【摘要】 目的 探讨建立局部性家兔肠系膜静脉血栓（MVT）模型的方法。 方法 于2008年1月，将36只家兔随机均分为3组，肠系膜前静脉局部阻断加静脉分支注射凝血酶，A组80 U/mL，B组40 U/mL，C组注射生理盐水1 mL。观测血栓形成时间、范围和周围静脉血D-二聚体（DD）变化。 结果 A、B两组均可建立控制范围内稳定MVT模型，血栓形成时间分别为（15.6±2.0） min和（22.3±2.5）min，两组比较有统计学意义（Plt;0.001）；术前A、B两组DD为（68.4±5.7）ng/mL、（72.7±6.4）ng/mL，血栓形成后为（209.0±24.0）ng/mL、（215.4±17.6）ng/mL，组内比较有统计学意义（Plt;0.001）；C组不形成血栓。 结论 局部静脉阻断加凝血酶注射法可建立稳定和范围可控的MVT模型，建模前后血浆DD值有一定实验参考价值。【Abstract】 Objective To establish the model of local mesenteric venous thrombosis (MVT) in rabbits. Methods In January 2008, 36 rabbits were randomly divided into three groups with 12 rabbits in each. The anterior mesenteric veins were blocked regionally, and at the same time the rabbits were injected with thrombin 80 U/mL through the branches of mesenteric vein in group A, 40 U/mL in group B, and 1 mL normal saline in group C. Time and range of thrombosis were observed, and D-dimer level in peripheral vein was tested. Results Stable MVT model was established in intended region in both group A and B. There was a significant reduction of thrombosis time in group A [(15.6±2.0) minutes] when compared with that in group B [(22.3±2.5) minutes] (Plt;0.001). The levels of D-dimer in group A two hours after operation [(209.0±24.0) ng/mL] increased significantly compared with that before the operation [(68.4±5.7) ng/mL](Plt;0.001); while the same condition was found in group B [(215.4±17.6) ng/mL vs (72.7±6.4) ng/mL] (Plt;0.001). No thrombus was found in group C. Conclusion Stable MVT model with controllable thrombotic range can be established by regional vein blockade plus thrombin injection. Plasma D-dimer levels before and after model establishment could be as a parameter for assessing the experiment.
The paper introduced bone graft nourished by venous blood, compared with vascularized and conventional bone graft in the animal experiment. B、h(?)ological, radiological methods and tatracycline labeling, the results confirmed that the bone gra(?) nourished by venous blood is inferior to the vascularized bone graft, but is significantly superior to the conventional bone graft in the survival amount, vitality of osteocytes and bone union. The survival mechanism and practicality of bone graft nourished by venous blood were preliminarily discussed in the paper.
为了解我国南方地区肺栓塞的现状,通过检索中国医院数字图书馆近9年(1999年～2008年)南方地区正式发表的与肺栓塞和深静脉血栓有关的论文共1288篇,进行了统计分析,发现:1、中国南方地区肺栓塞的发现数量逐年增加,且增幅明显;2、诊断水准达到一定程度的部分南方医院,诊断治疗肺栓塞的数量明显高于其他医院,并不比中国北方同类医院低;3、肺栓塞的漏诊、误诊现象依然普遍存在,提高认知和诊治水准仍然是今后工作的方向。
Objective To analyze inducing factors and clinical characteristics of deep venous thrombosis (DVT) and to explore clinical value of soluble cell surface differentiation antigen 40 ligand (sCD40L) in early diagnosis of DVT. Methods The patients with the DVT of lower extremity who had not received the anticoagulant and thrombolytic therapy in the Nanchong Central Hospital from January 2012 to January 2017 were collected, these patients were divided into an early-acute stage, mid-acute stage, late-acute stage, and subacute stage according to the clinical course of DVT. The sCD40L expression in the peripheral blood of DVT patients were detected by the enzyme linked immunosorbent assay. Results There were 100 patients with the DVT were included, including 31 cases of early-acute stage, 26 cases of mid-acute stage, 21 cases of late-acute stage, and 22 cases of subacute stage; 66 patients with the peripheral type, 28 patients with the central type, and 6 patients with the mixed type. ① The fracture, malignant tumor, long time in the bed following the thoracic or abdominal operation, joint replacement, and caesarean section were the successively main risk factors of the DVT. ② The early-acute stage of DVT was more common in the fracture patients, the mid- and late-acute stage of DVT often occurred in the joint replacement sufferer, and the subacute stage of DVT was usually found in the malignant tumor patients. ③ The sCD40L expression in the patients with the different stage DVT was signifiantly higher than that in the control group (20 healthy people in the physical examination, P<0.05). Furthermore, there was a significant difference in the different stage DVT patients (F=26.57, P=0.02), that is, the expression of sCD40L was the highest in the early-acute stage of DVT, and then gradually reduced (P<0.05). ④ The sCD40L expression had a significant difference among the central type DVT, mixed type DVT, and peripheral type DVT (F=12.51, P=0.02), which in the peripheral type DVT was significantly higher than that of the central type DVT (P<0.05) and mixed type DVT (P<0.05), but had no difference between the central type DVT and the mixed type DVT (P>0.05). ConclusionsCD40L might act as a blood index of early diagnosis and judgement of extent of DVT, especially be helpful in early-acute stage of DVT.
