下肢深静脉血栓形成的治疗进展

下肢深静脉血栓形成在欧美是一种比较常见的疾病,在我国随着临床医师意识的加强及诊疗水平的提高,其发病率也逐年上升。下肢深静脉血栓形成的危害是其并发症一肺栓塞和血栓形成后综合征,肺栓塞是临床上导致死亡的一个重要原因,而血栓形成后综合征严重影响患者的生活质量及工作能力,故其治疗成为一个热门话题。本文对下肢深静脉血栓形成的治疗...     

老年人肺栓塞临床特点及误诊原因分析

通过对38例临床表现、实验室检查、放射性核素肺灌注显像等方法确诊的老年肺栓塞患者进行回顾性分析,并比较老年患者和非老年患者在致病原因、临床表现及误诊方面的差异,证实下肢深静脉血栓的形成、恶性肿瘤、高血压动脉硬化等是老年人肺栓塞的主要危险因素。老年组肺栓塞的误诊率高达60.5%,高于非老年组(53.2%),最易误诊为肺炎,其次为心肌梗死。因此,老年人肺栓塞应引起临床医生高度重视。     

老年人肺栓塞临床特点及误诊原因分析

通过对38例临床表现、实验室检查、放射性核素肺灌注显像等方法确诊的老年肺栓塞患者进行回顾性分析,并比较老年患者和非老年患者在致病原因、临床表现及误诊方面的差异,证实下肢深静脉血栓的形成、恶性肿瘤、高血压动脉硬化等是老年人肺栓塞的主要危险因素.老年组肺栓塞的误诊率高达60.5%,高于非老年组(53.2%),最易误诊为肺炎,其次为心肌梗死.因此,老年人肺栓塞应引起临床医生高度重视.     

三种不同方法治疗下肢深静脉血栓的比较

收集来宾市人民医院2015年2月～2018年2月收治的120例下肢深静脉血栓患者,分成三组,分别给予抗凝(A组)、抗凝+患肢溶栓(B组)、抗凝+下腔静脉滤器植入+导管溶栓治疗(C组),比较三组治疗的结果。A组25例有效,15例无效;B组31例有效,9例无效;C组35例有效,5例无效。A组与B组比较两组差异无统计学意义,B组与C组比较两组差异无统计学意义,A组与C组比较两组差异有统计学意义(P0.05)。A、B、C三组在下肢肿胀消退天数、下肢周径差、并发症、住院时间方面比较差异无统计学意义。在住院费用方面A组与B组无差异,A组与C组、B组与C组差异有统计学意义(P0.05)。抗凝+患肢溶栓治疗下肢深静脉血栓形成是安全、有效、经济适用的一种治疗方法。     

慢性阻塞性肺疾病急性加重期合并深静脉血栓形成的相关因素分析

探讨慢性阻塞性肺疾病急性加重期患者发生深静脉血栓形成的相关因素。采用回顾性病例对照研究分析慢性阻塞性肺疾病急性加重期合并深静脉血栓形成患者21例(病例组)及同期不合并深静脉血栓形成的慢性阻塞性肺疾病急性加重期患者60例(对照组)的基本资料、实验室指标及临床特征。多因素Logistic回归分析显示:下肢不对称肿胀≥1cm、卧床时间≥5天、慢性阻塞性肺疾病GOLD分级Ⅲ级~Ⅳ级、D-二聚体≥500μg/L是慢性阻塞性肺疾病急性加重期合并深静脉血栓形成的危险因素(P0.05)。     

延迟支架置入在高血栓负荷急性STEMI老年患者中的临床分析

探讨延迟支架置入在高血栓负荷急性ST段抬高型心肌梗死(STEMI)老年患者中的临床应用价值。选取笔者所在医院发病12h内的老年高血栓负荷STEMI患者81例,罪犯血管行血栓抽吸后前向血流达TIMI 2级~3级且血栓积分≤2分的患者随机分为常规治疗组(33例)和延迟治疗组(28例)。比较两组患者术后慢血流/无复流发生率、心肌灌注呈色分级、术后6月心功能及术后6月内复合终点事件发生率。延迟组支架置入后慢血流/无复流发生率显著低于常规治疗组(P0.05),心肌呈色分级、术后6个月LVEF改善幅度明显高于常规组(P0.05),左心室舒张末期内径明显低于常规组(P0.05),6个月内复合终点事件发生率延迟组高于常规组,差异无统计学意义(P0.05)。血栓抽吸后延迟支架置入可显著减少老年高血栓负荷急性STEMI患者慢血流/无复流发生率,提高心肌灌注,改善老年患者心功能。     

炎症性肠病高凝状态与干预策略

炎症性肠病(IBD)患者发生静脉血栓(VTE)事件的风险大约是正常人的2倍~3倍,主要包括深静脉血栓(DVT)和肺栓塞(PE)。虽然具体机制尚不明确,但是研究发现IBD患者血液的高凝状态与纤溶系统的改变、血小板异常、凝血系统的激活以及血管内皮功能异常等有关。疾病严重程度、是否住院以及治疗的相关药物都影响着IBD患者的静脉血栓发生风险,积极改善疾病严重程度,谨慎选择治疗药物对于预防静脉血栓的发生有重要意义。肝素在改善IBD患者的高凝状态中起着重要作用,应根据指南对静脉血栓的发生进行积极的预防和治疗。     

