Application of buried auricular point combined with Wenjing Sanhan prescription in arteriosclerosis obliterans patients with resting pain

BACKGROUND Research on the combined use of ear acupoint embedding beans and warming meridians with cold-dispersing formulas for alleviating resting pain in patients with arteriosclerosis obliterans(ASO)remains limited.AIM To explore the therapeutic efficacy of auricular point embedding beans combined with Wenjing Sanhan prescription in alleviating resting pain in patients with lower-limb ASO.METHODS A total of 100 patients with ASO experiencing resting pain who were treated at our hospital from January 2022 to January 2023 were enrolled.They were randomly allocated into two groups using a double-blind approach.The control group was treated using a warming meridian with a cold-dispersing formula,while the study group received additional treatment with ear acupoint embedding beans.The clinical efficacy,ankle-brachial artery pressure ratio,hemorheological indicators,and traditional Chinese medicine symptom scores were compared between the two groups.RESULTS The clinical efficacy rate in the study group was significantly higher(94.00%)than that in the control group(72.00%,P<0.05).Moreover,the ankle-brachial artery pressure ratio was significantly higher in the study group after treatment(P<0.05).Hemorheological parameters,including whole blood viscosity,plasma viscosity(1.83±0.11)mPa/s,fibrinogen levels(3.30±0.21)g/L,platelet adhesion rate(49.87%±10.51%),and erythrocyte aggregation index(1.79±0)were improved in the study group compared to the control group.In addition,the scores for decreased skin temperature(1.41±0.26),intermittent claudication(1.30±0.20),and resting pain(1.23±0.31)were significantly lower in the study group than those in the control group(all P<0.05).The level of oxidative stress in the study group also exhibited significant improvement(P<0.05),and the levels of inflammatory factors were considerably lower than those in the control group.CONCLUSION The combination of ear point embedding beans and Wenjing Sanhan prescription demonstrates promising clinical efficacy in alleviating resting pain associated with ASO.

Analysis of the Effect of Problem-Oriented Nursing Intervention on Patients with Lower Extremity Arteriosclerosis Obliterans in Vascular Surgery

Objective: To analyze the effect of problem-oriented nursing intervention on patients with lower extremity arteriosclerosis obliterans (ASO) in vascular surgery. Methods: The clinical data of 128 patients with lower extremity ASO in vascular surgery were selected and randomly divided into groups A and B, with 64 cases each. Group A is the control group, and Group B is the observation group. Group A received the routine nursing intervention, and Group B received the problem-oriented nursing intervention. The compliance, self-care ability, psychological state, quality of life, and nursing satisfaction of the two groups of patients were evaluated based on various indicators. Results: After the intervention, the evaluation of self-care ability (ESCA) score of the patients in Group B was higher than that of Group A, and the symptom checklist-90 (SCL-90) score was lower than that of Group A. The differences were significant (t = 10.019, t = 3.118, P < 0.01). After the intervention, the World Health Organization Quality of Life Brief (WHOQOL-BREF) index scores of the two groups increased and the increase in Group B was significantly higher than Group A (P < 0.001). The compliance rate of Group B (62/ 96.88%) was higher than that of Group A (52/ 81.25%), and the difference was extremely significant (χ2 = 8.020, P < 0.01). Conclusion: Problem-oriented nursing intervention for patients with lower extremity ASO in vascular surgery improved the patient’s self-care ability, and quality of life, reduced the patient’s negative emotions, and enhanced their overall satisfaction.

