亲水涂层乳胶导尿管表面涂层的性能研究

目的 探讨亲水涂层导尿管表面涂层的润滑性及附着性。方法 在参考亲水涂层乳胶导尿管团体标准的前提下，研究表面亲水涂层对导尿管润滑性及附着性的影响。在模拟条件下，通过对亲水涂层导尿管表面摩擦系数、激活时间、表干时间、涂层牢固度的检测，为亲水涂层导尿管的应用稳定性提供可靠的技术参数。结果 亲水涂层的乳胶导尿管摩擦系数远小于无涂层导尿管；亲水涂层在水中激活并且晾干2 min后，再进行摩擦系数测试，摩擦系数无变化；涂层激活时间短，表干时间长，临床使用可节约医护人员操作时间。结论 亲水涂层乳胶导尿管的亲水润滑处理可大幅降低置管时的摩擦力，避免患者尿道损伤，提高便捷性和舒适度。     

PVC导尿管表面亲水润滑涂层的制备及性能研究

以公司现生产的PVC导尿管为基材,通过特殊工艺在其表面结合一层水溶性高分子——聚乙烯吡咯烷酮（PVP）,来制备亲水润滑涂层,并对导尿管表面涂层的润滑性能进行了研究。通过测定涂层的水接触角、附着性和吸水率及摩擦系数等来考察所制备涂层的吸水性、润滑性和耐水持久性。实验结果表明,所制备的涂层有效改善了导尿管表面的润滑性,而且涂层不易脱落,润滑持久性较好。     

应用双腔导尿管取小儿食道异物27例临床体会

目的探讨应用双腔导尿管取小儿食道异物的临床疗效。方法选取2005—2008年圆形表面光滑食道异物患儿27例,应用双腔导尿管取食道异物。结果27例均成功取出,无1例失败,成功率100％。结论应用双腔导尿管取此类异物方法是行之有效的。     

简易留置尿壶固定方法

留置导尿是临床上常用的护理技术，长期留置导尿管引起的相关感染是临床常见的医院感染。留置导尿可造成尿道、膀胱粘膜损伤；可因尿袋内尿液位置过高而造成逆行感染；因导尿管材料或留置导尿的刺激使尿道分泌物增多，适宜细菌繁殖和扩散；因昏迷患躁动、谵妄自行拔除导尿管造成尿道口损伤、破裂等。近年来我科对男性昏迷患的留置导尿换用了留置导尿壶，避免了上述种种弊端，既经济又耐用。方法如下。     

双腔气囊管留置导尿时常见问题的原因及对策

导尿术是临床中常见的操作技术之一，其主要目的是解决排尿困难和观察尿量。随着医疗器械的改革，气囊导尿管已被广泛使用，其中双腔气囊管已由硅胶为材料取代了橡胶，具有操作方便、固定牢靠、与组织相容性好、刺激性小的优点。但是，由于部分护理人员临床经验缺乏，又对气囊导尿管的结构以厦导尿相关理论和解剖知识不了解，因此引起了一系列问题，现将临床中遇到的常见问题的原因及对策综述如下。     

抗感染导尿管杀菌作用实验观察

目的为了证实Ｋ型医用抗感染导尿管的杀菌抗感染作用。方法采用表面涂布法进行标准菌的杀菌试验观察及初步临床使用观察。结果Ｋ型医用抗感染导尿管作用６０分钟，对大肠埃希氏菌（８０９９）的杀灭率为９３．７６％；对金黄色葡萄球菌（ＡＴＣＣ６５３８）的杀灭率为９１．９０％；对铜绿假单胞菌（ＡＴＣＣ２７８５３）的杀灭率为９５．２０％。临床使用３０例，均未出现刺激性反应。尿常规检查、尿培养及血常规检查均正常。结论Ｋ型医用抗感染导尿管具有明确的杀菌作用。临床使用安全。     

气囊导尿管留置导尿的常见并发症及护理对策

气囊导尿管是双腔硅胶导尿管，其质量不断更新，在组织相容性、引流效果、固定方法等方面，明显优于传统的单腔橡胶导尿管。对患者刺激小、操作简单、使用方便，不仅减轻了患者长期卧床带来的排尿困难，还控制了尿失禁引起的皮肤刺激与感染，减轻了患者的经济负担。目前已基本取代传统橡胶尿管，广泛用于引流尿液、经尿道治疗用药等方面。但由于护理不当，引起的并发症不少，给患者带来了伤害，做好气囊导尿管留置导尿的护理成为一个不容忽视的问题。     

