重组竹叶青蛇毒纤溶酶原激活剂TSV-PA体内溶栓效应观察

目的：观察重组竹叶青蛇毒纤溶酶原激活剂TSV—PA体内溶栓效应。方法：利用家兔制备的脑血栓模型，以生理盐水和尿激酶为对照，用数字减影血管造影技术观察重组竹叶青蛇毒纤溶酶原激活剂TSV—PA体内溶栓效果。结果：TSV—PA高剂量实验组(300μg/kg)再道时间为2h以内，TSV—PA低剂量实验组(150μg/kg)5h以内再通。尿激酶组(2000U／kg)再通时间为3—6h；24h以内生理盐水对照组没有观察到再通现象。实验动物45h后处死解剖，未观察到出血现象和其它异常现象。结论：重组TSV—PA在体内具有良好的溶栓活性。     

Resuscitation and circulatory support using extracorporeal membrane oxygenation for fulminant pulmonary embolism

Fulminant pulmonary embolism (PE) with circulatory collapse is associated with a high mortality rate due to acute right ventricular failure and hypoxia. Immediate and appropriate resuscitation and circulatory support in the perioperative period is mandatory to prevent sudden death. Extracorporeal membrane oxygenation (ECMO) was recently introduced for extracorporeal life support in patients with circulatory collapse and has provided an excellent outcome. We report on the effectiveness of ECMO support for fulminant PE. Seven patients were placed on veno-arterial ECMO for circulatory collapse caused by fulminant PE refractory to conventional treatment. After resuscitation, all patients underwent pulmonary angiography, and thrombolytic therapy was administered in all 7 patients under ECMO support. Three patients who did not improve by thrombolysis underwent embolectomy with standard cardiopulmonary bypass. Two thrombolysis and 2 surgery patients were weaned from bypass and survived. The duration of support ranged from 18-168 h (mean = 67.8 +/- 67.1 h), with maximum bypass flow rates of 2.0-4.5 (mean = 3.5 +/- 0.9). There were no device-related complications during support. In total, 4 patients (57%) were successfully weaned from support and discharged from the hospital in good condition. All patients who survived required prolonged support (27, 82, 151, and 168 h). We conclude that resuscitation and circulatory support using ECMO can be effective, life-saving measures in cases of circulatory collapse caused by fulminant PE.     

磁性微粒栓塞肝癌临床与病理分析

[目的]观察磁性微粒(Fe3O4)栓塞肝癌临床及病理变化,探讨其动脉栓塞作用疗效.[方法]Fe3O4微粒栓塞66例肝癌患者,其中8例栓后手术切除,标本HE染色切片.[结果]临床观察栓后综合征不明显,血生化检查显示肝、肾功能变化轻微,血清AFP多数明显下降(P＜0.05).栓后1个月CT、USG、DSA复查肿瘤明显缩小.病理检查镜下见血管内栓塞颗粒呈"筛网状"结构,其中血栓形成并机化,肿瘤组织坏死彻底.[结论]Fe3O4微粒具有缓慢栓塞血管作用,能明显减少栓后并发症.     

Pulmonary thrombo-embolism in nephrotic syndrome treated with tissue plasminogen activator

We describe the case of a boy with steroid sensitive nephrotic syndrome and left pulmonary artery thrombo-embolism. Clinical presentation initially suggested sepsis and respiratory signs were minor. Treatment with tissue plasminogen activator infused into the pulmonary artery was successful. Conclusion Pulmonary thrombo-embolism should be considered in unwell children with nephrotic syndrome. Received: 6 September 1996 / Accepted: 17 December 1996     

经眼上静脉入路行海绵窦栓塞的应用解剖学

目的：为经眼上静脉入路行海绵窦栓塞术，治疗颈动脉海绵窦瘘提供解剖学依据。方法：成人头部标本２４个，解剖观测眼上静脉及其眶外属支的形态、长度及外径等。结果：①眼上静脉由眶上静脉支和内眦静脉交通支组成。眶上静脉支穿经眶上孔处外径为１．３ｍｍ。内眦静脉外径为１．４ｍｍ，距内眦６～８ｍｍ，其交通支外径为１．４ｍｍ；②眼上静脉在眶腔内分为三段，外径平均达２．１～２．５ｍｍ。结论：经眼上静脉眶外属支入路具有可行性。     