NRG1、VASH-1水平对ASO患者介入治疗后再狭窄的预测价值

目的探讨血清神经调节蛋白1(NRG1)、血管生成抑制蛋白-1(VASH-1)对下肢动脉硬化闭塞症(ASO)患者介入治疗后再狭窄的预测价值,以期为临床治疗提供参考。方法选取选取2021年9月—2023年8月宝鸡市中医医院收治的112例ASO患者作为本次研究对象。根据介入治疗6个月后患者是否发生再狭窄分为再狭窄组(n=29)和非再狭窄组(n=83)。比较2组患者血清NRG1、VASH-1水平;采用受试者工作特性(ROC)曲线评估血清NRG1、VASH-1对ASO患者介入治疗后再狭窄的预测价值;采用二分类Logistic逐步回归分析探讨ASO患者介入治疗后再狭窄的影响因素。结果再狭窄组患者NRG1水平低于非再狭窄组,VASH-1水平高于非再狭窄组,差异均有统计学意义(P<0.05)。ROC曲线显示,血清NRG1联合VASH-1预测ASO患者介入治疗后再狭窄的曲线下面积(AUC)(95%CI)为0.903(0.852~0.954),特异度为87.11%,灵敏度为86.05%,其预测效能较高。2组患者性别构成、年龄、体质量指数、合并症、病变部位、总胆固醇水平、甘油三酯水平、高密度脂蛋白胆固醇(HDL-C)水平比较,差异均无统计学意义(P>0.05);再狭窄组患者吸烟占比、血管完全闭塞占比、血管病变长度、C反应蛋白(CRP)水平、糖化血红蛋白水平、低密度脂蛋白胆固醇(LDL-C)水平均大于非再狭窄组,差异均有统计学意义(P<0.05)。二分类Logistic逐步回归分析结果显示,CRP≥18.74 mg/L、LDL-C≥3.69 mmol/L、NRG1≤16.98 pg/mL、VASH-1≥553.49 ng/L是ASO患者介入治疗后再狭窄的独立危险因素(P<0.05)。结论血清NRG1水平降低、VASH-1水平升高与ASO患者介入治疗后再狭窄之间关系密切,且这2项指标可作为ASO患者介入治疗后再狭窄的重要预测因子。

Clinical and prognostic features in asymptomatic and symptomatic patients with arteriosclerosis obliterans

Background: Patients with arteriosclerosis obliterans (ASO) often have co-existing atherosclerotic diseases. The purpose of this study was to examine the clinical features of patients with ASO, including the overlap of atherosclerotic risk factors, characteristics of car-diovascular events, and clinical prognosis. Method: We enrolled 205 consecutive patients who had ankle brachial index (ABI) of ?0.9 between January 2008 and December 2009. Fontaine (F) classification and clinical background were evaluated and clinical events including mortality and major adverse cardiocerebro-vascular events (MACCEs) were determined. Results: There was a high prevalence of each risk factor. Sixty- five percent of subjects had three or more of the four overlapping risk factors, including hypertension, dia- betes, dyslipidemia, and smoking. After a maximum follow-up of 800 days, the incidence of MACCEs and mortality was 46% and 10%, respectively. We divided the patients into two groups according to the presence of ASO symptoms (F1 and F2-4) and compared the incidence of events. The incidence of MACCEs and mortality in the F2-4 group was significantly higher than that in the F1 group (P = 0.048, P = 0.044, respectively). After excluding lower extremity revascularization, coronary artery disease was a common cause of MACCEs, and the mortality rates after MACCEs increased in a stepwise manner according to F classification severity (P = 0.028). Conclusion: Patients with ASO had overlapping coronary risk factors and a high incidence rate of cardiovascular events. The incidence of coronary events was common, especially in symptomatic patients, and the mortality rates after MACCEs were high in accordance with F classification severity.

