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肢体大中血管损伤诊治经验

报道43例肢体大中血管损伤,治愈29例,功能欠佳4例,截肢6例,死亡4例。强调在急救中,以保存生命为前提。对腘部伤要动态观察。脉搏存在不能除外血管损伤,主张并发大静脉伤应修复。血管吻合后要妥善固定。

闭合性腘动脉损伤显微外科治疗

周围血管损伤的外科治疗

ADVANCES IN THE DIAGNOSIS AND TREATMENT OF ACUTE VASCULAR INJURIES

创伤性四肢血管损伤修复经验及教训

报道58例创伤性四肢主要血管损伤的修复。介绍了受伤原因、血管损伤部位、类型、并发症、处理方法。讨论了诊断及漏诊原因，修复原则及错误，分析了3例肢体坏死原因，认为尽早重建血管的连续性是恢复肢体血运的关键。

Surgical Emergency Treatment of Penetrating Heart and Great Vessels Trauma: Experience of 26 Patients

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。

Progress of Non-Invasive Arterial Measurements and Evaulation of Cardiovascular Injury of OSAHS

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。

腹部大血管损伤13例诊治体会

Application of a new temporary intravascular shunt device in limb injury of dogs

ObjectiveTo explore the effectiveness and safety of a new temporary intravascular shunt (TIVS) device for limb injury in dogs.MethodsEighteen adult beagle dogs, male or female, weighing (20±2) kg, were taken for experiment. A semi-amputated limb model was made by circular amputating the knee joint of one hindlimb, which retained only skin, femoral artery, femoral vein, femoral nerve, and femur. Then the femoral artery was clamped for 2 hours in all animals, resulting in the ischemic environment of the distal limbs. The animals were randomly divided into 3 groups (n=6). In group A, the bypass was started by using a new TIVS device and replenishing saline through the infusion port; In group B, after intravenous injection of heparin sodium solution, the bypass was started by using a new TIVS device and replenishing 3% heparin sodium solution through the infusion port; In group C, the bypass was started by using the self-made bypass tube. The bypass was end after 12 hours. The general vital signs (body temperature, heart rate, blood pressure) before and after bypass were measured, and the time required for the insertion of the bypass tube, the patency during the bypass, shedding, and thrombosis were recorded. Routine blood test and blood coagulation indicators [white blood cell (WBC), red blood cell (RBC), platelet (PLT), hemoglobin (HGB), activated partial thromboplastin time (APTT), fibrinogen (Fib)] and biochemical indicators [lactic dehydrogenase (LDH) and creatine kinase (CK)] were recorded before bypass and after 3, 6, 9, and 12 hours of bypass, respectively. The gastrocnemius muscles on the surgical side before and after bypass were harvested and the muscle necrosis, the wet-to-dry weight ratio, and the content of malondialdehyde (MDA) and myeloperoxidase (MPO) were measured. In addition, the gastrocnemius muscle and femoral artery were observed after bypass by HE staining.ResultsThere was no significant difference in body temperature, heart rate, and blood pressure between groups before and after bypass (P>0.05). Compared with groups A and B, the time required for the insertion of the bypass tube in group C was significantly longer (P<0.05), and the number of thrombus in the bypass tube, the blockage time significantly increased (P<0.05). Shedding and sliding of bypass tube occurred in 3 cases of group C, but no shedding or sliding of bypass tube occurred in groups A and B; there was no significant difference in the incidence of shedding between groups (P=1.000). There was no significant difference (P>0.05) in routine blood test, blood coagulation indicators, LDH, CK, MPO, MDA, and wet-to-dry weight ratio between groups before bypass. After bypass, the routine blood test and blood coagulation indicators of the 3 groups did not change significantly, and the differences between groups was not significant (P>0.05); LDH and CK gradually increased (P<0.05), and group C significantly higher than groups A and B at 12 hours (P<0.05). After bypass, thrombosis was seen in the bypass tube, the distal gastrocnemius muscle necrosis occurred in group C, and the femoral artery injury was slightly heavier than that in groups A and B.ConclusionThe new TIVS device is safe and effective and has the advantages of convenient implantation, lower thrombosis rate, and less limb ischemia-reperfusion injury.

四肢主要血管火器伤的修复重建

对40 例四肢主要血管火器伤患者的临床资料进行回顾性分析，总结损伤的有效救治方法。 方 法 1986 年5 月－ 2006 年11 月，收治40 例四肢主要血管火器伤患者。男35 例，女5 例；年龄16 ～ 50 岁，平均31. 2 岁。动脉完全断裂16 例，动脉部分断裂6 例，动脉缺损14 例，动脉血栓形成2 例，假性动脉瘤2 例。病程12 min ～ 20 h。彻底清创、充分减压和引流，根据不同情况选择自体静脉移植25 例，人造血管移植3 例，血管吻合6 例，血管修补4 例，带血管蒂的轴型皮瓣游离移植2 例。 结果 经抗感染、输血补液及抗凝、扩张血管等治疗，死亡1 例，截肢2 例，肾衰竭截肢1 例，成功修复36 例。伤口Ⅰ期愈合29 例，Ⅱ期愈合7 例。经7 个月～ 2 年随访，修复血管均恢复通血，肢端血运良好，动脉搏动正常，按英国医学会感觉运动功能评定标准：优28 例，良6 例，差2 例。 结论 “生命第一、肢体第二”是四肢主要血管火器伤的救治原则，采用自体静脉或人造血管旁路移植修复可获良好效果。