高龄患者周围动脉闭塞性疾病的外科治疗经验

目的　探讨 80岁以上高龄患者的周围血管疾病外科治疗的可行性。方法　对 30例 80岁以上高龄的急、慢性周围动脉闭塞患者的血管外科治疗进行回顾性分析。结果　 30例患者共施周围血管手术 32例次 ,术后 30d内病死率为 16 .7% (5 30 ) ,肢体保全率为 71.9% (2 3 32 )。其中急诊死亡为 2 7.3% (3 11) ,择期死亡为 10 .5 3% (2 19)。随访 2 4个月 ,全组生存率为 76 .7% (2 3 30 ) ,肢体保全率为 6 5 .6 % (2 1 32 )。结论　对经选择的 80岁以上患者施行周围血管手术是可行的 ,术后死亡率低 ,远期效果良好。     

旁路移植人工血管闭塞原因分析及再手术的术式选择

目的 分析旁路移植人工血管闭塞的原因，探讨再手术术式的选择。方法 回顾性分析自1993年1月至2002年5月治疗的旁路移植人工血管闭塞患者47例。均给予再手术治疗，其中单纯人工血管切开取栓9例；人工血管取栓 吻合口成形16例；人工血管或自体大隐静脉再移植22例。结果 单纯人工血管切开取栓术及人工血管取栓 吻合口成形术的2年再闭塞率分别为67％、56％，明显高于人工血管或自体大隐静脉再移植手术术式的9％。结论 人工血管或自体大隐静脉再移植手术的效果明显优于单纯人工血管切开取栓术及人工血管取栓 吻合口成形术。     

主髂动脉破裂外科治疗23例体会

目的探讨外科手术在主髂动脉破裂治疗中的地位。方法分析1984年4月至2003 年12月手术治疗的23例主髂动脉破裂患者的临床资料,主髂动脉瘤破裂18例,外伤性破裂5例。其中破损修补2例,人工血管置换21例。结果 23例患者中,手术抢救成功19例,死亡4例,其中术后48 h内死于急性肾功能衰竭2例,死于应激性溃疡并发消化道大出血1例,术后72 h内死于呼吸功能衰竭1例。结论对于主髂动脉破裂患者须积极纠正低血容量休克,同时迅速有效控制主髂动脉血流后尽快修补血管或行人工血管置换。     

医源性股动脉假性动脉瘤的治疗方法

Objective To evaluate the effect on ultrasound-guided locsl comprression and surgical to treat iatrogenic fem- oral artery pseudoanerurysms. Methods 197 patients were diagnosed as iatrogenic femoral artery pseudoaneurysms from Apri 1199 to April 2008.There were 122 male and 75 female, aged 59.7 years (rimed 40- 81 years). One. Hundrel and severty-one stahle cases were managed by ultrasound-guided local compression initially and 26 patients were directly treated with surgical repair because d the rupture of femoral artery pesudoaneurysms or the pseudoaneurysms≥40mm in diameter. Results 171 patients received llocal com- pression therapy, 137 cases were cured directly (the effective rate was 80%), but the last failed 34 cases were required conversion to surgical reparr. The nymber of the surgical repaired patients was 60 (incluing 26 cases with direct operation and 34 cases with required conversion to surgical repair). Forty-seven patients received direct excision of femoral artery pseudoaneurysm, six patients underwent angioplasty with autogenously saphenous vein patch, and seven patients got bypass operation with artificial vascular graft. During the perioperative period, no serious complications including bleeding, neuralgia, and lymphatic fistula even arterio venous fis- tula and so on, no death occurred. All patients were followed up for 1 month to5 years after the procedures, no local FAP recurred, no limb ischemia developed and no deaths occurred. Conclusion Uitrasound-guided compression, surgical repair, and ultrasound- guided percutaneous thrombin injection are the three main modalities of treating iatrogenic FAP, while ultrasound-guided compresson and magical therapy get popularized domestically. Ultrasound-guided comperession seems a safe, inexpensive, and effective method for the managerment of iatrogenic femoral artery pseudoaneurysms. It may be used as a lust-line therapetic modality for mint of the un-complicated patients. However, surgical repair can be reserved for those who failed comperssion therapy or unsuitable as mentioned above.     

发生在四肢的栓塞

说起脑血栓,大家都知道这是指脑血管发生了栓塞。而栓塞若发生在四肢,又会是什么情况呢? 老张患风湿性心脏病多年。这天他突然左脚发凉发麻,并且疼痛,老张以为是受了风,就用热毛巾敷,可症状不但没减轻,反而更加严重。他只得去医院。原来他得了“急性周围动脉栓塞”。 急性周围动脉血管栓塞主要是由于心脏的血栓脱落引起。一般多数血栓产生于房颤病人的左心房或近期心肌梗死患者的心窒壁内,也可产生于周围动脉瘤腔内,血栓脱落后便可循血流进入到周围动脉血管而发生栓塞。引起动脉栓塞的物质也可以是来源于心脏粘液瘤的脱落碎片。     

