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。     

100例急性心肌梗塞病人溶栓治疗的护理

通过对100例急性心肌梗塞再灌注的治疗实践,从护理学角度对溶栓的治疗护理工作进行讨论分析,认为护理工作在该项技术的实施当中至关重要.其目的是为了使更多的心肌梗塞患者得到及时、准确、有效地治疗和护理.     

肺血管栓塞的诊治分析

目的：提高对肺血管栓塞的诊治。方法：对17例肺血管栓塞病人的临床表现、诊断及治疗方法进行分析。结果：17例中4例死后尸检证实了生前的诊断,7例生前已有明确诊断。目前仍存活6例。17例中有13例曾误诊过,误诊率高达76％。结论：提高对肺血管栓塞的诊断意识,早诊早治,可降低患的病死率。     

Anticoagulation therapy for pulmonary embolism involving a myxoma mimicking,giant type C thrombus: A case report

Right heart thrombus (RHTh) with concurrent acute pulmonary embolism (PE) is rare and can seriously destabilize hemodynamics, leading to an emergency situation with high mortality. Diagnosis and treatment of RHTh with acute PE are not yet standardized. There are few reports of acute PE concurrent with RHTh and even less is known about patients with a right heart mural thrombus. For physicians, the diagnostic choice and treatment of these patients are particularly difficult due to the lack of knowledge. Here, we report a rare case of partial mural RHTh (type C RHTh) with acute PE. The mural mass in the right heart was initially diagnosed as atrial myxoma according to transthoracic echocardiography (TTE), and both pulmonary embolus and the mural mass were completely absorbed after administering Rivaroxiban. This case suggests that TTE alone is insufficient to identify and diagnoses a right heart mural mass such as this. However, novel oral anticoagulants may be effective at alleviating PE with type C RHTh.     

可调节式内膜剥离器用于亚急性下肢动脉栓塞治疗32例分析

正多数下肢动脉栓塞病人在急性期内(发病6～8 h以内)行手术治疗可取得较好的治疗效果,但部分病人可能因医疗条件或个人原因而选择保守治疗(如仅使用抗凝药物等),下肢动脉部分开放或仅侧支开放,将疾病由急性期拖入了亚急性期,此时的血栓机化,并且与血管内膜粘连紧密不易分开。笔者团队自制可调节式内膜剥离器用于取出亚急性下肢动脉栓塞病人的陈旧性机化血栓。现报告如下。     

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。     

Risk Factors and Outcomes for Preoperative Asymptomatic Pulmonary Embolism in Patients Aged 60 Years and Over with Hip Fracture

ObjectiveTo investigate the risk factors for, and outcomes of, preoperative asymptomatic pulmonary embolism (PE) in patients ≥60 years old following delayed operation for hip fracture.MethodsFrom March 2017 to December 2018, 90 patients aged ≥60 years with hip fracture who suffered a delay in surgery were recruited to this prospective study following admission to our hospital. Computed tomography pulmonary angiography (CTPA) was used to detect preoperative asymptomatic PE and calculated its incidence. Time from injury to admission, baseline characteristics, medical comorbidities, and blood biomarker levels were evaluated as potential risk factors. Logistic regression analysis was used to identify risk factors. Mortality and major bleeding events were recorded and compared between individuals with PE and without. Data were analyzed by t‐test, Mann–Whitney U test, χ ² test, Fisher''s exact test, and logistic regression analysis.ResultsThe incidence of preoperative asymptomatic PE was 18.9% (17/90 patients). In the univariate analysis, the risk factors for preoperative asymptomatic PE were male sex, hypertension, cerebrovascular accident, smoking, plasma D‐dimer level, potassium level, urea level, creatinine level, and cysteine level. Multivariate logistic regression analysis showed that the risk of preoperative asymptomatic PE was higher in patients with hypertension (odds ratio [OR] = 10.048; 95% confidence interval [CI], 1.118–90.333), cerebrovascular accident (OR = 20.135; 95% CI, 1.875–216.164), smoking (OR = 48.741; 95% CI, 4.155–571.788), high plasma D‐dimer levels (OR = 1.200; 95% CI, 1.062–157.300), and high plasma potassium levels (OR = 12.928; 95% CI, 1.062–157.300). All patients were followed up for 21.0 months (range, 2 to 36 months). Mortality within the first year postoperatively was higher in patients with PE (29.41% vs 9.59%, P = 0.046).ConclusionsIn view of the high incidence of preoperative asymptomatic PE and the inferior prognosis in individuals with PE, routine CTPA examination for preoperative asymptomatic PE could be useful for patients aged ≥60 years with hip fracture for whom surgery is delayed.     

Head injuries coexistent with pelvic or lower extremity fractures-early or delayed osteosynthesis

Summary The authors compared the results of a retrospective analysis of two groups of head-injured patients who had coexistent pelvic or lower extremit fractures. One group was treated with early osteosynthesis within the first 12 hours after trauma, simultaneously with neurosurgical treatment, while the second group was treated neurosurgically and osteosynthesis was postponed for 4 to 10 days. The second group revealed a higher mortality, which was due to fat embolism. We conclude that early osteosynthesis is the treatment of choice in patients with coexistent head injury and lower extremity fractures.     

综合治疗对脑梗塞相关危险因素的影响

目的　探讨综合治疗对脑梗塞复发的相关危险因素的影响。方法　随机选择85 例脑梗塞伴各类危险因素患者在综合治疗前后,对他们进行血压、空腹血糖、胆固醇、甘油三酯及血液流变学等8 项指标的测定。结果　经过1 ～3 年临床观察随访,有50 % 以上高血糖、高血脂、高粘滞血症患者检验指标趋于正常,94 .3 % 的高血压得到控制与稳定,经t 检验,血液流变学4 项P 值< 0 .05 ,差异有显著意义,高血压、空腹血糖、胆固醇、甘油三酯的P 值< 0 .01 ,差异有非常显著意义。结论　综合治疗对控制相关危险因素,预防脑梗塞复发有重要临床意义