1％和87．9％；住院期间2组均无严重出血及急性心脏缺血事件发生；出院前经超声心动图测得LVEF在溶栓治疗＋PCI组为64．8％，明显高于直接PCI组57．5％（P〈0．05）。结论 静脉溶栓治疗联合PCI治疗AMI合并2型DM早期再通率高。更有利于保护左室功能，不增加出血并发症。     

Ultrasound with Microbubble Contrast Agent and Urokinase for Thrombosis

This study was aimed at assessing the effects of urokinase (UK) in combination with ultrasound and microbubbles in in vitro and in vivo thrombolytic therapy for the treatment of deep vein thrombosis (DVT). Thrombi with formation times of 1, 3, 7, 14 and 21 d were used for thrombolysis. Forty-five adult mongrel dogs were used to evaluate thrombosis in vivo. Both in vitro and in vivo analyses revealed that UK?+?microbubbles had the best effect among the combinations. Thrombolysis <7 d was more effective at a thrombolysis rate of about 50%, but the thrombolytic effect of thrombi >7 d was poor at thrombolysis rates <30%. Ultrasound?+?UK significantly increased the thrombolysis rate of thrombi <7 d. These results suggest that the combination of ultrasound with microbubble contrast agents and UK may have a synergistic effect on thrombolysis.