ObjectiveTo explore the protective effect of low-molecular-weight heparin calcium (LHC) combined with trimetazidine on intestinal smooth muscle of intestinal acute mesangial vein thrombosis (AMVT) in rats and it's mechanism of effect. MethodsA total of 120 SD male rats were randomly divided into three groups, with 40 rats in each group. LHC group: after the AMVT model established, rats were subcutaneous injection the LHC (30 U/100 g) per 12 h until 72 h after surgery. LHC+trimetazidine group (LHCT group): after the AMVT model established, rats were subcutaneous injection the LHC (30 U/100 g) and tail vein injection the trimetazidine (10 mg/kg) per 12 h until 72 h after surgery. Normal saline group (NS group): after the AMVT model established, rats were subcutaneous injection the NS (0.2 mL/100 g) per 12 h until 72 after surgery. The AMVT model were established by blocking superior mesenteric vein of 8 cm and the edge vein arch. Vena cava blood samples and intestinal segments were collected sequentially at 6 h, 12 h, 24 h, 48 h and 72 h afrer surgery. The levels of malondialdehyde (MDA) and creatine kinase (CK) in the blood, and the level of ATP in the intestinal tissue samples were measured with ELISA. Intestinal tissue were taken from the rats for inestinal tissue section, stained with hematoxylin and eosin, examined under light microscopy and evaluated histopathologically using mesemeche scoring system at different time. ResultsCompared with the LHC group and NS group, the levels of MDA and CK in blood and histopathology score of intestinal tissues in rats were significantly decreased, and the level of ATP significantly increased in LHCT group at different time point (P < 0.05). ConclusionTrimetazidine can improve intestinal smooth muscle energy metabolism in the AMVT disease, comined with LHC early can avoid intestinal smooth muscle wall permeability coagulation necrosis and reduce the intestinal smooth muscle damage.
The high incidence and mortality rates existed in chronic pulmonary thromboembolism(PTE), with considerable misdiagnosis and missed diagnosis rate. The prognosis for patients with chronic thromboembolic pulmonary hypertension was poor with medical therapy. But the pulmonary thromboendarterectomy was well established.The postoperative pulmonary hypertension and reperfusion pulmonary edema are main complications and death causes. The key management after pulmonary thromboendarterectomy is important which decreases pulmonary hypertension , and prevents reperfusion pulmonary edema and re thromboembolism.
目的研究置管溶栓聯合球囊擴張導管碎栓治療下肢深靜脈血栓形成（DVT）的療效及安全性。 方法回顧性分析2011年9月至2015年1月本院收治的82例急性下肢DVT患者的臨床資料。將患者分成兩組：A組行單純經導管直接溶栓（CDT）治療，共32例，其中男10例、女22例，平均年齡（56±15）歲；B組行CDT聯合機械碎栓（球囊擴張導管碎栓）治療，共50例，其中男18例、女32例，平均年齡（57±17）歲。比較2組治療前后靜脈通暢率、靜脈通暢度評分、健側和患側下肢周徑差，比較2組尿激酶用量及溶栓導管留置時間，以出血并發癥、肺栓塞的發生率評價治療的安全性。 結果2組共82例患者完成溶栓及碎栓療程，B組較A組溶栓時間更短，A組平均9（7，12）d；B組平均5（4，7）d，2組差異有統計學意義（P<0.01）；B組較A組尿激酶用量更少，A組平均7.250（6.355，8.255）×106 U，B組平均4.925（3.715，5.810）×106 U，2組差異有統計學意義（P<0.01）；B組治療后的靜脈通暢度評分顯著優于A組，A組65.0%（40.5%，86.5%），B組為100%（90%，100%），差異有統計學意義（P<0.01）。治療后2組出血并發癥發生率差異無統計學意義（P=0.0976）。2組患者隨訪時間3～18個月，A組隨訪率50.0%，B組隨訪率58.0%，均未發生肺動脈栓塞。 結論在下腔靜脈濾器保護下，CDT聯合球囊擴張導管碎栓治療急性下肢DVT較單純CDT治療，溶栓效果好、尿激酶用量少、不增加肺栓塞及出血發生率。
Objective To analyze the clinical features of rickettsial infection complicated with pulmonary embolism and to improve clinicians’ knowledge of rickettsial infection complicated by thromboembolism events. Methods We retrospectively analyzed the clinical data of a patient with pulmonary thromboembolism complicated by Rickettsial felis infection and conducted a review of the relevant literature. The search terms "Rickettsia/Scrub typhus, thrombosis" or "Rickettsia/ Scrub typhus, embolism" were used to search the Wanfang ,VIP ,Chinese National Knowledge Infrastructure and PubMed databases from January 1985 to May 2023, respectively. Results The 81-year-old male patient was admitted to the hospital on June 1, 2021 due to "dizziness, sore throat for 11 days, fever for 7 days, and shortness of breath for 3 days". Physical examination revealed a eschar-like rash behind the left ear, venous