下腔静脉滤过器的临床应用(附29例分析)

目的 :评价置入下腔静脉滤过器预防静脉血栓脱落引起肺栓塞的效果和安全性。方法 :2 9例下肢深静脉血栓患者均经股静脉置入下腔静脉滤过器于下腔静脉内 ,术后立即摄腹部平片及血管造影 ,观察滤器位置、形态及血流情况 ,并积极进行局部溶栓治疗。结果 :全部滤过器均成功放置 ,在随后的溶栓、抗凝、祛聚、扩血管等治疗中 ,患肢肿胀和肺栓塞症状消失或明显减轻。随访 1个月～ 4 3个月 ,仅 1例出现滤过器移位。结论 :置入下腔静脉滤过器是预防肺栓塞安全有效的方法。     

布-加综合征并上腔静脉阻塞的处理

目的　探讨合并上腔静脉病变的布 -加综合征 (BCS)的治疗方法。方法　 3例术前均经彩色Doppler及血管造影确诊。 1例行腔房人工血管旁路 ,1例行下腔静脉破膜及扩张(PTA) ,1例行PTA及内支架置入 ;3例中 ,1例上腔静脉血栓延续至双侧颈内静脉者行溶栓治疗 ,余 2例上腔静脉病变未予处理。结果　 3例下腔静脉压力变化 :术前分别为 2 .40kPa、2 .16kPa、3.5 3kPa(平均 2 .98± 0 .12kPa) ,术后降至 0 .98kPa、1.2 7kPa和 1.0 8kPa(平均 0 .74± 0 .15kPa ,P <0 .0 5 )。随访 3月至 11年 ,2例症状及体征完全消失 ,1例明显缓解 ,均恢复正常生活及工作。结论　介入治疗是该类BCS的首选方法 ,其并存的局限性上腔静脉病变可不预处理。     

提高下腔静脉滤器回收率核心要点

静脉血栓栓塞症是院内常见的致死性心血管疾病之一,应用下腔静脉滤器能大幅度降低致死性肺栓塞的发生率,同时下腔静脉滤器长期植入带来的相关并发症不可忽视。越来越多的指南推荐当肺栓塞风险可控时应及时回收腔静脉滤器。但是由于临床理念与技术发展差异,临床上下腔静脉滤器的总体回收率并不高,大多数滤器最终还是永久性植入。减少滤器的并发症并大幅度提高下腔静脉滤器回收率须做到以下3点：（1）明确植入指征,严格选择,规范操作,精准植入。（2）植入后对滤器进行系统监测,及时处理原发血栓,充分抗凝。（3）有效处理滤器内血栓,回收技术规范化,充分利用多种介入技术提高回收率。     

Novel Rim Plating Technique for Treatment of the Inferior Pole Fracture of the Patella

To aim of the present paper was to introduce a novel fixation technique for the treatment of inferior pole fracture of the patella. We performed a prospective observational study of consecutive cases of inferior pole fracture of the patella that were treated at our institution between January 2018 and June 2019. The patients include three men and one woman, with an average age of 47 years (range: 42–59 years). All patients were treated with the novel rim plating fixation technique for preserving the inferior pole of the patella. During the surgery, a 2.4 mm straight locking compression plate was contoured to adapt to the arc of the lower half of the patella as the rim plate. After reduction of the fracture, the rim plate was fixed to the proximal fragment of the patella through multiple locking screws, against the continuous pull of the patellar tendon. The rim plate encircles and constricts the inferior pole fragments, functioning as a compression and blocking construct. If necessary, an additional anterior tension band or mini locking plate can be used to further prevent anterior displacement of the inferior pole fragments. Under this rigid fixation, motion of the knee and full weight‐bearing were encouraged postoperatively. The patients were followed up monthly until 12 months after surgery. The time to achieve 90°pain‐free, full range of motion of the knee, and fracture healing, were recorded. Related complications were monitored, including infection, loss of reduction, fixation failure, anterior knee pain, and soft‐tissue irritation. The modified Cincinnati knee rating system was used for knee function assessment. The average operative time was 58.8 min (range: 52–63 min). The average blood loss was 59.8 mL (range: 45–71 mL). For all patients, pain‐free 90° range of motion was restored in 2–4 weeks, and the full range of motion was restored in 8–11 weeks. All patients achieved bone union in 6–9 weeks with no displacement of the fragments or breakage of the implant. No patient complained of anterior knee pain or soft‐tissue irritation. The modified Cincinnati score at 12‐month follow up demonstrated excellent outcomes in all four patients. The rim plating technique may be a feasible option for the treatment of the inferior pole fracture of the patella.     

Inferior vena cava injury after blunt trauma: Case report

Introductioninferior vena cava IVC injury is rare with lethal outcomes, the clinical signs depends on the location and associated injuries, andt he treatment might be endovascular, surgical.Clinical caseA 25 years with no medical history was admitted to the emergency department after a car accident. After intubation and hemodynamic stabilization, the computerized tomography CT scan showed hepatic laceration with a rupture of the IVC in the retro-hepatic portion, he was admitted to the operation room for damage control laparotomy; the patient died 12 h after the operation despite appropriate management.ConclusionIVC are rare and lethal, the CT scan remains the gold standard and the evolution of endovascular techniques decreased the mortality rate.     