Mechanism of Simiao Yongan decoction in the treatment of arteriosclerosis obliterans of lower extremity through JAK/STAT signaling pathway

Objective:To predict the effective components,potential targets and pathways of Simiao Yong’an Decoction in the treatment of lower extremity arteriosclerosis obliterans(ASO)based on the method of network pharmacology,and to explore the mechanism of Simiao Yong’an Decoction in treating ASO combined with cell experiment.Methods:TCMSP database was used to screen the active components and targets of Simiao Yong’an decoction,and Genecards and OMIM databases were used to obtain ASO related proteins;PPI network of drug disease target proteins was constructed by string platform;go function and KEGG pathway enrichment of Simiao Yong’an Decoction ASO target were analyzed by David database.The drug target pathway with high correlation with ASO was selected.The model of vascular smooth muscle cell injury(VSMCs)induced by ox LDL was used,and Simiao Yong’an decoction containing pharmaceutical Qing was given to verify the therapeutic effect of Simiao Yong’an Decoction on ox LDL induced VSMCs and its regulation on highly correlated target pathway.Results:A total of 126 active components of Simiao Yong'an Decoction were screened,40 targets of Simiao Yong’an Decoction ASO were selected,99 go biological processes and 48 related signal pathways were related to ASO;the experimental results showed that with the passage of time,Simiao Yongan decoction could significantly inhibit the proliferation of VSMCs(P<0.05);compared with the model group,the percentage of BrdU positive cells in each dose group of Simiao Yong’an decoction was significantly higher than that in the model group In addition,Simiao Yong’an decoction could significantly inhibit the proliferation of VSMCs(P<0.05);in addition,Simiao Yongan decoction could inhibit the levels of IL-6 and IL-1β(P<0.05);significantly inhibit the expression of PCNA,JAK2 and STAT3 mRNA(P<0.05);Conclusions:Simiao Yong’an decoction has the effect of"multi-component,multi-target and multi-channel"in the treatment of ASO.It can inhibit the activation of JAK/STAT signaling pathway,play an anti-inflammatory role and inhibit the proliferation of vascular smooth muscle cells.

Efficacy and safety of Danhong injection in the treatment of arteriosclerosis obliterans:a meta-analysis of randomized controlled trials

Aims:To systematically evaluate the clinical efficacy and safety of danhong injection in the treatment of arteriosclerotic occlusion.Methods:Computer retrieval China knowledge network(CNKI),and Wiper Chinese journal database(VIP),and Wanfang data knowledge service platform,the Chinese biomedical literature database(CBM),Pubmed,science citation index(SCI)database,the Cochrane Library,including eight Chinese English database,to conform to the criteria for the two researchers use the recommended bias risk assessment method to evaluate the Cochrane bias risk,extracted data,and apply the Review Manager software Meta analysis and system evaluation.Results:Finally,13 studies were included,with a total number of 884 cases.The results showed that the clinical efficacy of danhong injection in the treatment of arteriosclerotic occlusion was higher than that of conventional treatment,and the difference was statistically significant[OR=3.08,95%CI(2.07,4.60),P<0.00001].The improvement of arteriosclerosis was more obvious[OR=0.15,95%CI(0.12,0.19),P<0.00001].The improvement of hemodynamics was more obvious[OR=-0.19,95%CI(-0.33,-0.04),P=0.01].No adverse reactions occurred.Conclusions:Danhong injection has higher clinical efficacy in the treatment of atherosclerotic occlusion,more obvious improvement in arteriosclerosis degree and hemodynamics,and higher safety.However,due to the low quality of literature research,more high-quality,large samples and randomized controlled double-blind clinical trials are needed to provide high-level evidence to further verify the efficacy and safety of danhong injection in the treatment of atherosclerotic occlusion.

