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.

Endoscopic ultrasound-guided vascular interventions: An expanding paradigm

Endoscopic ultrasound(EUS)has expanded its arena from a mere diagnostic modality to an essential therapeutic tool in managing gastrointestinal(GI)diseases.The proximity of the GI tract to the vascular structures in the mediastinum and the abdomen has facilitated the growth of EUS in the field of vascular interventions.EUS provides important clinical and anatomical information related to the vessels'size,appearance and location.Its excellent spatial resolution,use of colour doppler with or without contrast enhancement and ability to provide images“real-time”helps in precision while intervening vascular structures.Additionally,structures such as venous collaterals or varices can be dealt with optimally using EUS.EUS-guided vascular therapy with coil and glue combination has revolutionized the management of portal hypertension.It also helps to avoid radiation exposure in addition to being minimally invasive.These advantages have led EUS to become an upcoming modality to complement traditional interventional radiology in the field of vascular interventions.EUS-guided portal vein(PV)access and therapy is a new kid on the block.EUS-guided portal pressure gradient measurement,injecting chemotherapy in PV and intrahepatic portosystemic shunt has expanded the horizons of endo-hepatology.Lastly,EUS has also forayed into cardiac interventions allowing pericardial fluid aspiration and tumour biopsy with experimental data on access to valvular apparatus.Herein,we provide a comprehensive review of the expanding paradigm of EUS-guided vascular interventions in GI bleeding,portal vein access and its related therapeutic interventions,cardiac access,and therapy.A synopsis of all the technical details involving each procedure and the available data has been tabulated,and the future trends in this area have been highlighted.

Management of surgical splenorenal shunt-related hepatic myelopathy with endovascular interventional techniques

We present a case with hepatic myelopathy(HM) due to a surgical splenorenal shunt that was successfully treated by endovascular interventional techniques.A 39-year-old man presented with progressive spastic paraparesis of his lower limbs 14 mo after a splenorenal shunt.A portal venogram identified a widened patent splenorenal shunt.We used an occlusion balloon catheter initially to occlude the shunt.Further monitoring of the patient revealed a decrease in his serum ammonia level and an improvement in leg strength.We then used an Amplatzer vascular plug(AVP) to enable closure of the shunt.During the follow up period of 7 mo,the patient experienced significant clinical improvement and normalization of blood ammonia,without any complications.Occlusion of a surgically created splenorenal shunt with AVP represents an alternative therapy to surgery or coil embolization that can help to relieve shunt-induced HM symptoms.

Endoscopic ultrasound-guided vascular interventions: Current insights and emerging techniques

Endoscopic ultrasound(EUS)is one of the significant breakthroughs in the field of advanced endoscopy.In the last two decades,EUS has evolved from a diagnostic tool to a real-time therapeutic modality.The luminal gastrointestinal(GI)tract provides a unique opportunity to access multiple vascular structures,especially in the mediastinum and abdomen,thus permitting a variety of EUS-guided vascular interventions.The addition of the doppler and contrast-enhanced capability to EUS has further helped provide real-time visualization of blood flow in vessels through the GI tract.EUS-guided vascular interventions rely on standard endoscopic accessories and interventional tools such as fine-needle aspiration needles and fine-needle biopsy.EUS allows the visualization of various structures in real-time by differentiating tissue densities and vascularity,thus,avoiding radiation exposure.EUS-guided techniques also allow real-time microscopic examination after target biopsy.Furthermore,many necessary interventions can be done during the same procedure after diagnosis.This article provides an overview of EUS-guided vascular interventions such as variceal,non-variceal bleeding interventions,EUSguided portal vein(PV)access with the formation of an intrahepatic portosystemic shunt,and techniques related to diagnosis of GI malignancies.Furthermore,we discuss current insights and future outlook of therapeutic modalities like PV embolization,PV sampling,angiography,drug administration,and portal pressure measurement.

