下肢动脉硬化闭塞症的外科治疗

目的:探讨外科治疗下肢动脉硬化闭塞症的临床经验。方法:从1995年7月～2002年7月共对292例(313条肢体)动脉硬化闭塞症病人进行外科治疗,其中20条患肢施行解剖外血管重建术,38条患肢施行了腔内外科治疗或合并开放性血管重建手术,255条患肢施行了开放性手术重建下肢血供。结果:手术成功者患肢的踝肱指数与术前比较显著增加(P<0.01),症状得到明显改善。平均随访时间3.1年(0.5～7年),解剖外重建组移植血管一期通畅率为56%,腔内外科组通畅率为78%,开放性手术组通畅率为72%。结论:病人的全身情况、动脉病变的范围和程度是选择下肢动脉硬化闭塞症外科治疗方法的主要依据,为取得较好的长期通畅率和临床效果需要重视围手术期处理和术后随访。     

End-to-side anastomosis of rat carotid artery: comparison of different types of section and shape of the terminal end

Summary In 50 rats, different types of end-to-side carotid artery anastomoses were compared. In one technique, a longitudinal split in the long axis of the vessel was performed to enhance the diameter of the anastomosis. This theoretical advantage was not confirmed in this series. The clamping time, anastomoses time, and tamponade time were increased significantly when compared with a simple, slightly oblique end-to-side anastomosis. This study highlighted that the most simple type of end-to-side anastomosis gave less bleeding, achieved a quicker water-tight anastomosis and decreased the risk of late problems.     

Unpredictable Hearing Loss after Intratympanic Gentamicin Treatment for Vertigo. A New Theory

A new hypothesis is advanced suggesting that unpredictable cases of profound hearing loss after intratympanic gentamicin treatment (IGT) may be caused by decreased patency of the communication routes between the inner ear and the cerebrospinal fluid, primarily of the cochlear aqueduct. A tympanic displacement analyzer, which can indirectly analyze inner ear and intracranial pressure changes and can also evaluate the efficiency of communication between these two compartments, was used. Two cases are presented: in the first, a patient who became deaf after IGT showed signs of decreased patency of the communication routes with the tympanic membrane displacement (TMD) test; in the second, a patient without hearing damage after IGT had efficient communication evaluated by the TMD test. These preliminary findings are in accordance with the proposed pathophysiology. If future clinical studies confirm the present theory and findings, it may prove possible to predict and prevent deafness after IGT and possibly also after systemic aminoglycoside treatment.     

Patency of the supraclinoid internal carotid artery branches after flow diversion treatment. A meta-analysis

Background and purpose

Placement of flow-diverters across the ostia of major ICA branches carries a risk of arterial occlusion. We determined the rate of occlusion of the supraclinoid ICA branches and the related symptoms, following coverage with flow-diverters.

对比抗血小板与抗凝治疗对心脏瓣膜置换同期行冠状动脉旁路移植术后桥血管通畅情况的影响

目的对比抗血小板与抗凝治疗对心脏瓣膜置换同期行冠状动脉(冠脉)旁路移植术(CABG)后桥血管通畅情况的影响。方法选择2011年1月至2017年12月于中国医学科学院阜外医院行心脏瓣膜置换同期CABG手术并规律随诊的患者96例,其中男性78例,年龄(43~73)岁,平均年龄(60.8±9.05)岁。所有患者分为两组,抗血小板组为移植生物瓣或行瓣膜成形术的患者,该组患者双联治疗(拜阿司匹林联合华法林)至术后3~6个月,之后单用拜阿司匹林抗血小板治疗;抗凝组为移植机械瓣的患者,该组患者双联治疗至术后3~6个月后单用华法林抗凝治疗,并按照指南要求维持INR水平。通过收集患者冠脉桥血管CT血管成像检查结果评价桥血管通畅情况。结果抗血小板组和抗凝治疗组乳内动脉桥的通畅率分别为80.0%vs.82.5%(P=0.8),大隐静脉桥通畅率分别为77.2%vs.72.1%(P=0.512);随访期间两组出血事件均为牙龈出血,抗血小板组和抗凝治疗组出血事件比率为14%vs.7.5%(P=0.307),两组间比较差异无统计学意义。结论长期抗凝治疗与抗血小板治疗在维持桥血管通畅率方面无显著差异,且在医师指导下接受抗凝治疗的出血风险并未显著高于抗血小板治疗。     