LEASO患者血清miR-21、miR-126水平与HMGB1/TLR4信号通路活性和术后复发的关系

目的 探讨股腘型下肢动脉硬化闭塞症(LEASO)患者血清微小核糖核酸(miR)-21、miR-126水平与高迁移率族蛋白B1(HMGB1)/Toll样受体4(TLR4)信号通路活性和术后复发的关系。方法 选取行介入手术的股腘型LEASO患者120例,根据术后是否复发将股腘型LEASO患者分为复发组和未复发组。RF-qPCR剂检测血清miR-21、miR-126表达和外周血单个核细胞HMGB1 mRNA、TLR4 mRNA表达。采用Pearson相关性分析法分析股腘型LEASO患者血清miR-21、miR-126与外周血单个核细胞HMGB1 mRNA、TLR4 mRNA表达的相关性。多因素Logistic回归分析股腘型LEASO患者介入术后复发的影响因素。结果 120例股腘型LEASO患者随访2年,术后复发率为34.17%。与未复发组比较,复发组血清miR-21和外周血单个核细胞HMGB1 mRNA、TLR4 mRNA表达升高,血清miR-126表达降低(P均<0.05)。Pearson相关性分析显示,股腘型LEASO患者血清miR-21与外周血单个核细胞HMGB1 mRNA、TLR4 mRNA表达呈正相关(r分别为0.660、0.649,P均<0.05),miR-126与外周血单个核细胞HMGB1 mRNA、TLR4 mRNA表达呈负相关(r分别为-0.632、-0.641,P均<0.05),外周血单个核细胞HMGB1mRNA与TLR4 mRNA表达呈正相关(r=0.742,P<0.05)。多因素Logistic回归分析显示,高血压、糖尿病和miR-21、HMGB1 mRNA、TLR4 mRNA升高为股腘型LEASO患者介入术后复发的独立危险因素,miR-126升高为独立保护因素(P均<0.05)。结论 股腘型LEASO患者血清miR-21高表达和miR-126低表达与HMGB1/TLR4信号通路激活有关,是股腘型LEASO患者术后复发的独立影响因素。

普通球囊与药物涂层球囊治疗ASO支架内再狭窄的近期疗效对照

目的探讨普通球囊与药物涂层球囊(drug coated balloon,DCB)治疗下肢动脉硬化闭塞症(arteriosclerosis obliterans,ASO)支架内再狭窄的近期疗效对照。方法选择2021年1月至2022年12月我院收治的下肢动脉硬化闭塞症支架再狭窄患者90例作为研究对象,按照不同治疗方案分为普通组(45例,非顺应性后扩球囊普通球囊治疗)与药物涂层组(45例,药物涂层球囊治疗),观察两组术前、术后12 h、7 d时血管内皮功能[P选择素、一氧化氮(nitric oxide,NO)、内皮素-1(endothelin-1,ET-1)]水平;比较两组术前、术后6个月、术后12个月Rutherford分级及踝肱指数(ankle brachial index,ABI)及术后6个月、12个月靶向血管畅通情况。结果术后12 h、7 d,两组P选择素、ET-1水平高于术前,NO水平低于术前(P<0.05);而药物涂层组P选择素、ET-1水平低于普通组(P<0.05),而NO水平低于普通组(P<0.05);术后6个月、12个月Ruthweford分级低于术前(P<0.05);而药物涂层组Rutherford分级低于普通组,差异有统计学意义(P<0.05);术后3d、术后6个月、12个月两组ABI值高于术前(P<0.05);术后6个月、12个月药物涂层组ABI值高于普通组,差异有统计学意义(P<0.05);术后6个月、12个月药物涂层组靶向血管通畅率高于普通组(P<0.05),药物涂层组CD-TLR低于普通组,差异有统计学意义(P<0.05)。结论药物涂层球囊治疗可减少对患者血管内皮功能的损伤,改善患者下肢缺血症,维持靶向血管通畅。

Potential Mechanisms of Yanghe Decoction in the Treatment of Soft Tissue Sarcoma and Arteriosclerosis Obliterans Based on Network Pharmacology

