Objective To study the effect of the intracavity thrombolysis, aspiration of debris, percutaneous transcathete angioplasty (PTA) and percutaneous transtuminl angioplasty and stenting (PTAS) on treating peripheral arterial obliterans disease (PAOD). Methods From May 1994 to May 2008, interventional treatment was performed in 285 patients with PAOD. Intracavity thrombolysis and aspiration of debris were performed in 63 patients suffering from acute arterial occlusion. Intracavity thrombolysis and PTA were performed in 61 patients suffering from arteriostenosis combined with acute occlusion. Intracavity thrombolysis, PTA and PTAS were performed in 161 patients suffering from chronic arteriostenosis occlusion. Results Total success rate was 98.25% (280/285). The success rate in intracavity thrombolysis and aspiration of debris was 96.83% (61/63), with 88.89% (56/63) of the blood vessels restored, 7.94% (5/63) of the blood vessels partially restored, and another 3.17% (2/63) failed. The success rate in intracavity thrombolysis and PTA was 85.25% (52/61). The success rate in PTA and PTAS was 98.14% (158/161). The total complication rate was 7.02% (20/285), of them the local thrombolysis and thromboclasis accounting for 7.94% (5/63), the local thrombolysis and PTA accounting for 14.75% (9/61), the PTA and stent implantation accounting for 3.73% (6/161). Conclusion Percutaneous transluminal treatment for stenotic and occlusive lesions of peripheral artery can effectively keep the blood vessel unobstructed for a long time and raise the haemodynamics index remarkably.
To assess the efficacy and safety of thrombolytic therapy. Electronic search was applied to the Cochrane Airways Group register (MEDLINE, EMBASE, CINAHL standardized searches) with the date up to 2003 April. Hand searched respiratory journals and meeting abstracts. All randomized controlled trials comparing thrombolytic therapy with heparin alone or surgical intervention (eg. embolectomy) met the inclusion criteria. Two reviewers independently selected trials, assessed trial quality and extracted the data.
Objective To compare the clinical efficacy and safety of thrombolysis with anticoagulation therapy for patients with acute sub-massive pulmonary thromboembolism. Methods The clinical data of 84 patients with acute sub-massive pulmonary thromboembolism were analyzed retrospectively, mainly focusing on the in-hospital efficacy and safety of thrombolysis and/ or anticoagulation. The efficacy was evaluated based on 6 grades: cured, markedly improved, improved, not changed, deteriorated and died. Results Among the 84 patients,49 patients received thrombolysis and sequential anticoagulation therapy( thrombolysis group) , 35 patients received anticoagulation therapy alone( anticoagulation group) . As compared with the anticoagulation group, the thrombolysis group had higher effective rate( defined as patients who were cured, markedly improved or improved, 81. 6% versus 54. 3%, P = 0. 007) , lower critical event occurrence ( defined as clinical condition deteriorated or died, 2. 0% versus 14. 3% , P = 0. 032) . There was no significant difference in bleeding rates between the two groups ( thrombolysis group 20. 4% versus anticoagulation group 14. 3% , P gt; 0. 05) . No major bleeding or intracranial hemorrhage occurred in any of the patients. Conclusions Thrombolysis therapy may be more effective than anticoagulation therapy alone in patients with acute sub-massive pulmonary thromboembolism, and thus warrants further prospective randomized control study in large population.
ObjectiveTo evaluate the effectiveness and safety of the additional catheter-directed thrombolysis (CDT) and conventional treatment (CT) for treatment primary deep vein thrombosis. MethodsDatabases such as CNKI, WanFang Data, Pubmed, EMBASE.com, Medline, CBM, CSJD, CJFD, and the Cochrane Library were electronically searched from the date of their establishment to 30 June, 2013, and the relevant literatures and conference proceedings were also manually searched to include randomized controlled trials (RCTs) on comparison of additional CDT versus CT for primary deep vein thrombosis. Two reviewers independently screened studies according to the inclusion and exclusion criteria, extracted data, and accessed the methodological quality of the included studies. Then the meta-analysis was performed by using RevMan 5.1 software. Publication bias was assessed by STATA software. A meta-regression model was used to describe between study variability. ResultsTwo RCTs including 3 literatures contain 224 patients reporting data on safety and efficacy of CDT versus CT were included. There were no publication bias (Begg'S test, Z=1.02. P > 0.05;Egger'S test, t=0.98, P > 0.05). The results of meta-analysis showed that:in 6 months after surgery iliofemoral vein patency rate of CDT group was higher than that of CT group (OR=3.62, 95% CI:1.51-8.64, P=0.004), in 6 months after surgery CDT group with a lower rate than CT group of the iliofemoral vein occlusion and (or)venous reflux rate (OR=0.24, 95% CI:0.11-0.53, P=0.000), and the incidence rate of PTS in 24 months after surgery in CTD group was less than that of CT group (OR=0.55, 95% CI:0.31-0.96, P=0.040). There were no statistically significant of the major complications after surgery between CDT group and CT group (OR=1.34, 95% CI:0.12-15.69, P=0.810). But the incidence rates of minor complications and total complications after surgery in CT group were lower than those of CDT group (OR=13.67, 95% CI:4.08-45.83, P < 0.00 01 and OR=11.67, 95% CI:4.40-30.99, P < 0.000 01). ConclusionsCDT is a effective and positive way to treat early deep venous thrombosis especially in terms of the patency of vascular and prevent the occlusion and PTS. Due to the limitation of the included studies, large sample size, multicenter, and high quality studies are needed to verify the above conclusion, such as the ATTRACT Study. The intracavitary therapy could be applied to clinic combining individual conditions of patients.