静脉血栓栓塞症

静脉血栓栓塞症包含深静脉血栓形成和肺血栓栓塞症,是具有多种危险因素的潜在致死性疾病,其流行病学资料研究显示并非少见疾病.除检验前的临床评估和D-二聚体外,目前已有多种诊查手段用于静脉血栓栓塞症的诊断,其中螺旋CT造影已逐渐成为诊断的首选.根据病情,患者有抗凝、溶栓、手术和介入等多种选择.各医院要根据自身情况制订相应的临床策略,以最大限度提高诊治决策的成本-效益比.     

静脉血栓栓塞症

静脉血栓栓塞症包含深静脉血栓形成和肺血栓栓塞症,是具有多种危险因素的潜在致死性疾病,其流行病学资料研究显示并非少见疾病。除检验前的临床评估和D-二聚体外,目前已有多种诊查手段用于静脉血栓栓塞症的诊断,其中螺旋CT造影已逐渐成为诊断的首选。根据病情,患者有抗凝、溶栓、手术和介入等多种选择。各医院要根据自身情况制订相应的临床策略,以最大限度提高诊治决策的成本-效益比。     

代谢手术的近期与远期并发症

代谢手术改善代谢的机制可能与能量摄入限制、吸收不良、胃肠道激素及脂肪细胞因子等体内多种因素的改变有关,为病态肥胖及代谢性疾病的治疗带来了新的方法和希望。但是手术本身也会带来一系列近期和远期并发症,其中近期并发症包括吻合口瘘、肺栓塞、伤口感染、切口疝、深静脉血栓、横纹肌溶解症等,远期并发症包括蛋白质、维生素等营养代谢紊乱以及铁、锌、硒等微量营养素的缺乏。     

Using the common-sense model to predict risk perception and disease-related worry in individuals at increased risk for venous thrombosis.

OBJECTIVE: This study applied the Common-Sense Model (CSM) to predict risk perception and disease-related worry in 174 individuals with a genetic predisposition to venous thrombosis (thrombophilia). DESIGN: Participants completed an adapted version of the Illness Perception Questionnaire-Revised (IPQ-R) and measures assessing risk perception and worry. RESULTS: Regression analyses revealed that illness perceptions were predictors of risk perception and thrombosis worry. The hypothesis that illness perceptions mediate the relationship between a person's experience of venous thrombosis and perceived risk and thrombosis worry could not be confirmed. CONCLUSIONS: Further research should refine the IPQ-R for populations at risk of a disease and examine the value of the CSM in explaining the relationship between risk perception, worry, and health behavior.     

Hypercoagulable states and stroke: a selective review

Blood disorders have been implicated in approximately 5% to 10% of ischemic stroke, with an increased frequency in younger patients. Most disorders are associated with an increased thrombotic tendency and, therefore, an increased risk of ischemic stroke. Less commonly, a bleeding diathesis may predispose a patient to intracranial hemorrhage. While many conditions predisposing to thrombosis have been associated with stroke, there are relatively few prospective, epidemiological studies addressing hypercoagulable states and arterial stroke compared with the number of studies on the genetic thrombophilias, which are predominantly associated with venous thrombosis. When ordering tests of coagulation in stroke patients, one should keep in mind whether the results will influence therapy and/or patient outcome. It is generally not advocated to screen all stroke patients for a "hypercoagulable workup". Typically, patients to be screened for coagulation defects will have a prior history of one or more unexplained thromboembolic events. The yield for diagnosing a hypercoagulable state is typically greatest for young stroke patients or those with a family history of thrombosis and who have no other explanations for their stroke (cryptogenic stroke). The yield in typically low in unselected ischemic stroke patients and older patients. Treatment of a first stroke with a documented hypercoagulable state is typically long-term or indefinite duration warfarin, although there is a paucity of clinical trial data supporting this clinical approach.     

创伤性截肢术后并发症及处理

近年来因创伤或创伤后并发症行截肢手术的数量仍然比较多。限于手术时的客观和主观条件,截肢术后并发症并不少见,成为妨碍残肢功能康复的一个重要原因。手术后并发症主要有残端出血、感染、皮肤坏死、深静脉血栓、继发性骨筋膜室综合征,以及残肢疼痛、幻肢痛等,常常关系到病人的生命和后续治疗的进行,需要认真对待和处理。     

A Pilot Study to Assess the Feasibility of a Multicenter Cluster Randomized Trial for the Management of Asymptomatic Persons with a Thrombophilia

There is controversy whether asymptomatic first-degree relatives (FDRs) of patients with venous thromboembolism (VTE) and thrombophilia should be screened, followed, and prescribed prophylaxis during risk periods. We recruited consecutive probands with idiopathic VTE and thrombophilia from our thrombosis clinics. Those FDRs with thrombophilia were randomized in family clusters to receive one-time verbal counseling and no organized follow-up or counseling, educational material, reminder aids and follow-up. Only 203 of 1,129 FDRs were eligible and consented. Dropouts were common; 1 FDR (1.7%) developed VTE. VTE risk, ability to treat and prevent were underestimated by the participants. Patients with VTE and thrombophilia and their FDRs are often not interested in thrombophilia testing. Despite education to inform their knowledge, interest and follow-up were less than ideal. The question of the best educational approach in these patients remains unanswered. The value of testing and following asymptomatic carriers of probands with VTE and thrombophilia remains unknown.     