Giant vascular malformations invading the skull:A case report

BACKGROUND Vascular malformations(VMs)arise as a result of errors in the process of angiogenesis and are usually present at birth,but may not become apparent until after birth.However,giant VMs of the head and face are uncommon,with few reported cases,and the prognosis for their surgical intervention is unclear.CASE SUMMARY A 12-year-old girl was admitted to the hospital with findings of an enlarged right temporal scalp.After admission,computed tomography(CT)angiography of cerebral ateries showed a right occlusal gap and a right temporal artery venous malformation.Furthermore,cerebral angiography showed a right temporal lobe VM with multiple vessels supplying blood.The patient underwent surgery to remove the malformed vessels and the eroded skull.Two hours after the surgery,the patient's right pupil was dilated,and an urgent CT scan of the skull showed a right subdural haematoma under the incision,which was urgently removed by a second operation.After surgery,we gave continuous antibiotic anti-infection treatment,and the patient recovered well and was discharged two weeks later.CONCLUSION Surgical removal of giant haemangiomas is risky and adequate preoperative(including interventional embolisation)and intraoperative preparations should be made.

Endovascular interventions of the femoro-popliteal disease in the elderly

In the last few years the treatment of superficial femoral artery (SFA) occlusive disease has undergone greater changes in management including more aggressive endoluminal therapy, especially in the elderly patients who are at high risk for extra-vascular comorbidities from the surgical approach. While acute and chronic arterial limb ischemia is the conditions which the interventional cardiologists frequently encounter, the elderly population represents special problematic clinical and anatomical setting due to heavy calcification and poor distal run-off. Arterial thrombolysis, rheolytic thrombectomy, mechanical thrombectomy, laser angioplasty, cryoplasty, and new flexible long stents are some of the promising techniques to improve the technical and clinical outcomes in these elderly patients.

Feasibility study of emergency intervention for vascular injury outside the hospital

Background: Minimally invasive surgery in the field of traumatic vascular injury diagnosis and treatment has achieved good results. This study was designed to determine whether pre-hospital emergency intervention is feasible for vascular injury in a field intervention cabin under the condition of war or a disaster site.Methods: Different types of animal experiments of vascular injury intervention were performed in a field intervention cabin. Treatment capacity was evaluated by data collection, including duration of surgery, clinical evaluation, image clarity, and equipment handling. Environmental adaptability and mobility were evaluated by maneuverability and long-distance mobility.Results: A total of 56 surgeries(7 types) were performed in the field intervention cabin. Digital subtraction angiography(DSA) had good imaging performance. A total of 4800 km of long-distance mobility was performed, and all the equipment operated normally without any equipment failure. We participated in the medical service maneuver twice. The cabin unfolded and worked properly. There was no equipment damage during the medical service maneuver.Conclusion: Use of a field intervention cabin under the conditions of war or disaster is feasible for pre-hospital emergency intervention of vascular injury.

Effect of Intensive Therapy of Multiple Factors Intervention on Vascular Complications in Type 2 Diabetes

The effects of intensive versus regular therapy on incidence and progress of microalbuminuria in type 2 diabetes were compared. During a follow-up of 3 years, 96 cases of diabetes mellitus were randomized to intensive and regular therapy groups. HbA 1c goal was same in the two groups, but the goal of blood pressure (Bp) and lipid was more strict in the intensive therapy group than in the regular therapy group. There was statistically significant difference in the incidence and progression of vascular complications between the two groups. Logistic stepwise-regression analysis (odds ration, OR) showed that there was significant difference in the progression of nephropathy (OR 0.24, 95 % CI 0.12-0.76), retinopathy (OR 0.38, 95 % CI 0.16-0.88), peripheral neuropathy (OR 0.42, 95 % CI 0.22-0.86) and autonomic neuropathy (OR 0.29, 95 % CI 0.12-0.86) between the two groups (P<0.01). It was concluded that intensive blood glucose controlling could retard diabetic vascular complications. Intensive therapy of multiple factors interventions (controlling Bp, regulating blood lipid, improving microcirculation) could decrease various risk factors for diabetic vascular complications.