目的探討經腘靜脈置溶栓導管灌注溶栓治療急性下肢深靜脈血栓形成（DVT）的臨床應用價值。方法對28例急性DVT患者（其中2例合并肺動脈栓塞）在超聲引導下經患肢腘靜脈穿刺置入溶栓導管至髂、股靜脈血栓中進行溶栓治療，并對溶栓效果進行分析。 結果全組患者溶栓后癥狀明顯改善，下肢腫脹消退，肺部癥狀緩解。溶栓后患、健側大腿周徑差〔(1.72±1.23) cm〕明顯小于溶栓前〔(5.47±1.29) cm〕,差異有統計學意義(t=12.14，Plt;0.01)， 患肢大腿消腫率為91.58%; 溶栓后患、健側小腿周徑差〔(1.55±0.77) cm〕也明顯小于溶栓前〔(5.04±1.32) cm〕，差異有統計學意義（t=13.81，Plt;0.01)，患肢小腿消腫率為84.92%。溶栓后靜脈通暢評分〔(4.34±3.55)分〕明顯低于溶栓前〔(15.23±4.64) 分〕，差異有統計學意義(t=6.42，Plt;0.01 )，溶栓后靜脈平均通暢率為87.43%。 2例合并肺動脈栓塞患者中，1例栓子完全溶解，1例大部分溶解。 所有患者均無嚴重并發癥。 25例患者獲隨訪，隨訪1～12個月（平均7.16個月），無一例出現血栓再發。結論經腘靜脈置管溶栓治療急性DVT是一種安全、有效的治療方法。
ObjectiveTo observe the changes of central visual acuity and extracentral visual acuity in eyes with non-arteritic central retinal artery occlusion (NA-CRAO). MethodsA retrospective clinical study. From January 1, 2017 to December 31, 2024, 140 patients (140 eyes) diagnosed with NA-CRAO through ophthalmic examination at Department of Ophthalmology of First People's Hospital of Xianyang City were included in the study. All affected eyes underwent best corrected visual acuity (BCVA), visual field, intraocular pressure, fundus color photography, optical coherence tomography (OCT), and fluorescein angiography (FFA) examinations. After a clear diagnosis, conservative treatment such as reducing intraocular pressure, relieving spasms, and dilating blood vessels should be given immediately. Simultaneously, intravenous and/or arterial thrombolysis therapy should be administered based on the patient's overall condition. Under the same treatment conditions as other treatments, 33 eyes were treated with hyperbaric oxygen therapy within 24 hours after seeking medical attention. The changes in central visual acuity (BCVA) and peripheral visual acuity of the affected eye one month after treatment were observed. BCVA improvement of ≥ 1 line was defined as the increase of no light sensitivity to light sensitivity or above, and the increase of light sensitivity to 0.01 or above. The visual acuity outside the center was determined by the 0 ° axis in front of the eyeball at eye level, and was 10 ° outside visual acuity on the temporal side. Multivariate analysis using logistic regression analysis. ResultsAmong the 140 cases (140 eyes), there were 84 males (84 eyes) and 56 females (56 eyes). The mean age was (63.89±10.78) years. The duration of illness from the onset of symptoms to the time of diagnosis was 48 (2-720) hours. 6, 1, 14, 47, 41, 16, and 15 eyes were diagnosed with BCVA without light perception, uncertain light perception, manual/anterior, digital/anterior, 0.01-0.10, and ≥ 0.10, respectively. FFA examination revealed delayed arm retinal circulation time and filling of the retinal artery trunk to the peak, with changes in the "arterial front" observed in 126 eyes. OCT examination showed extensive edema and unclear structure in the inner layer of the retina in all patients. Out of 140 eyes, 122 were treated with intravenous thrombolysis and 4 with arterial thrombolysis; 14 eyes did not receive thrombolytic therapy. After treatment, 38 eyes (27.1%) showed an improvement of BCVA ≥ 1; 67 eyes (47.9%) did not show an improvement in BCVA, and the affected eye had a BCVA of approximately 0.6 without light perception; 17 eyes (12.1%) showed improvement in peripheral vision, and the peripheral vision of the affected eyes ranged from 0.01 to 0.1, all of whom were patients undergoing intravenous thrombolysis, and prior to treatment, this group of patients had complete blindness in the coarse side visual field of the Amsler grid, and their out of center visual acuity could not be measured. Among the 33 eyes treated with hyperbaric oxygen therapy, 24 eyes (72.7%) showed an increase in BCVA after treatment; 9 eyes did not improve, among which 4 eyes (12.1%) showed improvement in out of center visual acuity. Among the 107 eyes that did not receive hyperbaric oxygen therapy, 49 eyes (45.8%) showed an increase in BCVA after treatment. There was no improvement in 58 eyes (54.2%), among which 13 eyes (12.1%) showed an improvement in out of center visual acuity. The results of logistic regression analysis showed that intravenous thrombolysis and hyperbaric oxygen therapy were independent predictive factors for the improvement of central and extra central visual acuity (P＜0.05). ConclusionsHyperbaric oxygen therapy within 24 hours of seeking medical attention for patients with NA-CRAO disease course ≤ 1 month has a significant effect on the recovery of central and extra central vision. Intravenous thrombolysis and hyperbaric oxygen therapy are independent predictive factors for the improvement of central and extra central vision.