目的研究置管溶栓联合球囊扩张导管碎栓治疗下肢深静脉血栓形成（DVT）的疗效及安全性。 方法回顾性分析2011年9月至2015年1月本院收治的82例急性下肢DVT患者的临床资料。将患者分成两组：A组行单纯经导管直接溶栓（CDT）治疗，共32例，其中男10例、女22例，平均年龄（56±15）岁；B组行CDT联合机械碎栓（球囊扩张导管碎栓）治疗，共50例，其中男18例、女32例，平均年龄（57±17）岁。比较2组治疗前后静脉通畅率、静脉通畅度评分、健侧和患侧下肢周径差，比较2组尿激酶用量及溶栓导管留置时间，以出血并发症、肺栓塞的发生率评价治疗的安全性。 结果2组共82例患者完成溶栓及碎栓疗程，B组较A组溶栓时间更短，A组平均9（7，12）d；B组平均5（4，7）d，2组差异有统计学意义（P<0.01）；B组较A组尿激酶用量更少，A组平均7.250（6.355，8.255）×106 U，B组平均4.925（3.715，5.810）×106 U，2组差异有统计学意义（P<0.01）；B组治疗后的静脉通畅度评分显著优于A组，A组65.0%（40.5%，86.5%），B组为100%（90%，100%），差异有统计学意义（P<0.01）。治疗后2组出血并发症发生率差异无统计学意义（P=0.0976）。2组患者随访时间3～18个月，A组随访率50.0%，B组随访率58.0%，均未发生肺动脉栓塞。 结论在下腔静脉滤器保护下，CDT联合球囊扩张导管碎栓治疗急性下肢DVT较单纯CDT治疗，溶栓效果好、尿激酶用量少、不增加肺栓塞及出血发生率。
ObjectiveTo investigate the predictive factors of portal vein thrombosis (PVT) before and after splenectomy and gastroesophageal devascularization for liver cirrhosis with portal hypertension. MethodsSixty-one cases of liver cirrhosis with portal hypertension who underwent splenectomy and gastroesophageal devascularization were enrolled retrospectively. The patients were divided into PVT group and non-PVT group based on the presence or absence of postoperative PVT on day 7. The clinical factors related with PVT were analyzed. ResultsThere were 25 cases in the DVT group and 36 cases in the non-DVT group. The results of univariate analysis showed that the preoperative platelet (P=0.006), activated partial thromboplastin time (P=0.048), prothrombin time (P=0.028), and international normalized ratio (P=0.029), postoperative fibrin degradation product (P=0.002) and D-dimer (P=0.014) on day 1, portal venous diameter (P=0.050) had significant differences between the DVT group and non-DVT group. The results of logistic multivariate regression analysis showed that the preoperative platelet (OR=0.966, 95% CI 0.934-1.000, P=0.048) and postoperative fibrin degradation product on day 1(OR=1.055, 95% CI 1.011-1.103, P=0.017) were correlated with the PVT. The PVT might happen when preoperative platelet was less than 34.5×109/L (sensitibity 80.6%, specificity 60.0%) or postoperative fibrin degradation product on day 1 was more than 64.75 mg/L (sensitibity 48.0%, specificity 91.7%). ConclusionPreoperative platelet and postoperative fibrin degradation product on day 1 might predict PVT after splenectomy and gastroesophageal devascularization for liver cirrhosis with portal hypertension.