A new perspective on changes in vascular function due to hypoxia

This review discusses the functions of blood vessels such as coagulation,regulation,immunity,endocrinology,and nerve conduction from a new perspective and suggests that hypoxia plays a common role in the changes in vascular function in various cardiovascular and cerebrovascular diseases.Therefore,it is oxygen therapy regulation may be a particularly beneficial means by which to regulate vascular function due to its low risk of harm and ease of implementation.Further,the authors have identified a link between vascular function and diseases caused by endogenous hypoxia and analyzed it in depth.The potential effects of hypoxia regulation schemes such as hyperxia,hyperoxic-hypoxia alternations,hypoxia preconditioning,and intermittent hypoxia on vascular function are also discussed,and we present theoretical support for targeted vascular therapy.

Delayed hepatocarcinogenesis through antiangiogenic intervention in the nuclear factor-kappa B activation pathway in rats

BACKGROUND: The active form of nuclear factor-kappa B (NF-kappa B) is involved in the initiation, generation, and development of hepatocellular carcinoma (HCC), and is up-regulated in inflammation-associated malignancies. We investigated the dynamic expression of NF-kappa B and its influences on the occurrence of HCC through antiangiogenic (thalidomide) intervention in NF-kappa B activation. METHODS : Hepatoma models were induced with 2-fluorenylacetamide (2-FAA, 0.05%) in male Sprague-Dawley rats, and thalidomide (100 mg/kg body weight) was administered intragastrically to intervene in NF-kappa B activation. The pathological changes in the liver of sacrificed rats were assessed after hematoxylin and eosin staining. NF-kappa B mRNA was amplified by RT-nested PCR. The alterations of NF-kappa B and vascular endothelial growth factor (VEGF) expression were analyzed by enzyme-linked immunosorbent assay, immunohistochemistry, and Western blotting. RESULTS: Rat hepatocytes showed denatured, precancerous, and cancerous stages in hepatocarcinogenesis, with an increasing tendency of hepatic NF-kappa B, NF-kappa B mRNA, and VEGF expression, and their values in the HCC group were higher than those in controls (P<0.001). In the thalidomide-treated group, the morphologic changes generated only punctiform denaturation and necrosis at the early or middle stages, and nodular hyperplasia or a little atypical hyperplasia at the final stages, with the expression of NF-kappa B (chi(2)=9.93, P<0.001) and VEGF (chi(2)=8.024, P<0.001) lower than that in the 2-FAA group. CONCLUSION: NF-kappa B is overexpressed in hepatocarcinogenesis and antiangiogenic treatment down-regulates the expression of NF-kappa B and VEGF, and delays the occurrence of HCC. (Hepatobiliary Pancreat Dis Int 2010; 9: 169-174)

The Transradial Approach for Cardiac Catheterization and Percutaneous Coronary Intervention:A Review

Cardiac catheterization and percutaneous coronary intervention play an important role in the management of coronary artery disease.Although the transfemoral approach has been the traditionally dominant method,there has been an increased utilization of the transradial approach.Multiple observational studies and randomized clinical trials have shown fewer bleeding complications,reduced morbidity and mortality,improved quality of life,and better economic outcomes when the transradial approach is utilized when compared to the transfemoral approach.Despite its many benefits,utilization of this approach in certain countries including the United States has been less than optimal due to a lower adoption rates mostly driven by lack of training opportunities and decreased awareness of clinical benefits of the transradial approach.In this review,the history,observational trends,efficacy,and technical aspects of transradial cardiac catheterization and percutaneous coronary intervention are discussed.