Objective The objective of this study was to investigate potential mechanisms of Yanghe Decoction(YHD)in treating soft tissue sarcoma(STS)and arteriosclerosis obliterans(ASO)based on the use of network pharmacology.Methods Candidate compounds and potential targets were identifed through the TCM Systems Pharmacology database and a comprehensive literature search.Related targets of STS and ASO were collected in the GeneCards database,DisGeNET database,and Drugbank database.Furthermore,The STRING 11.0 database was used to determine protein-protein interaction(PPI)networks;common targets were obtained and imported into Cytoscape 3.7.2.Then,a PPI network comprising common targets was drawn,and network topology analysis was performed to screen for key shared targets.Gene ontology functional enrichment analysis and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis of key shared targets were performed by using Metascape software.Subsequently.a compound-target-pathway network was constructed via Cytoscape 3.7.2.Results The following signaling pathways were found to be associated with the mechanisms of YHD in treating STS and ASO:AGE-RAGE signaling pathway,IL-17 signaling pathway;HIF-1 signaling pathway,TNF signaling pathway,interactions between cytokines and cytokine receptors,Th17 cell differentiation,and NOD-like receptor signaling pathway.Among the compounds and targets involved in these pathways,quercetin,luteolin,and kaempferol were found to be core compounds,and TNF,IL-6,and MAPK1 were found to be core targets.Conclusion Taken together,our findings elucidated that potential mechanisms of YHD in treating STS and ASO involved cellular proliferation/differentiation,angiogen-esis,inflammation,immune responses,oxidative stress,and other related signaling pathways.

Application of Big Data Deep Learning in Auxiliary Diagnosis of Lower Extremity Arteriosclerosis Obliterans

At present,the incidence rate of arteriosclerosis obliterans(LEASO)of the lower extremities is significantly increased by aging and lifestyle changes.It is of great importance to predict the LEASO effectively and accurately by analyzing the imaging data of the lower extremities⑴.At this stage,China has entered the era of big data and artificial intelligence.Medical institutions at all levels can produce a large number of lower limb vascular image data every day.Using big data deep learning technology to intelligently analyze a large number of image data,and then carry out auxiliary diagnosis,so as to improve the diagnosis and treatment effect of LEASO is the focus of clinical research.

Advances in the management of arteriosclerosis of the lower extremity:Integrating Western and Chinese medicine approaches

This editorial provides a commentary on the recent article.The paper reviews current literature and explores innovative treatment strategies for lower extremity arteriosclerosis obliterans(LEASO)through an integrative approach.It highlights the effectiveness of combination therapies that merge traditional Chinese medicine(TCM)with Western medical practices,suggesting that such integrative methods may improve patient compliance and outcomes through personalized care.This paper stresses the importance of rigorous clinical trials to evaluate the efficacy and safety of TCM interventions within LEASO treatment protocols,advocating for evidence-based validation of these combined therapies.Our recommendations emphasize accurate diagnosis,appropriate pharmacological in-terventions,the use of advanced surgical and endovascular techniques,and the inclusion of TCM to address underlying dysfunctions.Additionally,continuous monitoring,patient education,and lifestyle modifications are essential to slow disease progression and achieve optimal patient outcomes.The paper concludes by calling for further research to develop standardized treatment protocols that effectively integrate both Western and Chinese medical approaches in managing LEASO.

