人arresten基因转染对自体移植静脉内膜增生的影响

目的:探讨体内转染arresten基因对自体移植静脉内膜增生的影响。方法:建立大鼠自体静脉移植模型。血管吻合术前，用脂质体介导重组质粒pSecTag2-AT（Ⅰ组），空载体pSecTag2转染（Ⅱ组）移植血管，等体积脂质体溶液处理移植血管(空白对照组，Ⅲ组）。各组动物均于4周后切取移植血管，RT-PCR检测移植血管中arresten mRNA的表达；常规HE，Verhoeff弹力纤维染色；计算机图象分析检测移植静脉血管内膜及中膜面积、厚度；免疫组化检测移植血管内膜α-SMA及PCNA的表达；Western blot检测TGF-β1蛋白的表达。结果:Ⅰ组转染的移植静脉中有目的基因mRNA的表达, 而Ⅱ、Ⅲ组无Ⅰ组内膜、中膜面积小均于Ⅱ组和Ⅲ组，差异有显著性（P<0.05）。而内膜面积/中膜面积3组间无统计学差异（P>0.05）；Ⅰ组内膜厚度小于Ⅱ组和Ⅲ组，组间比较有统计学差异（P<0.01）；α-SMA染色表明增生内膜中的细胞是血管平滑肌细胞；PCNA阳性细胞数及表达指数Ⅰ组均低于Ⅱ组和Ⅲ组（P<0.05）；Ⅰ组TGF-β1蛋白的表达明显低于Ⅱ组和Ⅲ组。结论:移植血管转染arresten基因，可有效抑制自体移植静脉内膜的增生，在防治血管移植术后再狭窄方面显示出良好的临床应用前景。     

Topical propranolol hydrochloride gel for superficial infantile hemangiomas

The clinical efficacy and safety of topical propranolol hydrochloride gel in the treatment of superficial infantile hemangiomas (IHs) were assessed. Fifty-one cases of IHs from Oct. 2010 to Sept. 2011 were subjected to the topical propranolol hydrochloride gel intervention in Fuzhou General Hospital of Nanjing Military Commands, China. Changes in size, texture, color, peak systolic velocity of the hemangiomas, resistance index and adverse effects were observed. The results were evaluated by using Achauer system, and responses of IHs to pranpronolol were considered scaleⅠ(poor) in 4 patients (17.24%), scaleⅡ(moderate) in 18 patients (24.14%), scale Ⅲ (good) in 22 patients (44.83%) and scale Ⅳ (excellent) in 7 patients (13.79%). The response of superficial hemangiomas was significantly better than other hemangiomas (P<0.05), and no differences in response were found among different primary sites (P>0.05). Our study indicates that topical application of 3% propranolol hydrochloride gel is effective and safe in treating IHs.     

下肢深静脉血栓行下腔静脉滤器置入加置管药物溶栓术护理

目的总结下腔静脉滤器置入加置管药物溶栓术的观察及护理要点。方法对76例有肺栓塞倾向的下肢深静脉血栓患者放置下腔静脉滤器加置管药物溶栓术,同时加强患者的术前宣教,术前准备及术后病情的观察及护理。结果 76例患者均溶栓成功,未发生肺栓塞、滤器移位、出血等并发症。结论应用下腔静脉滤器置入能有效预防肺栓塞,置管药物溶栓术可加快溶栓效果,并且术式简单、安全、有效,同时有针对性的护理是其治疗成功的重要保证。     

Analysis of 287 patients with aortic dissection: General characteristics,outcomes and risk factors in a single center

The general characteristics,outcomes and risk factors of the patients with aortic dissection(AD) were evaluated in a single medical center.From January 2002 to December 2008,284 patients with AD were treated and followed-up at our institution,including 105 cases of type A AD and 179 cases of type B AD.The patients in each type were divided into three groups according to management:medical treatment group(A or B),open surgery group(A or B),and stent-graft group(A or B).The characteristics and follow-up outcomes were compared between the groups or subgroups.The results showed that there was significant difference in the prognosis for type A AD between medical treatment group and open surgery group,but there was no significant difference in the prognosis for type B AD between medical treatment group and stent-graft group.Independent risk factors of follow-up mortality for patients with type A AD included a history of atherosclerosis(HR,3.807;95% confidence interval [CI],1.489 to 7.611;P=0.003),in-hospital hypotension/shock(HR,4.687;95% CI,1.846 to 11.900;P=0.001),in-hospital myocardial ischemia or infarction(HR,3.734;95% CI,1.613 to 8.643;P=0.002),pleural effusion(HR,2.210;95% CI,1.080 to 4.521;P=0.030),branch vessel involvement(HR,2.747;95% CI,1.202 to 6.278;P=0.016) and surgical treatment(HR,0.177;95% CI,0.063 to 0.502;P=0.001).And there were insignificant independent predictors for mortality of the patients with type B AD.It was concluded that there were significant differences in characteristics and one year mortality between type A AD and type B AD,but after one year,there was no significant difference in the mortality and complications of them.There were several discordant risk factors of AD,such as female gender,age,thrombus,abrupt onset of pain that were considered as the risk factors in some papers.And there was no definite risk factor of mortality in this study in the patients with type B AD.     