Acute mesenteric ischemia due to percutaneous coronary intervention:A case report

BACKGROUND Percutaneous coronary intervention(PCI) is extensively used to treat acute coronary syndromes(ACS).Acute mesenteric ischemia is a life-threatening disease if untreated.CASE SUMMARY An 81-year-old female presented with 3 d of lethargy and 1 d of dyspnea.On November 16,2021,the patient developed a coma.Her oxygen saturation dropped to 70%-80%,the patient was admitted to the intensive care unit for further treatment.Chest computed tomography(CT) showed chronic bronchitis,emphysema,and multiple lung infections.Abdominal CT scan showed no obvious abnormalities,but have severely calcified abdominal vessels.The patient received assisted ventilation,and vasoactive,and anti-infection drugs.Troponin level was elevated.Since the patient was in a coma,it could not be determined whether she had chest pain.The cardiologist assumed that the patient had developed ACS;therefore,the patient underwent PCI via the left femoral artery approach,and no obvious abnormalities were found in the left and right coronary arteries.On the second postoperative day,the patient presented with abdominal distension and decreased bowel sounds;constipation was considered and a glycerin enema was administered.On day 4,the patient suddenly lost consciousness,and had decreased blood pressure,abdominal wall swelling with increased tension,and absence of bowel sounds.An urgent abdominal CT scan revealed gas in her hepatic portal system with extensive bowel wall necrosis.The patient died on day 5 due to intractable shock.CONCLUSION The potential serious complications in patients undergoing PCI,especially the patients who are hemodynamically unstable and have severely calcified abdominal vessels,should all be considered.

预见性干预在介入手术治疗儿童脉管畸形中的应用价值

目的 探讨预见性护理干预对脉管畸形患儿经介入治疗在预防或降低常见并发症、不良反应中的应用价值,患者及家属焦虑情绪改善和满意度评价。方法 选取河北省儿童医院2019~2022年介入治疗936例脉管畸形患儿,随机等分为对照组和观察组,每组468例。对照组采用一般护理方法,遵照医嘱执行治疗和护理至出院。观察组在一般护理基础上,采用预见性护理干预。比较2组患儿发热、腹泻、哭闹烦躁、疼痛、呕吐等不良反应发生情况;比较经血管栓塞剂,硬化剂注射治疗后发生感染、皮肤糜烂、局部组织缺损,穿刺部位出血等并发症发生情况;比较2组患儿及家属焦虑情绪状态;比较满意度问卷调查结果。结果 观察组患儿不良反应、并发症发生率低于对照组,差异有统计学意义(P<0.05);观察组患者及家属焦虑情绪明显好转,且满意度问卷调查结果,观察组满意度优于对照组,差异均有统计学意义(P<0.05)。结论 预见性护理干预在介入治疗儿童脉管畸形中能够降低不良反应/并发症发生率,患儿及家属摆脱焦虑情绪状态,满意度得到明显提升,有助提高介入治疗儿童脉管畸形的疗效。

元宇宙在血管外科教学中的应用

元宇宙作为新兴科技被广泛应用于各个领域,包括医学领域。将元宇宙应用于医学教育领域可以提升教育水平。血管外科的治疗方式涉及介入手术,介入手术需借助射线完成,射线对医生的健康造成影响,尤其对未婚未孕的医学生而言,需要避免过量射线的暴露。元宇宙借助情景模拟,可以让医学生在虚拟现实中体验手术,避免射线伤害。医学生的培养和临床实践分不开,尤其是外科医生的培养,传统教学实践不能满足血管外科教学的需要,元宇宙的VR(增强现实)/AR(虚拟现实)/MR(混合现实)技术可以对学生进行实践训练,而且可以重复利用。面对知识日新月异地更新,元宇宙可以通过大数据分析出有用的知识,并以生动形象的画面展现出来,帮助学生理解知识并灵活掌握。通过元宇宙的应用可以培养学生主动学习的动力和兴趣,提高学习成绩和教学水平。该文将探讨元宇宙在血管外科教学中的应用现状及展望。

