The efficacy of hemodialysis in interventional therapy in coronary artery disease patients with chronic renal insufficiency

The aim of this study was to explore the efficacy and safety of hemodialysis in interventional therapy for patients with coronary artery disease combined with chronic renal insufficiency. With the aging and social development, the number of coronary artery disease patients with chronic renal insufficiency gradually increased. Total 58 coronary heart disease patients with chronic renal dysfunction were selected. These patients were characterized with typical angina symptoms and typical electrocardiogram (ECG) changes of onset angina. Continuous oral administration of sodium bicarbonate tablets 1?g 3/day?×?3 days and slow intravenous input sodium chloride 1000 ～1500 mL 3–12?h before operation were given. By this way, all patients were treated by hydration and alkalization. After percutaneous coronary intervention (PCI) treatment, patients were immediately transferred to undergo 4?h of dialysis treatment without removing indwelling of femoral artery puncture sheath tube to protect renal function. Changes in renal function including serum creatinine, glomerular filtration rate, and urine were observed and recorded. All patients were successfully underwent PCI treatment. Within one month after PCI, there were no obvious complication and no stent thrombosis occurred. Among of 58 patients, 56 cases showed no significant increase in serum creatinine levels compared with those before operation. However, serum creatinine level of one patient increased to 251?umol/L and one patient still required permanent dialysis. Using hemodialysis in interventional therapy in coronary artery disease patients with chronic renal insufficiency could significantly improve the prognosis of the patients.     

股动脉穿刺压迫约束带的设计与临床应用

目的探讨自制约束带在股动脉穿刺术后压迫止血的有效性和安全性。方法选择经股动脉穿刺行介入治疗的患者196例,将其随机分为观察组(n=96)与对照组(n=100)。对照组常规在股动脉穿刺点用弹力绷带8字型加压包扎的基础上使用沙袋压迫止血6h,观察组在股动脉穿刺点使用自制约束带加压固定止血,两组患者均下肢制动24h。比较两组术后约束相关并发症。结果观察组穿刺部位假性动脉瘤、皮肤过敏反应及排尿困难发生率均为0,皮下淤血和血肿、皮肤过敏反应发生率显著低于对照组(均P0.05)。结论股动脉穿刺压迫约束带使用安全有效,且护理操作简单。     

彩色多普勒超声引导下腔内治疗股腘动脉硬化闭塞症

目的探讨彩色多普勒超声引导下股腘动脉硬化闭塞症腔内治疗的近期疗效及安全性。方法收集股腘动脉硬化闭塞症患者19例(共21条肢体),在彩色多普勒超声引导下进行腔内治疗。结果 19例患者中,重度肢体缺血(卢瑟福分级4~6级)6例,间歇性跛行(卢瑟福分级2~3级)13例。合并慢性肾功能不全12例,高血压病13例,糖尿病11例,含碘对比剂过敏2例,肾衰竭2例。21条肢体中,泛大西洋介入学会协议(TASC)A级12条、TASC B级6条、TASC C级3条。1例TASC C级病变腔内治疗失败,转开放转流手术,余18例20条肢体均治疗成功,无手术相关并发症。术前踝肱指数与术后比较差异有统计学意义(0.47±0.12vs 0.89±0.15,P0.05)。术后1个月病变段通畅率100%(20/20),术后6个月通畅率90.00%(18/20)。术后随访期间肾功能无恶化。结论对于存在对比剂肾病风险、含碘离子对比剂过敏的患者,彩色多普勒超声引导下的下肢动脉成形术是较好选择。     

Percutaneous embolization of varicocele: technique,indications, relative contraindications,and complications

There are several options for the treatment of varicocele, including surgical repair either by open or microsurgical approach, laparoscopy, or through percutaneous embolization of the internal spermatic vein. The ultimate goal of varicocele treatment relies on the occlusion of the dilated veins that drain the testis. Percutaneous embolization offers a rapid recovery and can be successfully accomplished in approximately 90% of attempts. However, the technique demands interventional radiologic expertise and has potential serious complications, including vascular perforation, coil migration, and thrombosis of pampiniform plexus. This review discusses the common indications, relative contraindications, technical details, and risks associated with percutaneous embolization of varicocele.     

颅内动脉瘤患者介入栓塞术后脑供血不足发生的影响因素分析

目的分析颅内动脉瘤(IA)患者介入栓塞术后脑供血不足发生的影响因素。方法回顾性分析接受介入栓塞术治疗的90例IA患者病例资料、相关检查资料;统计患者术后3周脑供血不足发生情况,设计基线资料填写表,阅读并记录患者相关基线资料,将可能的影响因素纳入,经Logistic回归分析找出可能导致IA患者介入栓塞术后脑供血不足发生的影响因素。结果90例IA患者术后有13例发生脑供血不足,发生率为14.44%;IA患者脑供血不足发生者动脉瘤最大径、吸烟史、合并高血压、Hunt-Hess分级、甘油三酯(TG)水平、总胆固醇(TC)水平与未发生脑供血不足者比较,差异有显著性(P＜0.05);经Logistic回归分析,动脉瘤最大径＞10 mm、合并高血压、TG和TC水平升高可能是IA患者介入栓塞术后脑供血不足发生的危险因素(P＜0.05)。结论IA患者介入栓塞术后脑供血不足可能与动脉瘤最大径＞10 mm、合并高血压、TG和TC水平升高有关。     