Functional paraganglioma with tumor thrombus in the inferior vena cava,first case report

Pheochromocytoma (PHEO) is a rare neuroendocrine that tumor originated from the adrenal medulla that secrets catecholamines. Tumors from extra-adrenal chromaffin tissues are called extra-adrenal PHEO or paraganglioma (PGL). To our knowledge, adrenal PHEO and subclinical PGL with inferior vena cava (IVC) invasion had been sporadically reported, while functional PGL with IVC tumor thrombus has not been publicly reported yet. Perioperative management of those diseases is less well established because of their multidisciplinary nature and rarity. We herein present a case of primary malignant PGL with IVC invasion. A 16-year-old female patient with a history of severe paroxysmal hypertension was admitted to Peking Union Medical College Hospital on suspicion of retroperitoneal mass. In-house diagnostic work-up revealed a malignant PGL with IVC invasion, inferior mesenteric artery encasement and, aorta engagement. Multi-disciplinary discussions were held and careful preoperative preparation plans were made. After everything was ready, the functional PGL and tumor thrombus were completely resected, then a reconstruction of IVC was performed. The patient was discharged on postoperative day 14 and all her clinical symptoms disappeared afterward. No evidence of tumor residual or metastasis was found in the subsequent six months of follow-up. Gene tests were made for her and her family. Albeit its rarity, functional PGL with IVC invasion is not unresectable, a multi-disciplinary task force should be established to settle down every detail. We recommended 3-dimensional imaging reconstruction for gaining a better anatomic understanding. Literature reviews showed that complete resection is the premise of a good prognosis. In particular cases, complementary or alternative therapy like chemotherapy and ¹³¹I-metaiodobenzylguanidine might help, family hereditary genetic tests are advised as well.     

肾静脉上结扎大鼠下腔静脉后的血流动力学和肾功能改变及其临床意义

目的探讨肾静脉平面以上结扎大鼠下腔静脉后的心、肾功能及肾脏病理改变。方法在肾静脉平面以上结扎大鼠下腔静脉,术后1,6,24,48h检测心率、射血分数、心输出量、每搏输出量、鼠尾动脉压等心脏血流动力学指标。术后6h、12h、24h、2d、3d、4d、5d、7d检测血肌酐、尿素氮、24h尿量及N-乙酰-β-D-氨基葡萄糖苷(NAG)酶并观察肾脏病理改变。结果肾静脉平面以上结扎大鼠下腔静脉后心输出量减少、血压下降,但至术后48h可完全代偿。术后血肌酐、尿素氮、尿NAG酶升高,肾脏瘀血并见大量管型;术后第3天,肾脏恢复正常结构;术后第4天,血肌酐、尿素氮恢复正常;术后第5天,尿NAG酶恢复正常。所有动物均存活。结论肾静脉平面以上结扎大鼠下腔静脉,可因回心血量急骤减少和双肾瘀血而影响心、肾功能。但心功能术后48h即可完全代偿。肾功能术后第5天即可完全代偿。建议当腹膜后肿瘤侵及肾静脉以上段下腔静脉时,可在切除肿瘤及累及下腔静脉段后,直接结扎下腔静脉残端,不必附加切除右肾。术后早期应注意经上肢浅静脉补充液体以增加回心血量。     

自适应算法与小波变换在心电信号滤波中的应用

心电信号是一种基本的人体生理信号,具有重要的临床诊断价值。然而,体表检测人体心电信号中常带有工频干扰、基线漂移、肌电干扰等各种噪声,给临床对心血管疾病的诊断带来了障碍。为了消除心电信号检测过程中带有的上述三种噪声,采用LM S自适应算法及小波变换理论,有针对性的设计了自适应滤波器、小波变换滤波器和自适应信号分离器等三种数字滤波器来滤除相应干扰。结果表明,对心电信号中存在的这三种噪声具有很好的滤波效果。     

Relationship between venous return and right-atrial pressure

The dynamics and amplitude of changes in venous return and right atrial pressure (central venous pressure) in response to pressor stimuli were studied in acute experiments on cats. The increase in venous return was accompanied by either increase, or decrease in the central venous pressure. Thus, shifts in systemic venous return were not accompanied by simultaneous and co-directed changes in the central venous pressure. These findings suggest the absence of a direct relationship between these parameters.     

肝段下腔静脉阻塞症的外科治疗（附54例报告）

目的 探讨肝段下腔静脉阻塞症的有效治疗方法。方法 ５４例病人中,２０例下腔静脉隔膜破膜术,５例行下腔静脉切开根治性隔膜切除术,１６例行下腔静脉右心耳人造血管转流术,８例行肠系膜上静脉－右心耳人造血管转流术;４例作了下腔静脉－右心耳、肠系膜上静脉、下腔静脉人造血管联合转流术,１例行肺包脾手术。结果 本组５４例患者中,除３例分别于术后１２ｄ、４５ｄ、７个月因肝肾功能衰竭死亡死亡外,其余５１例术后症状明