目的 探讨颈内动脉颅外段起始部急性闭塞的不同开通策略及其可行性.方法 回顾性分析2015年5月至2018年1月收治的15例颈内动脉起始段急性闭塞患者临床资料.分别采用不同方法(微导管+微导丝、小球囊+微导丝、多功能管+超滑导丝)开通闭塞段,对开通策略制定、手术器械选择及其开通效果进行初步评估.结果 15例患者均成功开通闭塞段血管,发生远端栓塞事件2例.术后90 d随访均恢复良好,无明显后遗症状.结论 对于颈内动脉急性闭塞,手术策略上既要提高开通成功率,尽量缩短开通时间,更要兼顾手术安全.微导管、导丝配合通过病变方法应作为首选,但在特殊条件下其它开通方式可作为补充.

回顾性分析2015年5月至2018年5月河北大学附属医院介入血管外科应用远端-近端逆向操作技术开通9例颈内动脉起始段急性闭塞合并远端闭塞患者的临床资料.9例患者中,合并颈内动脉末端闭塞1例,合并同侧大脑中动脉闭塞7例,同侧大脑中动脉及大脑前动脉并存闭塞1例.9例患者的闭塞血管均成功再通,且未出现症状性颅内出血及远端栓塞等严重并发症.9例患者术后90 d改良Rankin量表评分(mRS)均提示预后良好(0～3分).远端-近端逆向操作技术对于颈动脉串联病变合并急性缺血性卒中患者可能是一种安全、有效的治疗选择,本文着重总结其介人器材的选择、手术策略的制定及具体操作细节.

目的 探讨支架辅助颅内动脉瘤栓塞术后急性血栓形成的原因、干预及预防措施.方法 回顾性分析自2016年9月-2017年6月本院15例接受支架辅助颅内动脉瘤栓塞术的颅内动脉瘤的患者, 收集包括病史、体征、辅助检查、手术过程、影像学资料.结果 15例患者中3例发生支架内急性血栓形成, 患者术后未苏醒或醒后发生肢体活动障碍或数小时再次昏迷, 再次行全脑血管造影证实支架内急性血栓形成, 给予动脉内溶栓治疗后均获再通, 无溶栓及血栓形成相关致残致死情况发生.结论 支架辅助颅内动脉瘤栓塞术后支架内急性血栓形成原因较多, 娴熟的手术技术、积极的干预措施以及准确的术前评估可减少或避免不良后果发生.

目的 观察颈动脉内膜切除术(carotid endarterectomy,CEA)和支架成形术(carotid artery stenting,CAS)治疗颈动脉狭窄的效果及安全性.方法 32例颈动脉狭窄病人行CEA治疗(CEA组),28例颈动脉狭窄病人行CAS治疗(CAS组),比较两组病人的住院天数、费用、不良事件发生率及美国国立卫生研究院卒中计量表(NIHSS)和日常生活能力(ADL)评分.结果 CAS组病人住院费用高于CEA组,但CEA组病人心脏不良事件和颅神经损伤发生率高于CAS组,差异有统计学意义(P＜0.05).CAS组ADL评分高于CEA组,NIHSS评分低于CEA组,差异均有统计学意义(P＜0.05).结论 CAS较CEA治疗颈动脉狭窄术后不良事件少,病人预后较好.

颈动脉游离漂浮血栓(free floating thrombus,FFT)是指近端附着在颈动脉壁上而远端游离随血流做周期性运动的细长血栓 [1] ,多见于颈内动脉,既往罕见报道。存在FFT的患者发生脑动脉栓塞的风险很高,临床常表现为因缺血导致的神经功能缺损症状。颈动脉FFT的病因目前尚不明确,其最佳治疗方法仍然存在着争议。现报道河北大学附属医院介入血管外科收治的1例右侧颈总动脉FFT患者,并结合文献进行复习。

OBJECTIVE To investigate the prevalence of infections in hepatitis B liver cirrhosis patients complicated with primary liver cancer so as to provide theoretical basis for early diagnosis , prevention , and treatment . METHODS A total of 374 hepatitis B virus infection liver cirrhosis patients complicated with primary liver cancer who were treated in the hospital from May 2013 to May 2015 were enrolled in the study and assigned as the group A ;meanwhile ,636 liver cirrhosis patients complicated with hepatitis B virus infection were set as the group B . The test of hepatitis B virus load was carried out for all of the enrolled patients by using fluorescence polymerase‐chain‐reaction ,the five indicators for hepatitis B virus were detected by means of enzyme‐linked immunosorbent assay ,the liver function was examined with the use of automatic biochemical equipment ,and the clinical character‐istics of the two groups of patients were comprehensively analyzed .RESULTS The average value of HBV DNA (log10IU/mL) was (5 .47 ± 1 .35) in the group A ,(5 .47 ± 1 .35) in the group B ;there was significant difference in the positive rate of HBV DNA between the group A and the group B (P<0 .05) .There was significant differ‐encein the bile acid ,alanine aminotransferase (ALT),total bilirubin (TB),gamma‐glutamyl transpeptidase (GGT) ,globulin (GLB) ,alpha‐fetoprotein (AFP) ,or alkaline phosphatase (ALP ) between the two groups of patients (P<0 .05) .CONCLUSION As for the hepatitis B liver cirrhosis patients who are aged more than 40 years old ,male ,positive for HBeAb ,or at low level of replication of HBV DNA ,it is necessary to conduct the screen‐ing for primary liver cancer and carry out the joint detection of ALP ,GGT ,and AFP so as to perform the early di‐agnosis and treatment .