下肢深静脉血栓导管溶栓临床护理路径的构建

目的构建下肢深静脉血栓导管溶栓的临床护理路径。方法通过文献回顾、病历回顾,结合临床资深专家的意见和建议,设计形成下肢深静脉血栓导管溶栓临床护理路径初稿。采用两轮专家咨询法和两轮预试验对本路径进行验证、修订,最终确定切实可行的下肢深静脉血栓导管溶栓临床护理路径。结果构建了由护理篇和患者篇组成的下肢深静脉血栓导管溶栓临床护理路径。结论下肢深静脉血栓导管溶栓临床护理路径的构建,可有效地指导护士进行有预见性的工作,对规范护理行为具有实用价值。     

Effect of Anti-KDR Antibody on the Proliferation of Hemangioma Vascular Endothelial Cells in vitro

The suppressive effect of anti-KDR antibody against VEGF on proliferation of hemangioma-derived vascular endothelial cells(HVECs) was investigated.HVECs from one case of hemangioma in proliferative phase were cultured.Both primary culture and sub-culture were conducted in M199 medium.The HVECs of passage 3 were divided into 4 groups based on the concentrations of anti-KDR antibody.Cell count was performed and inhibitory rate of HVECs was measured before and 9 days after interference.The results showed that the number of HVECs in the anti-KDR antibody-treated groups was significantly decreased and the inhibitory rate of HVECs by anti-KDR antibody(50,10 and 2 μg/mL) was 84%,63% and 39% respectively at 9th day after interference,with the difference being significant.In the control group,the number of HVECs was increased significantly.In was concluded that the anti-KDR antibody could suppress the activity of VEGF through blocking the KDR,indicating the potential clinical applications of anti-KDR antibody in the treatment of hemangioma.     

头臂型大动脉炎致严重脑缺血的手术治疗

目的探讨手术治疗头臂型大动脉炎所导致的严重脑缺血的疗效和经验。方法15例重症头臂型大动脉炎患者经胸行人工血管旁路术,升主动脉-双腋动脉、单颈内动脉(ICA)架桥6例,升主动脉-双腋动脉架桥3例,升主动脉-单腋动脉、单ICA架桥5例,1例合并腹主动脉闭塞的复合型,一期行升主动脉-双腋动脉、单ICA架桥,二期行单侧腋股搭桥术。结果经胸行人工血管旁路术可明显改善头臂型大动脉炎所导致的严重脑缺血症状。15例手术患者无一例死亡,术后随访3~40个月,患者均无明显脑缺血症状复发,并能正常地工作、生活。结论重症头臂型大动脉炎的患者如果出现严重的脑缺血症状,急性期如果激素治疗无效,或在非活动期,都应积极行人工血管旁路术。该手术不仅疗效确切,能迅速缓解症状,挽救患者的生命,预防失明和偏瘫;而且远期疗效肯定,辅以长期的药物治疗,能够达到治愈的效果。     

间歇充气加压对直肠癌术后凝血功能和下肢深静脉血流动力学的影响

目的探讨间歇充气加压（IPC）对直肠癌患者术后凝血功能和下肢深静脉血流动力学的影响,以及对下肢深静脉血栓（DVT）的预防作用。方法将120例直肠癌根治手术患者按随机数字表法随机分为IPC组和对照组各60例,对照组按常规术后处理．IPC组在常规术后处理的基础上使用IPC。分别于术前及术后1、3、5和7d检测凝血酶原时间（PTT）、活化部分凝血活酶时间（APITr）、纤维蛋白原（FIB）、凝血酶原国际标准化值（INR）及血浆D一二聚体（D—D）含量;用彩色多普勒超声检查髂外、股及胭静脉管径和血流速度,计算平均血流速度（v）及血流量（Q）。结果对照组发生下肢DVT8例（13．3％）,IPC组发生1例（1．7％）,差异有统计学意义（P〈0．05）。两组患者术前frr、APTT、INR、FIB和D—D差异均无统计学意义（均P〉0．05）;术后1d,两组frr、APTT、INR与术前比较,差异均无统计学意义（均P〉0．05）,而FIB和D．D较术前显著升高（P〈0．05）,两组问差异无统计学意义（P〉0．05）。随着术后时间延长,两组PT逐步缩短（P〈0．05）,APTr和INR均无显著变化（P〉0．05）,FIB和D—D逐步升高（P〈0．05）,但两组间差异无统计学意义（P〉O．05）。术后1、3、5和7d,对照组下肢深静脉平均血流速度及血流量均小于IPC组,差异均有统计学意义（均P〈0．05）。结论间歇充气加压能改善直肠癌术后患者下肢深静脉血流动力学指标,有效预防术后下肢DVT的发生,是一种安全而简便的物理疗法。     

Cockett综合征合并股青肿的综合治疗分析：附7例报告

目的：探讨应用下腔静脉滤器置入、手术取栓、静脉溶栓综合治疗Cockett综合征合并股青肿（PCD）的途径及疗效。方法：对10年间收治的Cockett综合征合并PCD的7例患者的临床资料进行回顾性分析。结果：7例均有典型PCD表现, 其足背动脉、胫后动脉搏动均消失；均经多普勒检查证为Cockett综合征合并PCD；均行手术治疗。3例行腔静脉滤器植入术, 3例行球囊导管阻绝术, 1例患者行PALMA术, 7例均行术中取栓和术后溶栓治疗。7例术后患肢足背动脉搏动均恢复, 疼痛消失, 消肿, 未出现手术并发症。经6个月至3年随访, 未见血栓复发及其他并发症发生。结论：综合介入、手术、溶栓治疗Cockett综合征合并PCD不仅成功率高, 近期疗效好, 而且安全可靠。