血液透析患者动静脉内瘘血栓形成的治疗方法探讨

目的总结血液透析患者动静脉内瘘后血栓形成的治疗经验。方法 156例动静脉内瘘后血栓形成患者,早期采用溶栓治疗,而晚期采用手术治疗。结果 47例采用溶栓治疗,成功率为53.2%,其中6h内、6h后溶栓成功率分别为85.7%、26.9%(P<0.01)。131例(含溶栓失败22例)手术治疗者中,成功率为84.7%,其中静脉-动脉端侧吻合、取栓加吻合口扩张的成功率分别为94.2%、48.1%(P<0.01)。结论动静脉内瘘后血栓形成患者在阻塞6h内采用溶栓治疗,而阻塞超过72h者首选静脉-动脉端侧吻合手术。     

Thrombolytic Therapy in Dogs and Cats

Objective: To review the thrombolytic agents most commonly used in humans, their mechanisms of action, potential uses, adverse effects, and reports of their use in dogs and cats.
Human data synthesis: Thrombolytic agents avaliable in human medicine include streptokinase, urokinase, tissueplasminogen activator (t-PA), single-chain urokinase plasma activator (scu-PA) and anisoylated plasminogen-strep-tokinase activator complex (APSAC). These agents were originally used for the management of proximal deep vein thrombosis and severe pulmonary embolism but more recently, use of these drugs has been extended to include the treatment of acute peripheral arterial disease, cerebrovascular disease (stroke) and acute coronary thrombosis. The most predictable side effect associated with the use of thrombolytic therapy is hemorrhage.
Veterinary data synthesis: Clinical experience with thrombolytic agents in small animals is limited to streptokinase and t-PA. It is possible, that as in humans, canine and feline patients with PTE and right ventricular dysfunction may benefit from thrombolytic therapy but there are no veterinary studies to support this theory to date. Successful use of streptokinase has been documented in a small number of canine patients with systemic thromboembolism. ⁶³ Thrombolytic therapy is relatively efficacious in cats with aortic thromboemboli but is associated with a high mortality rate. ^59,60,64 With regard to use of t-PA in veterinary medicine, the small number of animals treated with varying protocols makes it impossible to provide safe and effective dose recommendations at this time.
Conclusions: Future goals for thrombolytic therapy in veterinary medicine include determination of more specific clinical indications, as well as design of effective protocols that minimize mortality and morbidity.     

桥接治疗急性缺血性脑卒中患者的血管再通率及远期神经功能恢复分析

目的 探讨重组组织型纤溶酶原激活物（rtPA）静脉溶栓联合血管内介入治疗（即桥接治疗法）对急性缺血性脑卒中患者的治疗效果。方法 选取我院（2015年1月-2018年1月）收治的100例急性缺血性脑卒中患者进行回顾性分析,根据治疗方法分为观察组47例（桥接治疗法）、对照组53例（rtPA静脉溶栓疗法）,对比两组治疗后的血管再通率、神经功能恢复情况。结果 观察组前循环梗死血管（颈内动脉、大脑前动脉、大脑中动脉）再通率91.49%,对照组前循环梗死血管再通率50.94%,两组比较差异具有统计学意义（P<0.01）;观察组治疗14 d、治疗28 d、治疗3个月,神经功能缺损（NIHSS）评分均显著的低于对照组（P<0.01）;根据mRS标准,观察组的预后良好87.23%,对照组预后良好52.83%,两组比较差异具有统计学意义（P<0.01）;观察组的并发症发生率8.51%,对照组并发症发生率16.98%,两组比较差异无统计学意义（P>0.05）。结论 桥接治疗对缺血性脑卒中患者的效果优于rtPA静脉溶栓疗法,对于患者远期神经功能恢复具有显著效果。     

宽体金线蛭不同工艺提取物的抗凝溶栓活性比较研究

宽体金线蛭（Whitmania pigra）具有抗凝溶栓的药理作用,但其药效受提取工艺的影响。为全面评价并筛选出合适的提取工艺,本试验采用脱脂、水提、酸提和酶解等不同工艺制备了14种提取物,并对提取物的抗凝活性、纤溶活性与体外溶栓活性进行分析。结果表明,脱脂胃蛋白酶酶解提取物的抗凝血酶活性显著高于其他提取物,且具有较强的纤溶活性和体外溶栓活性;仿生酶解提取物具有较强的抗凝血酶活性和体外溶栓活性;脱脂仿生酶解提取物具有较强的纤溶活性和体外溶栓活性;脱脂加热的水提提取物具有较强的纤溶活性和体外溶栓活性。脱脂胃蛋白酶酶解提取物中,分子量小于3 kDa的多肽具有较强的抗凝血酶活性和纤溶活性。此外,三个水提提取物、仿生酶解物、脱脂仿生酶解物和粗酶酶解提取物对纤维蛋白原的α肽链均具有溶解作用。综上所述,宽体金线蛭提取物均具有抗凝溶栓的药理作用,酶解提取物优于水提提取物和酸提提取物,脱脂处理有利于活性物质的提取,其中胃蛋白酶酶解提取物效果最佳,并且脱脂胃蛋白酶酶解物的小分子多肽成分具有最佳的抗凝血酶活性和纤溶活性。本试验结果为进一步开发利用宽体金线蛭的药理作用提供了理论依据。     

Stenting of the caudal aorta and aortic trifurcation for the treatment of thrombosis in 7 dogs

BackgroundAortic and aortoiliac thrombosis in dogs causes disease and death.ObjectiveTo describe the procedure and outcomes for stenting the caudal aorta and aortoiliac trifurcation.AnimalsSeven client‐owned dogs that underwent aortic/aortoiliac stenting for treatment of thrombosis.MethodsRetrospective multi‐center investigation. Medical records were reviewed for dogs that underwent stenting of the aorta or aortoiliac trifurcation between 2008 and 2020. Information collected included history, signalment, clinicopathologic data, diagnostic imaging, procedure reports, and outcomes.ResultsSeven dogs with an occlusive thrombus located at or near the aortic trifurcation were included. Four of 7 dogs were non‐ambulatory. Hind limbs were paretic in 5 dogs, paralyzed in 1 dog, and claudication alone was noted in 1 dog. Five of the 7 dogs had protein‐losing nephropathy (PLN). Of 5 dogs with PLN, 1 had protein‐losing enteropathy (PLE) and controlled hypothyroidism and 1 had caudal aortic chondrosarcoma. Two dogs had no identified underlying disease. Angiography was performed before catheter directed thrombolysis and stent placement. No deaths occurred during the procedure. Postoperative complications included pain (4/7), bruising and edema (3/7), bruising only (1/7), and edema only (1/7). Median survival time (MST) of the 7 dogs was 264 days (range, 1‐1053 days). Five of 7 dogs were ambulatory within 2 days of stenting and survived to discharge with a MST of 425 days (range, 208‐1053 days).Conclusions and Clinical ImportanceStenting of the aorta and aortoiliac trifurcation can provide an apparently safe and effective treatment with rapid return to ambulation for some dogs with aortic thrombosis.     

纳豆芽孢杆菌发酵液体外溶栓效果试验

纳豆激酶是纳豆芽孢杆菌的重要代谢产物。为探究纳豆激酶的溶栓效果,以纳豆浸提液、纳豆激酶发酵液为供试材料,以鸡血块、人工血栓为供试反应底物,观察各反应物的溶栓效果。试验结果表明：纳豆激酶发酵液、纳豆浸提液有溶解人工血栓的作用;纳豆激酶发酵液和纳豆浸提液对鸡血块的溶解率分别为60％和52％。