颈动脉支架植入术中低血流动力学紊乱相关危险因素

目的分析颈动脉支架植入(CAS)术中低血流动力学紊乱(HD)的危险因素。方法回顾性分析121例接受CAS患者,根据CAS术中血压和心率变化评估有无HD;以单因素及多因素logistic回归分析筛选CAS中发生HD的危险因素。结果共42例发生HD(HD组),其中27例见于球囊扩张时,14例见于植入支架时,1例见于以封堵器封堵血管时;79例未见HD(非HD组)。单因素分析显示,组间患者年龄、颈动脉狭窄程度和部位(有无累及球部或分叉部)、血管斑块性质及球囊后扩张差异均有统计学意义(P均<0.05);多元logistic回归结果显示,年龄、狭窄部位、血管斑块性质及球囊后扩张均为HD的独立危险因素(P均<0.05)。结论CAS术中发生HD与患者年龄、颈动脉狭窄部位、血管斑块性质及有无球囊后扩张有关。     

腔内技术二期隔绝Stanford B型主动脉夹层远端破口并重建腹主动脉内脏分支

目的观察腔内技术二期隔绝Stanford B型主动脉夹层(AD)远端破口并重建腹主动脉内脏分支的效果。方法回顾性分析12例接受体外预开窗技术二期手术隔绝Stanford B型AD远端破口并重建内脏分支患者资料,记录手术成功率及术后并发症,以主动脉CT血管造影(CTA)随访评估疗效。结果12例手术均成功,技术成功率100%。术后2例股动脉穿刺点血肿,3例肺部感染,均经保守治疗后好转。随访1~23个月,中位随访时间15个月,未见脑梗死、心肌梗死、截瘫、脏器缺血等严重并发症及死亡;复查主动脉CTA示AD破口隔绝良好,假腔内血栓形成,无内漏、新发破口及分支支架闭塞等。结论腔内技术可有效隔绝Stanford B型AD远端破口并重建腹主动脉内脏分支。     

超声导引下介入治疗继发孔型房间隔缺损及合并畸形428例临床报告

目的:报告我院1998年10月~2004年10月超声导引下介入治疗ASD合并畸形428例,主要讨论介入适应证,操作原则及临床效果。方法:住院患者继发孔型ASD 428例,男150例,女278例(男∶女=1∶1.9),年龄2~74岁(平均26.6±16.6)。428例ASD为中央型,其中单一ASD 416例,多发型ASD 12例,合并畸形70例,其中合并肺动脉瓣狭窄(PS)14例,肺动脉高压(PH)11例,二尖瓣狭窄(MS)(芦停巴赫综合征)3例,合并室上速3例,合并心房纤颤14例,其它25例。使用日本东芝6000型和美国惠普1500型彩色多普勒血流显像仪和食道超声(TEE)探头频率分别为2.5MHz和5MHz。术前用TTE诊断,术中用TEE配合,儿童<10岁用TTE配合。结果:介入术中超声导引导入球囊导管测量最大ASD伸展直径,用TTE或TEE测量ASD直径及确定ASD位置、大小及数目。428例ASD患者成功介入425例,介入技术成功率99.3%。介入手术并发症总发生率2.1%。合并畸形的治疗,超声导引介入治疗合并畸形,待合并畸形治愈后方再行ASD介入治疗,本组合并畸形介入治疗成功率100%。结论:ASD及合并畸形的介入治疗,必须要在超声导引和监测下主要掌握ASD及合并畸形疾病的适应证,操作规范化,成功率很高,而且是安全有效的。     

腔内治疗逆行撕裂Stanford A型主动脉夹层:Meta分析

目的 采用Meta分析评价腔内治疗逆行撕裂Stanford A型主动脉夹层（RAAD）的效果。方法 检索万方数据库、中国知网及PubMed、Embase、Cochrane library数据库,获得有关腔内治疗RAAD的文献。依据纳入标准筛选文献,采用R软件对文献进行Meta分析,综合评价腔内治疗RAAD围手术期并发症、死亡率及预后。结果 最终纳入11篇文献、共224例RAAD患者。Meta分析结果显示,腔内治疗RAAD围手术期内漏发生率10.22%[95% CI（0.02,0.18）],神经系统并发症发生率0.75%[95% CI（0.00,0.03）],围手术期死亡率1.22%[95% CI（0.00,0.03）]。随访期间6例死亡[0.60%,95% CI（0.00,0.03）],其中5例死因为非主动脉相关性;8例再次接受手术干预[0.89%,95% CI（0.00,0.03）]。结论 腔内治疗RAAD安全、有效。