ObjectiveTo investigate the clinical efficacy of catheter directed thrombolysis (CDT) through three different approaches combined with iliac venous endovascular therapy for acute deep venous thrombosis (DVT) complicated with Cockett syndrome of the lower extremities. MethodThe clinical data of 87 patients with CDT through three different approaches (small saphenous vein group, popliteal vein group, and posterior tibial vein group) combined with iliac venous endovascular therapy for DVT complicated with Cockett syndrome of the lower extremities were analyzed retrospectively. ResultsThe lower extremity swelling of all the patients were disappeared obviously within 72 h after surgery, there was no death related surgery and pulmonary embolism. The limb edema reduction rates had no significant differences among the small saphenous vein group, popliteal vein group, and posterior tibial vein group﹝(77±13)% versus (82±12)% versus (77±18)%, P > 0.05﹞. The recanalization rates of thrombolysis had no significant differences among the above three groups﹝(86.5±10.6)% versus (92.0±7.7)% versus (87.3±7.8)%, P > 0.05﹞. The time required for the cannulation in the posterior tibial vein group was significantly shorter than that of the small saphenous vein group or popliteal vein group﹝(15.14±3.62) min versus (32.62±9.36) min or (42.79±13.30) min, P < 0.01﹞. All the patients were performed by balloon dilatation and iliac vein stenting. Eighty-seven cases were followed-up for 1-24 months, the primary patency rate of iliac venous was 100%. ConclusionsCDT with iliac venous endovascular therapy is an effective method in treatment of acute DVT with Cockett syndrome. CDT through posterior tibial vein is an easier and effective method with less complications and time. This way could be acceptable in basal hospital.
目的 探索缺血性腦卒中患者溶栓前血壓管理和預后的相關性，并分析溶栓前血壓管理考慮顱內外血管狀態的必要性。 方法 計算機檢索PUBMED數據庫，并輔以其他檢索，對所有涉及溶栓前血壓的文獻進行整理，并根據“溶栓類型、是否進行溶栓前血壓管理、是否進行溶栓前血管評估”對文獻進行分類，對其溶栓后的癥狀性顱內出血率進行分析對比。 結果 大多數靜脈溶栓文獻無血管評估的數據，其出血率波動于較高水平；進行了血管評估，而未提及血壓管理或雖未進行血壓管理，但所有患者的血壓符合指南中對于血壓的要求的文獻也呈現了較高的出血率；有1篇進行了血管評估的動脈溶栓文獻沒有癥狀性顱內出血事件發生。 結論 當前證據表明現有的溶栓前血壓管理模式還不夠完善，這也在一定程度上可以解釋目前較高的溶栓后癥狀性出血率。合理的溶栓前血壓管理模式有待進一步探索。溶栓前血壓管理考慮顱內外血管狀態，根據血管病變程度對溶栓前血壓進行分級管理可能會成為一個較佳的血壓管理模式。
Objective To assess the effect of different thrombolytic agents, and different regimens in acute ischaemic stroke. Methods A systematic review of all the relevant randomized controlled trials (RCTs) was performed. RCTs were identified from the Cochrane Stroke Group trials register, Embase (1980 to 1997), handsearching Japanese and Chinese journals, and personal contact with pharmaceutical companies. We included randomised and quasi-randomised trials in patients with confirmed acute ischaemic stroke comparing different doses of a thrombolytic agent, or different thrombolytic agent, or the same agent given by different routes. Results Eight trials involving 1 334 patients were included. Concealment of allocation was generally adequate. All the trials were conducted in Japan. Different doses (of tissue plasminogen activator or urokinase) were compared in six trials. Different agents (tissue plasminogen activator versus urokinase,or tissue-cultured urokinase versus conventional urokinase) were compared in three trials. Few data were available for functional outcomes. A higher dose of thrombolytic therapy was associated with a five-fold increase in fatal intracranial haernorrhages (odds ratio 5.02, 95% confidence interval 1.56 to 16.18). There was a non-significant trend towards more early deaths or clinically significant intracranial haemorrhages in higher dose group. No difference in late deaths or extra-cranial haemorrhages was shown between low and higher doses. However, very few of these events occurred. No difference was shown between the different thrombolytic agents tested. Conclusions There is not enough evidence to conclude whether lower doses of thrombolytic agents might be safer or more effective than higher doses in acute ischaemic stroke. It is not possible to conclude whether one agent might be better than another, or which route of administration might be best.