肺动脉血栓栓塞症与凝血纤溶系统失衡

在生理状态下,凝血与纤溶处于动态平衡状态;当这种平衡失衡时,便可招致出血不止或形成栓塞。体内某些抗凝途径的蛋白缺陷会使机体处于高凝状态而导致静脉血栓栓塞性疾病(VTE),已经报道有多种栓塞因素与VTE的发生有关;人们通常认为,慢性栓塞性肺动脉高压(CTE-PH)是静脉系统栓子反复脱落至肺动脉所致,很自然的会想到CTE-PH的发病可能与以上多种栓塞因素有关,然而,目前研究更倾向于CTEPH和VTE并没有直接的关系或者说是两个独立的疾病。     

宫颈癌根治术前预处理减少输尿管损伤及下肢静脉血栓临床观察

通过对术前考虑盆腔粘连可能比较严重的宫颈癌根治术（RH）术中穿着医用弹力袜行双下肢弹力加压,并经膀胱镜放置输尿管导管作预处理,减少下肢静脉血栓及输尿管损伤的临床效果。回顾性研究在我院行手术治疗的术前考虑盆腔粘连可能比较严重的宫颈癌患者364例,其中182例接受广泛子宫切除及盆腔淋巴结清扫术,术中穿着医用弹力袜行双下肢弹力加压,作为研究组,另182例单纯接受广泛子宫切除及盆腔淋巴结清扫术,未作预处理,作为对照组。结果研究组无一例损伤输尿管,对照组2例发生输尿管损伤（P ＜0．05）。因此,术前考虑盆腔粘连可能比较严重的 RH 术中穿着医用弹力袜行双下肢弹力加压,并经膀胱镜放置输尿管导管常规作预处理,可明显减少下肢静脉血栓、尿潴留及输尿管损伤,值得临床推广应用。     

预测癌症患者静脉血栓栓塞的生物标记

癌症患者发生静脉血栓与肺栓塞的危险性增加.为预测不同类型肿瘤患者的静脉血栓栓塞（VTE）发生率,特别研究了一些生物标记.已证实血细胞计数（白细胞与血小板计数升高）是有用的预测因子.D-二聚体、凝血酶原片段1＋2、可溶性P选择素、FⅧ、凝血酶水平升高与未来VTE风险相关.组织因子微粒与VTE风险的关系因肿瘤类型不同而不同：组织因子微粒与胰腺癌VTE风险有相关性已被证实;与胶质母细胞瘤、结直肠癌、胃癌的相关性未获证实.目前建立了包含临床与试验室标记物的预测VTE的风险评估模型,为便于应用抗凝剂预防VTE,危险分层需进一步改进以更好地鉴别VTE患者.     

Pregnancy and stroke

The risks of ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage are not increased in the 9 months of gestation except for a high risk in the 2 days prior and 1 day postpartum. The remaining 6 weeks postpartum also have an increased risk of ischemic stroke and intracerebral hemorrhage, though less than the peripartum period. Although there are some rare causes of stroke specific to pregnancy and the postpartum period, eclampsia, cardiomyopathy, postpartum cerebral venous thrombosis, and, possibly, paradoxical embolism warrant special consideration. The diagnostic and therapeutic approaches to stroke during pregnancy and the postpartum period are similar to the approaches in the nonpregnant woman with some minor modifications based on consideration of the welfare of the fetus. There is a theoretical risk of magnetic resonance imaging exposure during the first and second trimester but the benefit to the mother of obtaining the information may outweigh the risk. Available evidence suggests that low-dose aspirin (<150 mg/day) during the second and third trimesters is safe for both mother and fetus. Postpartum use of low-dose aspirin by breast-feeding mother is also safe for infant. While proper counseling is imperative, a history of pregnancy-related stroke should not be a contraindication for subsequent pregnancy.     

The self in deep ecology: A response to Watson

ABSTRACT

Richard Watson maintains that deep ecology suffers from an internal contradiction and should therefore be rejected. Watson contends that deep ecology claims to be non-anthropocentric while at the same time is committed to setting humans apart from nature, which is inherently anthropocentric. I argue that Watson’s objection arises out of a fundamental misunderstanding of how deep ecologist’s conceive of the ‘Self.’ Drawing on resources from Buddhism, I offer an understanding of the ‘Self’ that is fully consistent with deep ecology, and does not lead to the anthropocentric contradiction that Watson identifies. The paper will proceed as follows: First, I articulate Watson’s objection, and briefly discuss the traditional deep ecology position. Next, I turn to a discussion of the ‘Self’ and show that there are conceptions of human nature that are not separate from ‘Nature.’ It will thus be shown that deep ecology is not inconsistent and need not be rejected.