Objective To investigate the results and applicationvalue of crotch-shaped vein grafts in repairing defects of the vessels with a large diameter.Methods From June 1998 to October 2003, 35 cases of vesseldefects with a large diameter were repaired with crotch-shaped vein graft (29 males and 6 females,aged 18 to 45 years with an average of 25.7 years ). The locations of defects were femoral artery in 25 cases, popliteal artery in 2 cases, femoral vein in 7 cases, and subclavian vein in 1 case. The interval between injure and operatioinwas 1-8.5 hours (4.1 hours on average).The blood flows of trouble and healthy vascular were determined with Doppler detector and compared preoperatively andpostoperatively. Results All the anastomotic stomas were patent in 35 cases. Thirty-one cases were followed up 6 weeks to 24 months (9.5 months on average), the patent rate was 100%, no case occurred vasospasm or tromboembolism; 2 cases occurred stomal leak and became hematoma, 3 cases occurred muscular necrosis, and the 5 cases achieved primary healing after secondary operation. The Doppler results showed that there was statistically significant difference in the blood flow betweenpostoperation and preoperation (Plt;0.01), but no statistically significant difference when compared the trouble vascular after operation with healthy vascular (Pgt;0.05). Conclusion The methodof crotch-shaped vein grafts is safe and effective in repairing defects of vessels with a large diameter,which is easy to draw materials and handy to operate. It has a promising value in clinical application.
目的总结心脏大血管穿透伤的临床特点、早期诊断和救治经验,提高抢救成功率。 方法回顾性分析2007年7月至2014年6月我院26例心脏大血管穿透伤患者的临床资料,男23例、女3例,年龄16~71(22.0±8.4)岁。其中刀刺伤25例,钢锥刺伤1例;心脏穿透伤23例,升主动脉刀刺伤2例,主肺动脉刀刺伤1例;心脏压塞型7例,失血休克型8例,心脏压塞+失血休克型2例,亚临床型9例。26例就诊后30 min至3 h急诊在全身麻醉下行开胸手术治疗,侧开胸手术20例,前正中开胸手术6例,其中2例在体外循环下手术。 结果全组死亡2例,均为失血休克型,1例69岁右心室贯通伤和右冠状动脉主干损伤男性患者术中死于低心排血量综合征,1例38岁右心室前壁穿透伤男性患者术后死于纵隔感染导致的多器官功能衰竭,其余患者痊愈出院,救治成功率达92.3%。18例随访1个月至7年,无后遗症发生。 结论迅速明确伤情,及时诊断,急诊开胸探查是提高心脏大血管穿透伤抢救成功率的关键。
From June, 1987 through June, 1994, 126 cases of injuries of major arteries of the extremities were treated, in which Nationedmade Teflon artificial vascular prosthesis was used to repair in 20 cases. Eighteen of the twenty cases were operated immediately after initial injury and the other two had secondary operation. The sites of the original injuries were as follows: the external iliac artery in 1, femoral artery in 15, popliteal artery in 2 and the brachial artery in 2. The length of the defect of the artery was measured from 3 to 12cm. In 2 of 20 cases, the artificial vascular prosthesis was used because of the failurs of primary repair from autogenous saphaneous vein graft. The shortterm patency rate was 100 per cent and the longterm patency rate was 95 per cent. The diagnosis of vascular injury, the properties of the artificial vascular prosthesis and the points important in operation were discussed.
阻塞性睡眠呼吸暂停低通气综合征( OSAHS) 是心血管疾病的独立危险因素[1,2 ]。睡眠过程中反复发生氧饱和度降低和频繁觉醒是心血管损伤的病理生理基础。OSAHS 血管损害的早期改变可表现为血管僵硬度增加, 对亚临床血管病变患者开展早期动脉弹性功能检测及早进行干预, 可有效预防心血管疾病的发生。本文就常用的无创动脉硬化检测lt;br /gt;技术及其对OSAHS 心血管损伤的评估相关研究进展进行综述。
To report the diagnosis methods and cl inical treatment effects of blood vessel trunk damage in l imbs. Methods From January 2001 to June 2006, 72 patients with vascular injury in l imbs were treated. There were 50 males and 22 females, aged from 5-60 years (median 39 years) and including 44 cases of open injury and 28 cases of closed injury.The locations were subclavian artery in 1, femoral artery in 23, popl iteal artery in 20, radia artery and ulna artery in 12, brachial artery in 11, axilary artery in 3 and anterior and posterior tibia artery in 2. The disease course was 30 minutes to 27 days. Injured arteries were repaired by suturing directly in 3 cases, by end-end anastomosis in 39 cases and by saphenous transplantation in 30 cases. The length of transplant veins was 3 cm to 8 cm. Results In 72 cases, 67 survived and 5 were given amputation. Fortyeight cases were followed up 6 months to 5 years. The blood flow rate and the diameter of blood vessel on the affected l imbs were not different from that of normal l imbs by colorful Doppler blood flow monitor. Forty cases recovered satisfactory l imb function. Eight cases had different degrees of dysfunction, of them, four cases received functional reconstructive operation, and the function and appearance were improved. Conclusion To investigate the mechanism and situation of injury, to examine patients carefully and analyze comprehensively are the key points of making earl ier diagnosis for branch blood vessel damage; microsurgical repair of the injured blood vessel is the assurance of the blood flow rate. For the blood vessel above elbow and knee injured and lacked blood supply more than 4 hours and fascia syndrome, earl ier opening the fascia cavity is the effective methods to recover the function of the l imbs and to avoid disabil ity.