thrombosis in both lower limbs was detected by color ultrasound, computed tomographic pulmonary angiography indicated multiple pulmonary embolism in both lungs, and positive rickettsiae on peripheral blood next-generation sequencing, confirming the diagnosis of Rickettsial felis infection complicated by venous thromboembolism (VTE) in both lower limbs and pulmonary embolism. Twenty manuscripts, including 20 cases, were retrieved from databases. Among them, Rickettsial felis infection combined with thromboembolism event was not found. With the addition of our case, a total of 21 cases were analyzed in detail. Six of the 21 cases were complicated with VTE, 10 with pulmonary embolism, 5 with intracranial venous thrombosis, 6 with thrombosis at other sites (jugular venous thrombosis, mesenteric thrombosis, aortic thrombosis, etc), and 8 of which had concurrently involved systemic thrombosis. Of the 4 deaths, 2 cases had mesenteric embolism, 1 case had cerebral infarction, and 1 case had systemic multiple thrombus. Conclusions Rickettsial infection symptoms and signs are often atypical, can be complicated with lower limb VTE or pulmonary embolism. Early identification, diagnosis and treatment are very important, especially for patients with dyspnea, chest pain and other related symptoms.
目的探討下肢深靜脈血栓形成(DVT)的治療方法及經驗。方法分析我院2007年1月至2010年1月期間237例DVT患者的臨床資料，其中行以抗凝、祛聚為主的非手術治療198例，行介入手術治療39例。結果198例給予抗凝、祛聚為主的非手術治療者中臨床治愈85例(42.93%)，有效108例(54.55%)，無效5例(2.52%); 39例給予介入手術治療(均先行下腔靜脈濾器置入，然后行球囊導管取栓治療33例，行介入溶栓6例)者均臨床治愈(100%)。總有效率為97.89%（232/237)。對39例行介入手術治療患者術后隨訪3～24個月(平均10個月)，2例患者出現下腔靜脈阻塞并發下肢DVT，經抗凝、祛聚等治療后癥狀緩解； 均未見濾器移位、肺栓塞等并發癥。結論DVT患者介入治療效果優于非手術治療，早期診斷和合理的治療方案是DVT治療成功的關鍵。
Objective To explore the treatment of thromboangitis obliterans (TAO) of lower extremities. Methods From March 1994 to February 2009, 24 cases (26 limbs) affected by chronic ischemia were diagnosed as TAO by Doppler ultrasound and DSA, CTA or MRA. According to the different levels of the extensive and diffuse arterial occlusion, the revascularization was performed in the ways: 19 cases (21 limbs) underwent venous arterialization, 3 cases (3 limbs) underwent endovascular therapy, and 2 cases (2 limbs) underwent thrombectomy. Results After the venous arterialization, 19 cases (21 limbs) were followed up for 1 to 14.5 years. Apart from the 5 limbs amputation (23.8%), the postoperative results of the most limbs were satisfactory (61.9%). The ABI before therapy (0.38±0.11) was significantly lower than that 6 months after therapy (0.79±0.08), Plt;0.05. In 3 cases (3 limbs) underwent endovascular therapy, one case failed and then received the venous arterialization. Two cases (2 limbs) finished thrombectomy successfully. After endovascular therapy and thrombectomy, these 4 cases were followed up for 1 to 4 years without the amputation. ConclusionIn order to improve the curative effect, it is important to choose the suitable therapeutic strategy according to the different levels of the extensive and diffuse arterial occlusion. The venous arterialization is an effective treatment for TAO of lower extremities.
Inpatients after COVID-19 infection, especially those admitted to intensive care unit (ICU), may encounter a series of coagulation dysfunction, which may lead to thrombosis, such as pulmonary embolism (PE), deep vein thrombosis (DVT) or arterial thrombosis (AT). Although there are many literatures on the incidence rate, prevention and treatment of venous thromboembolism (VTE) in hospitalized patients with COVID-19 infection, there are few data on the symptomatic and subclinical incidence rate of VTE after COVID-19 infection discharge. Therefore, there are no specific recommendations or guidelines for the prevention of VTE after discharge from hospital due to COVID-19 infection, and the current guidelines are controversial. In this study, we reviewed and summarized the existing literature on the incidence rate, prevention, diagnosis and treatment of venous thromboembolism in patients with COVID-19 infection, in order to provide guidance for VTE prevention in patients with COVID-19 infection after discharge.