基于重症病例及现代病理生理机制的四妙勇安汤方证条文内涵解读及其治疗糖尿病足伴感染、脓毒症、动脉硬化性闭塞症等急危重症体会

四妙勇安汤出自《验方新编》,该方具有清热解毒,活血止痛功效,主治热毒炽盛之脱疽,临床表现为患肢暗红微肿,皮温灼热,溃烂腐臭,疼痛剧烈,或见发热口渴,舌质红,脉数。现今临床多将该方用于血管闭塞性脉管炎、下肢动脉硬化闭塞性溃疡、下肢血管支架成形术后支架内再狭窄、深脓疱病、深静脉血栓、糖尿病性下肢动脉硬化闭塞症、糖尿病足溃疡、急性膝关节炎、下肢静脉曲张、冠心病、经皮冠状动脉介入(PCI)术后、脓毒症、痛风、肿瘤、小儿慢性扁桃体炎等疾病的治疗。研究发现,糖尿病足伴感染、脓毒症、动脉硬化性闭塞症、血管闭塞性脉管炎等,属中医学“脱骨疽”范畴。四妙勇安汤为古代治疗“脱骨疽”的专病专方。四妙勇安汤的方证指征,(1)疾病方面,可用于动脉硬化性闭塞症、血管闭塞性脉管炎、糖尿病足、深脓疱病等。(2)症状方面,指征包括手指、足趾部位黯红,发黑,微肿,灼热,溃烂腐臭,甚则脚趾脱落,手脚腐烂坍陷,剧烈疼痛,难以忍受;皮肤溃烂蔓延,脓水淋漓,淋巴结肿大增生;伴见口干,口渴,烦躁,小便黄,大便干;舌暗红,苔薄白,脉弦数。(3)方证加减规律方面,针对合并顽固性低血压时,笔者用四妙勇安汤加大剂量黄芪以益气、扶正、托毒,常能达到升血压、抗炎作用。(4)合方规律方面,该方常与四妙丸、桂枝茯苓丸合方。大剂量用药是该方取效的关键。中西医结合疗法在糖尿病足伴感染、脓毒症、感染性休克、动脉硬化性闭塞症、血管闭塞性脉管炎的治疗中具有重要作用。

紫杉醇药涂球囊扩张治疗ASO患者疗效及SIRT7水平对术后血管再狭窄的预测

目的观察紫杉醇药涂球囊扩张(DCB)治疗下肢动脉硬化闭塞症(ASO)疗效及SIRT7水平对术后血管再狭窄的预测。方法将112例下肢ASO患者随机均分为DCB组和金属裸支架(BMS)组。比较两组患者临床疗效、血管畅通率、靶病变血流重建率、动脉硬化指标、血流动力学指标、血小板活化因子水平及沉默信息调节因子7(SIRT7)水平。根据术后血管是否发生再狭窄分为狭窄组和对照组,Logistic回归分析其术后血管再狭窄的高危因素,ROC曲线下面积评价SIRT7对其术后再狭窄的预测效能。结果与BMS组比较,DCB组临床疗效、术后血管畅通率、血小板活化因子水平升高,靶病变血流重建率、动脉硬化指标、血流动力学指标水平降低(P<0.05)。狭窄组术后SIRT7水平较对照组降低(P<0.05)。术后低SIRT7水平是其术后再狭窄的高危因素,对其术后血管再狭窄的预测效能较高。结论DCB治疗ASO的疗效满意;术后低SIRT7水平为支架术后血管再狭窄的有效预测指标。

化浊通脉散对家兔ASO模型血清及组织中TXB_2、ET影响的实验研究

[目的]研究化浊通脉散治疗家兔下肢动脉粥样硬化闭塞症(ASO)模型的机制,进行初步探讨。[方法]40只新西兰家兔以高脂饮食和股动脉球囊扩张术建立ASO模型,随机分为4组:即化浊通脉散组(A),阿司匹林组(B),模型组(C),假手术组(D),检测药物干预前后家兔血清中一氧化氮(NO)、内皮素(ET)、6-酮-前列腺素F1α(6-Keto-PGF1α)、血栓烷素(TXB2)水平,实验结束后应用高倍透射电子显微镜(TEM)观察局部血管内皮细胞形态。[结果]化浊通脉散可以降低TXB2、ET及可升高NO、6-Keto-PGF1α的水平(P<0.01),且局部损伤血管脂肪细胞明显减少。[结论]化浊通脉散具有保护动脉血管内皮细胞及防治ASO的作用。