氨基胍对大鼠急性肺栓塞后肺组织细胞凋亡的影响

目的　观察氨基胍对大鼠急性肺栓塞后肺组织细胞凋亡的影响。方法　将大鼠随机分为对照组、模型组、治疗(AG)组,采用改良的导管方法将体外已凝的大鼠血栓注入右心房制备大鼠急性肺栓塞模型。AG组于制成肺栓塞后立即腹腔注射氨基胍,模型组给等容量的生理盐水,对照组只通过导管注入血清。于肺栓塞后1h放血处死大鼠,迅速取肺组织,流式细胞仪(FCM)测定肺组织细胞凋亡率,免疫组化法检测Caspase - 3蛋白的表达。结果　肺栓塞后,肺组织细胞凋亡率明显上升,Caspase - 3蛋白表达阳性细胞明显增多,给予氨基胍后细胞凋亡率明显下降,Caspase- 3蛋白表达阳性细胞数明显减少。结论　氨基胍可降低急性肺栓塞后肺组织细胞凋亡率及Caspase - 3蛋白表达,对急性肺栓塞大鼠有保护作用。     

肺动脉栓塞的彩色多普勒超声诊断

目的 探讨彩色多普勒超声诊断肺动脉栓塞的意义。方法 对临床诊断肺动脉栓塞患者18例行经胸超声心动图检查和下肢深静脉彩色多普勒超声检查。结果 18例患者中，超声检出肺动脉血栓直接征象10例，其中合并右室乳头肌下方血栓及三尖瓣前叶瓣环血栓各1例，合并下肢血栓9例。18例均有右房、右室增大，伴有三尖瓣重度返流，肺动脉重度高压（肺动脉收缩压为110～140mmHg）。结论 彩色多普勒超声是一无创、快速、简单易行的肺动脉栓塞诊断方法，对该病疗效观察及预后判断也有重要作用。     

下肢深静脉血栓并肺栓塞的综合治疗

目的 评价采用综合治疗方法治疗下肢静脉血栓并急性肺动脉栓塞的临床价值。方法 对37例下肢静脉血栓形成（4例合并急性肺动脉栓塞）患者采用下腔静脉滤过器置放、溶栓、复方丹参静脉滴注、抗凝治疗相结合的方法进行治疗，以临床症状和病灶的医学影像改变判断其疗效。结果 肢体肿胀完全消失，彩色多普勒检查示下肢静脉完全再通7例，症状体征消失，长久站立或行走后轻度肿胀，彩色多普勒检查示下肢静脉部分通畅，血流信号明显22例，肿胀减轻，长久站立或行走后肿胀明显加重，休息后再度缓解8例。4例肺栓塞患者症状明显好转。3例CT检查发现肺内病灶的患者治疗后肺内病灶明显缩小2例，病灶消失1例。无一例严重并发症。结论 采用综合治疗方法治疗下肢静脉血栓并急性肺动脉栓塞是一种安全、效果好的方法，可改善其疗效。     

单纯抗凝与导管内溶栓加抗凝治疗肺动脉栓塞疗效对比分析

目的评价单纯抗凝与导管内溶栓加抗凝治疗肺动脉栓塞疗效对比。方法经肺动脉造影或增强螺旋CT证实的急性肺动脉栓塞患者63例，随机分两组，一组单纯肝素抗凝32例，另一组导管内尿激酶溶栓加肝素抗凝31例。结果单纯抗凝治疗总有效率96．7％；导管内溶栓加抗凝治疗总有效率100％，但临床症状改善较快。单纯抗凝无效1例，经导管内溶栓后好转。经导管内溶栓出现消化道出血1例。本观察无1例死亡。结论单纯抗凝与导管内溶栓加抗凝治疗总有效率相近，无并发症出现。所以对无血液动力学改变的急性肺动脉栓塞单纯肝素抗凝即可取得确切疗效，可降低风险。     

经导管子宫动脉注药治疗子宫疤痕异位妊娠的临床分析

目的 探讨子宫疤痕异位妊娠的最佳治疗方法。方法 12例子宫疤痕异位妊娠首先行导管双侧子宫动脉注入二氢叶酸还原酶抑制剂（MTX）和明胶海绵条栓塞术后，在超声监视下再行清除胚胎（清官）术。结果 12例子宫疤痕异位妊娠均一次性彻底清除妊娠胚胎组织，出血极少，无1例发生子宫穿孔或术中、术后大出血，术后月经恢复正常。结论 子宫疤痕异位妊娠首先行经导管双侧子宫动脉注药加柽塞术后再行清官术，是避免清官术中发生大出血而切除子宫的有效方法，更是一种安全可靠方法。