股动脉穿刺压迫约束带的设计与临床应用

目的探讨自制约束带在股动脉穿刺术后压迫止血的有效性和安全性。方法选择经股动脉穿刺行介入治疗的患者196例,将其随机分为观察组(n=96)与对照组(n=100)。对照组常规在股动脉穿刺点用弹力绷带8字型加压包扎的基础上使用沙袋压迫止血6h,观察组在股动脉穿刺点使用自制约束带加压固定止血,两组患者均下肢制动24h。比较两组术后约束相关并发症。结果观察组穿刺部位假性动脉瘤、皮肤过敏反应及排尿困难发生率均为0,皮下淤血和血肿、皮肤过敏反应发生率显著低于对照组(均P<0.05)。结论股动脉穿刺压迫约束带使用安全有效,且护理操作简单。

Percutaneous thrombin embolization of a pancreaticoduodenal artery pseudoaneurysm after failing of the endovascular treatment

Pancreatico-duodenal artery(PDA) pseudoaneurysms are rare vascular conditions with high mortality rates after rupture and they are frequently secondary to pan-creatitis, surgery, trauma or infection. Due to the high risk of rupture and bleeding, it is mandatory to treat all pseudoaneurysms, regardless of their size or symp-tomatology. First option of treatment is open surgical repair, but it has high mortality rate, especially in he-modynamically unstable patients. In the recent years, percutaneous ultrasonography(US)- or computed to-mography-guided thrombin injection was proposed as an alternative method for treating visceral aneurysms and pseudoaneurysms, but few reports described this therapy in case of peri-pancreatic pseudoaneurysms. We present a rare case of pseudoaneurysm of the PDA in a patient with no previous history of pancreatitis nor major surgery but with an occlusive lesion of the celiac axis. To the best of our knowledge this is the first reported case of PDA pseudoaneurysm successfully treated in emergency by single transabdominal US-guided injection of thrombin after failed attempts of percutaneous catheterization of the feeding vessel of the pseudoaneurysm.

非心源性急性下肢动脉缺血的临床诊疗体会

目的探讨非心源性原因导致的急性下肢动脉缺血的临床经验与诊疗体会。方法对52例不同病因引起的急性下肢动脉缺血的患者分别采取了具有针对性的诊断与治疗,如经股动脉入路切开取栓术、动脉硬化斑块切除+经股动脉切开取栓术、取自体血管(大隐静脉)或人工血管进行移植重建术、股静脉切开取栓术、损伤动脉修复、吻合术及髂动脉开窗手术。结果本组无死亡病例,3例患者截肢,49例患者肢体得到救治,术后平均随访21个月。结论非心源性原因所导致的急性下肢动脉缺血,其诊断与治疗有着一定的复杂性和困难性,我们实际可以认为急性下肢动脉缺血是诸多疾病的一个共同并发症。