依达拉奉右莰醇治疗血管介入术后急性脑梗死的疗效及对血液流变学和血清Lp-PLA2 NSE水平的影响

目的探讨依达拉奉右莰醇治疗血管介入术后急性脑梗死患者(ACI)的临床效果,以及血液流变学和血清脂蛋白相关磷脂酶A2(Lp-PLA2)、神经元特异性烯醇化酶(NSE)水平的影响。方法选入2020-01—2023-01在陕西省人民医院行血管介入术治疗的ACI患者120例,根据术后治疗方案不同分为2组,各60例。对照组接受常规治疗,观察组接受常规治疗+依达拉奉右莰醇治疗。评价2组的临床疗效、血液流变学、血清Lp-PLA2和NSE水平变化等,并进行比较。结果2组术后各观测点(术后7d、14d和6个月)采用美国国立卫生研究院卒中量表(NIHSS)评分均较术前降低(P<0.05),且观察组更低(P<0.05);观察组治疗总有效率为93.33%,高于对照组的75.00%(P<0.05);2组术前血液流变学指标无统计学差异(P>0.05),术后14 d观察组血浆黏度(PV)、全血高切黏度(HSV)与低切黏度(LSV)均低于对照组(P<0.05);相较于术前,2组术后14 d血清Lp-PLA2和NSE水平降低(P<0.05),且观察组更低(P<0.05);2组不良反应总发生率无统计学差异(P>0.05);治疗6个月内,观察组不良结局总发生率为3.33%低于对照组的18.33%(P<0.05)。结论依达拉奉右莰醇可明显提高ACI患者血管介入手术疗效,改善神经功能和血液流变学,调节血清Lp-PLA2、NSE水平,减少不良结局。

桡动脉外周血管介入治疗肝癌的临床效果

目的探究肝癌患者经桡动脉途径行外周血管介入治疗的可行性与安全性。方法选取80例肝癌患者,随机分为对照组(40例)及观察组(40例)。对照组给予经股动脉外周血管介入术,观察组给予经桡动脉外周血管介入术。比较2组穿刺时间、穿刺成功率、手术成功率,住院相关指标(住院费用、住院时间、术后住院时间),曝光剂量、曝光时间、手术时间及相关并发症发生情况。结果观察组穿刺时间、住院时间、术后住院时间明显低于对照组(P<0.05);2组穿刺成功率、手术成功率、曝光剂量、曝光时间、住院费用及手术时间比较无明显差异(P>0.05)。观察组并发症发生率为2.50%,明显低于对照组的20.00%(P<0.05)。结论肝癌患者经桡动脉及股动脉进行外周血管介入术效果相当,但经桡动脉介入术患者恢复更快,安全可行。

早期量化功能锻炼联合中医三联干预措施对糖尿病周围血管病变患者的影响

目的:观察早期量化功能锻炼联合中医三联干预措施对糖尿病周围血管病变患者的影响。方法:将68例糖尿病周围血管病变患者按照随机数字表法分为对照组和研究组各34例,对照组采用常规护理措施,研究组采用早期量化功能锻炼联合中医三联干预措施,比较两组患者干预前后下肢动脉血流量、负性情绪评分及干预后糖尿病生活质量特异性量表(diabetes specific quality of lifescale,DSQL)总评分与护理效果。结果:干预1个月后,两组患者下肢动脉血流量高于干预前,研究组高于对照组(P<0.05);两组患者焦虑自评量表、抑郁自评量表评分低于干预前,研究组低于对照组(P<0.05);研究组DSQL总评分低于对照组(P<0.05),研究组总有效率为97.06%(33/34),高于对照组的79.41%(27/34)(P<0.05)。结论:早期量化功能锻炼联合中医三联干预措施能增加糖尿病周围血管病变患者下肢动脉血流量,提高患者生活质量和护理效果,改善患者不良情绪。