大隐静脉和上臂头静脉移植对70岁以上病人心肌血管重建作用的比较

目的　冠状动脉旁路移植术是治疗缺血性心脏病一种常规方法 ,但是由于所采用的移植血管不同 ,导致治疗的效果也不尽相同。目前治疗常用的血管为大隐静脉 +乳内动脉为标准手术术式。然而诸多原因限制 ,有时大隐静脉不适合作为移植材料。本研究对大隐静脉与上臂头静脉作为移植材料进行比较。方法　接受乳内动脉和大隐静脉旁路移植术组 35例 ,平均年龄 77岁 ,接受乳内动脉 +上臂头静脉旁路移植术组 15例 ,平均年龄 75岁 ,二组之间 ,体重 ,心肌梗死病史 ,心功能 ,平均每例冠状动脉病变以及平均移植血管数没有明显差别。结果　乳内动脉和大隐静脉旁路移植术组和乳内动脉 +上臂头静脉旁路移植术组之间 ,乳内动脉的五年累计通畅率分别为 96 %和94 % ,二组之间没有显著性差异 (P>0 .0 5 ) ,大隐静脉的通畅率为 70 % ,上臂头静脉为 4 8% ,二组之间差异性不明显 (P>0 .0 5 )。结论　通过两组间的 5年累计通畅率的比较 ,我们认为在高龄病人上臂头静脉作为移植血管效果差 ,术后通畅率低 ,但可以作为移植血管的最后选择。     

冠状动脉旁路移植术后近中期桥血管闭塞的相关高危因素分析

目的 分析冠状动脉旁路移植术（coronary artery bypass graft,CABG）后近中期桥血管的通畅率及其相关的危险因素,为术后患者预防桥血管病变提供依据。方法 选取2009年9月至2014年9月在衡水市人民医院心外科接受首次CABG术患者38例,入选的患者在复查期间未再行任何血管再通术（PTCA、PCI及CABG等）,术后4～59（28.1±17.6）个月复查时均行CTA检查,部分患者行CAG检查对照,分别计算动脉桥血管和静脉桥血管的通畅情况,分析影响CABG术后患者桥血管通畅情况的高危因素。结果 CABG术后桥血管的总体通畅率为75.3%;LIMA的总体通畅率为92.9%,SV的总体通畅率为64.4%。结论 乳内动脉桥血管通畅率明显高于大隐静脉桥血管;患者的手术年龄、性别以及综合相关危险因素等都会影响桥血管通畅率。     

联合股-股动脉旁路移植术的单臂支架腔内修复腹主动脉瘤的经验

目的探讨联合股-股动脉旁路移植术(cross-femoral bypass grafting,CFBG)的单臂支架型血管(aortouniiliac,AUI)腔内修复腹主动脉瘤(endovascular aneurysm repair,EVAR)的疗效。方法1997年5月~2007年2月,对8例因髂动脉的特殊解剖条件无法应用分叉支架型血管的腹主动脉瘤采用联合CFBG的AUI支架型血管进行EVAR治疗。术后观察内漏、缺血并发症、股股旁路血管的通畅性以及下肢血供情况等。结果围手术期无死亡,1例因急性心肌梗死于术后15个月死亡。3例原发性内漏分别于术后1、3、6个月自愈。8例平均随访24个月(3~72个月),旁路均通畅,1例于术后1年吻合口轻微狭窄但无下肢缺血症状。结论因髂动脉解剖条件复杂不能应用分叉支架型血管的腹主动脉瘤采用联合CFBG的AUI支架型血管进行EVAR是安全、有效的。     

The efficacy of heparinization in prolonging patency of arterial and central venous catheters in children: a randomized double-blind trial

This study evaluates the efficacy of heparinization in prolonging patency of arterial and central venous catheters in children. A randomized double-blind trial in a tertiary 10-bed pediatric intensive care unit was used to evaluate 300 children (age older than 4 weeks, younger than 18 years). Trial medication consisted of either NaCl 0.9% infusion or NaCl 0.9% infusion to which 1 IU of heparin per milliliter was added. The number of nonpatent arterial and central venous catheters and the duration of stay of patent arterial and central venous catheters were measured. There was a significant risk increase for nonpatency in the nonheparinized arterial catheters (relative risk [RR]: 3.54; 95% confidence interval [CI]: 1.01-12.42). No significant risk increase for nonpatency could be demonstrated for the nonheparinized central venous catheters (RR: 7.63; 95% CI: 0.40-145). The median duration of stay of the patent arterial and central venous catheters was similar for both treatment groups. These results indicate that the use of normal saline in arterial catheters is associated with an increased frequency of catheter nonpatency as compared with heparinized saline.