Objective To observe the effect of Endovascular stenting in the patients with internal carotid artery stenosis.Methods 32 patients underwent digital subtraction angiography(DSA)and carotid stenting,and to observe the change of image information before and after treatment, and to evaluate effect of interventional therapy.Results Internal carotid artery stenosis degree obviously improved than before in the patients with internal carotid artery stenosis,the reduction of stenosis degree of stenosis≥70% 20 cases,50%~70% 7 cases,<50% 5 cases. Adverse reactions were mild that DSA imaging and treatment during and after stent implantation.Conclusion Endovascular carotid stenting can obviously improve the internal carotid artery stenosis,and it is an effective and treatment method.

Objective To investigate the effect of Tongxinluo capsule on ischemic cerebrovascular patients with stent implantation and effect on vascular endothelial function and blood rheology. Methods Eighty-five ischemic cerebrovascular disease patients after stenting were randomly divided into study group of 49 cases, control group of 36 cases. 2 groups of pa-tients were given anti platelet aggregation, intensive lipid-lowering routine drug treatment. The study group also had given Tongxinluo capsule. Treatment lasted for 8 weeks, vascular endothelial growth factor (VEGF),endothelin-1(ET-1),nitric ox-ide ( NO) level and blood rheology indexes change of the 2 groups were detected and compared. Results Before treatment, the levels of VEGF, ET-1, NO and whole blood viscosity, plasma viscosity, hematocrit, fibrinogen in 2 groups of patients showed no statistical significant differences ( P >0. 05). Compared with the control group, after 8 weeks of treatment, the level of ET-1, whole blood viscosity, plasma viscosity, hematocrit and fibrinogen were in patients with study group decreased significantly ( P <0. 05), serum VEGF, NO level increased significantly ( P <0. 05). Conclusion Tongxinluo capsule can obviously improve the postoperative hemorheology and vascular endothelial function in ischemic cerebrovascular disease pa-tients, improve the recovery of neurological function.

Objectives To explore the value of the sensitivity of heart type fatty acid binding protein(H-FABP) in acute coronary syndrome(ACS)and compare with cardiac troponin I(cTnI).Methods 105 patients with ACS as patient group,measured in serial blood samples to detect H-FABP and cTnI after chest pain 3h,6h,12h,we analysed changes of H-FABP and CInI after chest pain during different phase.20 health peoples as control group.Results patient group:the level of H-FABP 3h(11.62±3.4)μg/L,6h(18.6±5.1)μg/L,12h(6.67±4.7)μg/L,was higher obviously than that of control group(4±2.7μg/L).At 3h after chest pain,the sensitivity rate of H-FABP was 63.8%,the sensitivity of cTnI was 8.57%,At 6h after chest pain,the sensitivity rate of H-FABP was 95%,the sensitivity of cTnI was 13.3%,At 12h after chest pain,the sensitivity rate of H-FABP was 40%,the sensitivity of cTnI was 46.2%.At 3h,6h after chest pain the masculine rate of H-FABP step up obviously than cTnI.Conclusion The sensitivityof H-FABP can be used to diagnose ACS earlier than cTnI.The appearance time and peak at time of H-FABP is earlier than cTnI,before 6h chest pain,the H-FABP in ACS are more sensitive than cTnI for diagnosis ACS,H-FABP can increase the diagnosis efficiency for ACS.

目的 对比冠脉支架置入术(PCI)与非体外循环冠状动脉旁路移植术(OPCABG)围术期心肌肌钙蛋白I(cTnI)的变化规律,评估两种治疗方法心肌损伤的差异,为围术期心肌保护提供客观的理论依据.方法 选取冠心病患者40例,PCI组及OPCABG组各20例.PCI组于术前,第1支支架置入后1,3,6,12,24h采静脉血;OPCABG组于术前,第1支桥动脉血管开始灌注后1,3,6,12,24h采静脉血,检测cTnI浓度水平.结果 PCI组:术前正常水平,术后在3-6h开始升高,24h达到高峰;OPCABG组:术前正常水平,术后1-3h开始升高,24h达到高峰;OPCABG组cTnI开始升高的时间早于PCI组,且峰值要高于PCI组,两组间有统计学差异(P<0.05).结论 两组围术期cTnI的变化规律相似,两种手术方式围术期心肌损伤存在差异.