益气养阴化瘀汤对冠心病经皮冠状动脉介入治疗术后患者心功能和血管内皮功能的影响

目的观察益气养阴化瘀汤对冠心病经皮冠状动脉介入治疗(PCI)术后患者心功能及血管内皮功能的影响。方法将62例冠心病PCI术后患者按照随机数字表法分为2组。对照组31例予常规抗血小板聚集、稳定斑块等药物治疗,治疗组31例在对照组治疗基础上加用益气养阴化瘀汤治疗,均治疗4周。比较2组治疗前后中医症状评分、血管内皮功能[血清一氧化氮(NO)、血管内皮生长因子(VEGF)、内皮素-1(ET-1)]、心功能[心脏每搏输出量(SV)、左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)及左心室收缩末期容积(LVESV)]、血液流变学指标[全血黏度(CP)、血浆黏度(PV)、红细胞比容(Hct)及红细胞聚集指数(AI)]变化,并比较2组心绞痛疗效和不良事件发生率。结果治疗后,2组中医症状胸闷疼痛、心悸盗汗、五心烦热及失眠多梦评分及总分均较本组治疗前下降(P<0.05),且治疗组均低于对照组(P<0.05)。治疗后,2组NO及VEGF水平均较本组治疗前上升(P<0.05),且治疗组高于对照组(P<0.05);治疗后,2组ET-1水平均较本组治疗前下降(P<0.05),且治疗组低于对照组(P<0.05)。治疗后,2组LVEF及SV均较本组治疗前上升(P<0.05),且治疗组高于对照组(P<0.05);治疗后,2组LVEDD、LVESD及LVESV均较本组治疗前下降(P<0.05),且治疗组低于对照组(P<0.05)。治疗后,2组CP、PV、Hct及AI水平均较本组治疗前下降(P<0.05),且治疗组低于对照组(P<0.05)。治疗组心绞痛疗效总有效率为87.10%(27/31),不良事件发生率6.45%(2/31),对照组分别为64.52%(20/31)、16.13%(5/31),治疗组心绞痛疗效总有效率高于对照组(P<0.05),2组不良事件发生率比较差异无统计学意义(P>0.05)。结论益气养阴化瘀汤可有效改善冠心病PCI术后患者心功能和血管内皮功能,且未增加不良事件发生。

血管栓塞介入治疗脑动脉瘤的临床效果及其对并发症发生率的影响分析

目的:研究分析血管栓塞介入治疗脑动脉瘤的临床效果及对并发症发生率的影响。方法:选取2018年1月—2022年1月样本医院接诊的100例脑动脉瘤患者作为研究对象,按照治疗方法将其分为实验组和对照组,每组各50例,实验组选择血管栓塞介入治疗,对照组选择开颅夹闭的手术治疗形式。对比两组患者住院情况、手术的时间、并发症及预后情况。结果:实验组患者住院时间和手术治疗时间均短于对照组,差异有统计学意义(t=4.939、11.839,P<0.05);实验组患者并发症发生率明显少于对照组,差异有统计学意义(χ^(2)=7.162,P<0.05);使用Glasgow评分评价预后,实验组患者预后优秀率高于对照组,差异有统计学意义(χ^(2)=9.091,P<0.05)。结论:使用血管栓塞介入治疗脑动脉瘤效果较好,可改善患者预后、降低并发症、缩短住院时间和手术时间。

复方丹参滴丸配合阿托伐他汀对冠心病患者行经皮冠状动脉介入术后血管内皮功能和血管炎性反应的影响

目的分析复方丹参滴丸配合阿托伐他汀对冠状动脉粥样硬化性心脏病(简称冠心病)患者行经皮冠状动脉介入术(percutaneous coronary intervention,PCI)后血管内皮功能和血管炎性反应的影响。方法选取2023年1月—2024年1月中南大学湘雅医院收治的94例冠心病患者为研究对象,所有患者均接受PCI,按治疗方法不同分组,每组47例。单药组采用阿托伐他汀治疗,联合组给予复方丹参滴丸、阿托伐他汀联合治疗,对比两组临床疗效、血管内皮功能、血管炎性反应。结果联合组临床总有效率为95.74%(45/47),高于单药组的74.47%(35/47),差异有统计学意义(χ^(2)=9.598,P<0.05)。治疗8周后,联合组的血管性血友病因子、内皮素-1、肿瘤坏死因子-α、白细胞介素-6、超敏C反应蛋白水平低于单药组,血清一氧化氮水平高于单药组,差异有统计学意义(P均<0.05)。结论冠心病患者PCI术后应用复方丹参滴丸配合阿托伐他汀治疗,可有效抑制炎症因子释放,改善血管内皮功能,临床疗效显著。