ASO与DMASO的MSCTA影像学表现差异性研究

目的:探讨动脉硬化性闭塞症(ASO)与糖尿病动脉硬化性闭塞症(DMASO)的MSCTA影像学表现的差异性,以期为两种疾病的鉴别诊断提供客观依据,更好的指导临床诊断与治疗。方法:纳入66例诊断为ASO与DMASO的患者,其中ASO41例,DMASO25例。行MSCTA检查,将获得的动脉期轴位图像数据结合多种后处理图像,对扫描范围内动脉节段的观察指标进行记录及分析。结果:ASO与DMASO的MSCTA影像学表现差异性,与糖尿病动脉硬化性闭塞症相比较,动脉硬化性闭塞症在髂总动脉双侧狭窄、髂外动脉的双侧钙化、髂外动脉单侧增厚、髂内动脉单双侧狭窄及单双侧闭塞、股总动脉单双侧狭窄、股深动脉双侧狭窄及双侧闭塞、动脉单侧狭窄等方面占比重较大。结论:动脉硬化性闭塞症与糖尿病动脉硬化性闭塞症的MSCTA影像学表现存在差异性。研究结果可以为两种疾病的鉴别诊断提供客观依据。

从“因虚致瘀”论ASO介入术后再狭窄的中医防治

下肢动脉硬化闭塞症发病率逐年升高,介入手术是其治疗的首选方式,然介入术后易再发狭窄,严重影响患者的预后。蔡炳勤教授认为ASO是"因虚致瘀",体虚为本,血瘀为标,手术是为祛邪,但也耗伤气血,亦生新邪,再发血瘀,因此对于ASO术后再狭窄的防治应补虚固本,辨证施治。

黄芪桂枝五物汤对糖尿病性下肢动脉硬化闭塞症大鼠动脉炎症的作用及其机制研究

目的:研究黄芪桂枝五物汤对糖尿病性下肢动脉硬化闭塞症大鼠的治疗作用及其机制。方法:将48只健康雄性SD大鼠随机分为模型组、低剂量中药组、高剂量中药组和空白对照组,每组12只,低剂量中药组和高剂量中药组分别给予1倍和2倍等效剂量中药汤剂灌胃,模型组和空白对照组给予生理盐水灌胃,连续干预4周。末次给药后24 h,观察大鼠一般情况、体质量、血糖水平,酶联免疫吸附法检测血清肿瘤坏死因子-α(TNF-α)、白细胞介素-16(IL-16)、一氧化氮(NO)、内皮素-1(ET-1)水平,观察腓肠肌新生血管密度,HE染色观察动脉血管病理变化,免疫印迹法检测缺氧诱导因子-1α(HIF-1α)/血管内皮生长因子(VEGF)通路蛋白表达水平。结果:低剂量中药组、高剂量中药组及模型组大鼠较空白对照组精神状态差,活跃性减弱,血糖升高,血清炎症因子水平升高,血管内皮功能受损。与模型组比较,低剂量中药组大鼠精神状态更好,行动较活跃,血糖下降,血清炎症因子水平降低,内皮细胞功能更完善,腓肠肌组织新生血管密度更高,HIF-1α及VEGF蛋白表达水平更高(P <0.05)。与低剂量中药组比较,高剂量中药组大鼠血糖下降,血清炎症因子水平降低,NO水平无显著差异,ET-1水平下降,腓肠肌组织新生血管密度更高,VEGF蛋白表达水平更高(P <0.05)。结论:黄芪桂枝五物汤可能通过调节HIF-1α/VEGF信号通路而抑制局部炎症反应,改善内皮细胞功能,从而起到治疗糖尿病性下肢动脉硬化闭塞症的作用。