【摘要】 目的 〖JP2〗评价腔静脉滤器植入联合足背静脉溶栓在下肢深静脉血栓（DVT）治疗中的疗效。 方法 2006年12月-2009年10月，对26 例下肢深静脉血栓患者行下腔静脉滤器植入术，并结合足背静脉溶栓治疗。 结果 26例患者均未出现大出血和致死性肺动脉栓塞等严重并发症，彩色多普勒超声显示17例患者下肢DVT 完全溶解，11例部分溶解。 结论 介入性综合治疗下肢DVT 是一种安全可行、疗效好的方法。【Abstract】 Objective To evaluate the therapeutic effect of filter planting combining thrombolysis therapy through the dorsum pedis vein on patients with deep veins thrombosis of lower limb. Methods The clinical data of 26 patients from December 2006 to October 2009 were retrospectively analyzed. All the patients underwent filter planting combining thrombolysis therapy through the dorsum pedis vein. Results There was no serious complication such as hemorrhea or fatal pulmonary embolism. The phlebothrombosis was fully dissolved in 11 patients and partial dissolved in 17 patients. Conclusion Interventional combined therapy is safe and effective for deep venous thrombosis of lower limb.
Objective To investigate the early diagnosis of lower l imb deep vein thrombosis (DVT) after major orthopedic surgeries. Methods From October 2005 to June 2009, color doppler sonography and hemorheology detection were carried out for 62 cases undergoing first total hip arthroplasty (THA), 14 cases undergoing total knee arthroplasty (TKA), and 86 cases undergoing hip fractures surgery (HFS) before operation and 1, 7, 14 days after operation. The plasma D-dimerlevels of the DVT were also examined for the THA patients before operation and 3 days after operation. Of all cases, therewere 89 males and 73 females, aged from 34 to 74 years (51.5 years on average). After operation, all the patients were treated with the regular low molecular weight heparin sodium against DVT. Results After operation, 17 cases (10.5%) developed DVT, including 8 THA cases, 1 TKA case, and 8 HFS cases. Preoperative color doppler sonography showed no abnormal echo, normal b blood flow signal, and normal periodical variation in vein blood flow without regurgitation. Postoperative examinations showed that the vascular occlusion of common femoral vein and popl iteal vein occurred in DVT patients. There were significant differences (P lt; 0.05) in whole blood viscosity between patients with DVT and without DVT after 1, 14 days and no significant difference (P gt; 0.05) before operation and 7 days after operation. There was no significant difference (P gt; 0.05) in plasma viscosity and erythrocyte aggregation index, between patients with DVT and without DVT pre- and postoperation. There was significant difference (P lt; 0.05) in erythrocyte deformation index between patients with DVT and without DVT 14 days after operation. The preoperative plasma D-dimer levels of patients with DVT and without DVT were (372.00 ± 148.62) ng/mL and (369.00 ± 141.03) ng/mL, respectively, showing no significant difference (P gt; 0.05); the 3 days postoperatively levels were (574.00 ± 217.29) ng/mL and (391.00 ± 120.16) ng/mL, respectively, showing significant difference (P lt; 0.05). Conclusion Color doppler sonography in combination of hemorheology and plasma D-dimer examination can be beneficial for the early diagnosis of DVT in major orthopedic surgeries.
目的探讨下肢深静脉血栓形成(DVT)的治疗方法及经验。方法分析我院2007年1月至2010年1月期间237例DVT患者的临床资料，其中行以抗凝、祛聚为主的非手术治疗198例，行介入手术治疗39例。结果198例给予抗凝、祛聚为主的非手术治疗者中临床治愈85例(42.93%)，有效108例(54.55%)，无效5例(2.52%); 39例给予介入手术治疗(均先行下腔静脉滤器置入，然后行球囊导管取栓治疗33例，行介入溶栓6例)者均临床治愈(100%)。总有效率为97.89%（232/237)。对39例行介入手术治疗患者术后随访3～24个月(平均10个月)，2例患者出现下腔静脉阻塞并发下肢DVT，经抗凝、祛聚等治疗后症状缓解； 均未见滤器移位、肺栓塞等并发症。结论DVT患者介入治疗效果优于非手术治疗，早期诊断和合理的治疗方案是DVT治疗成功的关键。