医源性股动脉假性动脉瘤的治疗方法

Objective To evaluate the effect on ultrasound-guided locsl comprression and surgical to treat iatrogenic fem- oral artery pseudoanerurysms. Methods 197 patients were diagnosed as iatrogenic femoral artery pseudoaneurysms from Apri 1199 to April 2008.There were 122 male and 75 female, aged 59.7 years (rimed 40- 81 years). One. Hundrel and severty-one stahle cases were managed by ultrasound-guided local compression initially and 26 patients were directly treated with surgical repair because d the rupture of femoral artery pesudoaneurysms or the pseudoaneurysms≥40mm in diameter. Results 171 patients received llocal com- pression therapy, 137 cases were cured directly (the effective rate was 80%), but the last failed 34 cases were required conversion to surgical reparr. The nymber of the surgical repaired patients was 60 (incluing 26 cases with direct operation and 34 cases with required conversion to surgical repair). Forty-seven patients received direct excision of femoral artery pseudoaneurysm, six patients underwent angioplasty with autogenously saphenous vein patch, and seven patients got bypass operation with artificial vascular graft. During the perioperative period, no serious complications including bleeding, neuralgia, and lymphatic fistula even arterio venous fis- tula and so on, no death occurred. All patients were followed up for 1 month to5 years after the procedures, no local FAP recurred, no limb ischemia developed and no deaths occurred. Conclusion Uitrasound-guided compression, surgical repair, and ultrasound- guided percutaneous thrombin injection are the three main modalities of treating iatrogenic FAP, while ultrasound-guided compresson and magical therapy get popularized domestically. Ultrasound-guided comperession seems a safe, inexpensive, and effective method for the managerment of iatrogenic femoral artery pseudoaneurysms. It may be used as a lust-line therapetic modality for mint of the un-complicated patients. However, surgical repair can be reserved for those who failed comperssion therapy or unsuitable as mentioned above.     

慢性下肢缺血≠脉管炎

慢性下肢缺血性病变在临床上非常多见。其主要表现是:病变早期,下肢尤其是足趾部苍白冷凉;中期可出现间歇性跛行,也就是当步行一段路后,小腿或足部出现疼痛,休息数分钟后疼痛便可消失,重新步行后疼痛再次出现;晚期可出现静息痛,即休息时,尤其是在夜深人静时,足部疼痛难忍,病人常抱足而坐,彻夜不能安眠,严重时足趾部甚至整个患肢发生紫绀乃至坏疽。检查可见足背、胫后甚或股、腘动脉搏动消失。患肢皮肤温度明显降低,以足趾部最为明显。当患肢发生坏疽后,截胶之苦便不可避免了。     

四肢无脉征的治疗与保健

当机体某一本应能用手指触知脉搏跳动的部位而却未能触知时(除极少数人动脉血管走行异常外),我们便可以说该部位“无脉”。无脉现象是一种临床病变体征,而非某一种疾病的名称。出现了无脉征即意味着该部位的动脉血管腔发生了闭塞或严重狭窄,致使其远端血流中断或明显减少。这种现象多发生在四肢,患肢表现畏寒、发凉、苍白、间歇跛行、疼痛以致溃疡和坏疽。     

红葡萄酒的保健作用

28随着医学保健知识的普及,目前许多人都已经知道高脂肪、高蛋白、高胆固醇类食品是导致动脉硬化和心脏病的主要原因。但人们不能解释的是,为什么许多吃大量脂类食品的南欧人心脏病发生率却很低,比如法国人的心脏病发生率就明显低于美国人。传统的法国食品是包含有黄油、奶酪和许多其他高胆固醇食品的。英国科学家近来对这一现象做了大量的调查研究。他们注意到了法国人的饮食中还有另外一个重要部分——红葡萄酒。科学家发现,在红葡萄酒中有一种天然的化学物质——多酚,它能够阻止心脏血管发生动脉硬化和形成血栓,从而避免心肌供血不足和梗…     

不同时期大动脉炎患者血浆差异表达蛋白的变化

目的 在血浆中筛选与大动脉炎疾病和时期相关的血浆差异表达蛋白.方法 提取各20例大动脉炎急、慢性期患者和20例健康者的血浆进行蛋白双向凝胶电泳,计算机图像软件分析筛选差异性表达的蛋白点,基质辅助激光解析电离飞行时间(MALDI-TOF)质谱鉴定差异表达蛋白.并对部分蛋白采用酶联免疫吸附法(ELISA)检测血浆中的含量.结果 筛选鉴定出疾病差异表达蛋白14种,包括血清淀粉样蛋白A,血清淀粉样P物质,纤维蛋白原,C3c,C4a,C7,C4结合蛋白,补体因子H-相关蛋白1,α-1酸性糖蛋白,重组激活基因蛋白1(RAG1),载脂蛋白A-Ⅰ、Ⅳ,α1-微球蛋白,转甲状腺素蛋白,结合珠蛋白;其中与大动脉炎不同时期相关的蛋白有血清淀粉样蛋白A、纤维蛋白原、转甲状腺素蛋白、结合珠蛋白.在ELJSA检测中,急性期患者血清中血清淀粉样蛋白A水平(中位数95.9 mg/L)和显著高于慢性期(中位数49.2 mg/L,P=0.009)和健康对照组(中位数23.9 mg/L,P=0.001).急性期补体C4结合蛋白C4BP(中位数88.5 mg/L)显著高于慢性期(中位数61.7mg/L,P=0.023)和正常对照(中位数32.6 mg/L,P=0.001).结论 大动脉患者血浆有多种免疫有关蛋白和急性时相蛋白的表达,有可能用于疾病不同时期的判定;补体激活,补体调节蛋白和自身抗体的产生均参与大动脉炎的免疫病理机制,对这些蛋白的进一步研究有助于阐明大动脉炎的病理机制.