腕踝针联合桃红四物汤治疗血脉瘀阻型Ⅰ~Ⅱ期下肢动脉硬化闭塞症疗效观察

目的观察腕踝针联合桃红四物汤治疗血脉瘀阻型Ⅰ~Ⅱ期下肢动脉硬化闭塞症的临床疗效。方法将98例血脉瘀阻型Ⅰ~Ⅱ期下肢动脉硬化闭塞症患者随机分为观察组和对照组,每组49例。对照组给予桃红四物汤治疗,观察组在对照组基础上给予腕踝针治疗。观察两组治疗前后中医证候积分、超声指标(足背动脉血管峰值流速、血管内径和血流量)、踝肱指数及动脉硬化指数、血管内皮功能(血清一氧化氮和内皮素-1水平)和血液流变学指标(全血低切黏度、全血高切黏度和血浆黏度)变化,并比较两组临床疗效及不良反应情况。结果观察组总有效率为91.5%,显著高于对照组的76.6%(P<0.05)。两组治疗后肢体麻木评分、肢体发凉评分、肢体疼痛评分均较治疗前降低(P<0.05),且观察组低于对照组(P<0.05)。两组治疗后血管峰值流速、血管内径及血流量均较治疗前升高(P<0.05),且观察组高于对照组(P<0.05)。两组治疗后踝肱指数均较治疗前升高(P<0.05),动脉硬化指数均较治疗前降低(P<0.05),且观察组优于对照组(P<0.05)。两组治疗后血清一氧化氮水平均较治疗前升高(P<0.05),血清内皮素-1水平均较治疗前降低(P<0.05),且观察组优于对照组(P<0.05)。两组治疗后全血低切黏度、全血高切黏度、血浆黏度水平均较治疗前降低(P<0.05),且观察组低于对照组(P<0.05)。两组治疗过程中均未出现严重不良反应。结论腕踝针联合桃红四物汤治疗血脉瘀阻型Ⅰ~Ⅱ期下肢动脉硬化闭塞症临床疗效显著。

下肢ASO患者血管腔内治疗前后血浆NPY的动态变化

目的研究下肢动脉硬化性闭塞症(ASO)患者血管腔内治疗前后血浆神经肽Y(NPY)水平的动态变化。方法采用放射免疫法检测13例下肢ASO患者(ASO组)接受血管腔内治疗前和治疗后不同时间点(即刻和第1、3、5 d)的血浆NPY水平,以15名健康体检者作为正常对照(对照组)。比较血管腔内治疗前与治疗后第3天时患肢踝/肱指数(ABI)和ASO临床分期。结果ASO组治疗前血浆NPY水平显著高于对照组,为(250.67±88.27)pg/mLvs(168.40±64.64)pg/mL,两组间比较差异有统计学意义(P<0.05);ASO组治疗后即刻的血浆NPY水平升达峰值,为(307.21±103.75)pg/mL,随后逐渐降低。治疗后第3天患肢ABI较治疗前显著升高(0.81±0.19vs 0.45±0.17),差异有统计学意义(P<0.01),同时ASO临床分期明显改善。结论ASO患者血浆NPY在严重缺血状态下释放增加,治疗后随着患肢缺血状态的纠正(ABI升高)及临床症状的好转,血浆NPY水平逐渐下降接近正常水平。

下肢动脉硬化闭塞症腔内治疗术后再狭窄高危人群自我管理体验的质性研究

目的:探究下肢动脉硬化闭塞症(ASO)腔内治疗术后再狭窄高危人群自我管理中的体验和感受,为临床护理实践提供参考。方法:采用质性研究中的现象学研究法,对2023年9月—11月在洛阳市某三级甲等医院血管外科就诊的12例病人进行半结构式访谈,采用Nvivo 12.0和Colaizzi七步分析法对访谈资料进行分析。结果:共归纳出ASO腔内治疗术后再狭窄高危人群自我管理体验的4个主题和5个次主题:身心困扰(足部皮肤温度低、出现间歇性跛行、面对新环境时的不安与焦虑、对腔内治疗术的困惑和恐惧、对疾病预后的担忧)、ASO知识获取途径缺乏、疾病重视度欠缺、难以改变的不良习惯。结论:ASO管腔再狭窄高危人群在自我管理过程中存在较多问题,护理人员应注重其需求和体验,为ASO管腔再狭窄高危人群构建个性化、全程化自我管理方案,从而预防管腔再狭窄的发生。