留置导尿管表面生物膜细菌学检测的临床价值

目的前瞻性研究导尿管表面生物膜检测,为临床诊断和治疗导尿管伴随性尿路感染(UTIc)提供实验依据. 方法对52例留置导尿管患者作拔管前和拔管24 h后中段尿培养及导尿管表面生物膜细菌学检测;无菌操作将导尿管分取3段置5 ml灭菌生理盐水内旋涡仪洗脱表面生物膜;分别取样本液50 μl接种于7%～8%新鲜羊血营养琼脂平板和沙保罗琼脂平板分离菌落并计数;采用Bio-Merieux API鉴定系统作菌种鉴定. 结果拔管前中段尿培养阳性16例(30.8%),假阳性2例(11.1%),拔管24 h后中段尿培养阳性22例(42.3%);52例导尿管表面生物膜培养阳性33例(63.5%),其中15例UTIc培养均阳性;18例菌尿症患者与15例UTIc各段导尿管表面生物膜细菌菌落数分别经t检验,均为P>0.05,差异无明显性;52例择期手术留置导尿管患者共检出14种41株细菌,主要为葡萄球菌属10株(24.4%)、真菌10株(24.4%)、大肠埃希菌9株(22.0%)、其他G-杆菌12株(29.2%). 结论 UTIc细菌学检测特异性和敏感性为导尿管表面生物膜>拔管24h后中段尿>拔管前中段尿.     

一次性使用导尿管细胞毒性试验研究

为了进一步明确目前导尿管的毒性情况,对进行注册检测的一次性使用导尿管类产品进行了细胞毒性试验评价,并就试验方法与导尿管材质间的关系进行了分析。分析结果表明,在导尿管的上市检测中加强细胞毒性的检测,对于临床导尿管的选择,有着重要的指导意义。     

昏迷患者导尿管性尿道狭窄29例临床分析

目的探讨昏迷患者留置导尿管至尿道狭窄的原因及防治措施。方法回顾性分析收治的29例昏迷患者导尿管性尿道狭窄的临床资料。结果悬垂部尿道狭窄21例，尿道外口狭窄6例，膜部尿道狭窄2例。采用尿道扩张18例，尿道外口切开3例，尿道吻合8例。28例痊愈，1例复发再次手术。结论昏迷患者导尿管性尿道狭窄与多种因素有关，全身血液动力学改变、感染和导尿管护理不当是重要因素。导尿管性尿道狭窄重在预防，适时恰当处理能获得较好疗效。     

Neuropathy target esterase in human lymphocytes

Measurement of neuropathy target esterase activity (NTE) in blood lymphocytes has been suggested as a possible biomonitor for organophosphate-induced delayed polyneuropathy. Human lymphocyte NTE was characterized in vitro according to the sensitivity to several organophosphate inhibitors, which was found similar to that of the nervous system enzyme. Methods for collection, storage, and processing of blood and the NTE assay are described (averaged coefficient of variation of the method is 8%). The mean (+/- SD) value of lymphocyte NTE activity in a caucasian population (108 healthy subjects) was 11.5 +/- 2.5 nMoles/min X mg of protein. No sex or age differences were detected. The averaged intraindividual coefficient of variation was 10.1%. These results suggest the feasibility of the test in clinical conditions, a sufficient reproducibility of the test, and a large interindividual variation. Appropriate baseline values are advisable when using the test to evaluate the effects of an occupational exposure to organophosphorus esters which may cause delayed polyneuropathy.     

医用导管聚合物亲水润滑涂层研究进展

医用导管聚合物亲水润滑涂层是指通过一定的结合力固定于导管表面的高亲水性涂层膜,可解决导管应用时的组织摩擦问题,改善患者的舒适度,有效减少感染发生。该文以医用导管涂层开发的全过程为主线,对亲水润滑涂层聚合物种类、涂层技术开发及涂层产品性能评价方法三个方面进行综述,提出了该领域目前存在的主要问题,并对未来的发展方向进行了展望。     

机器人辅助导管插入系统技术进展

机器人辅助导管插入是肝动脉化疗栓塞等微创手术的关键技术。此系统主要由导丝进给与检测装置、力反馈装置、成像及图像处理设备等组成。目前对主动导管系统的研究较为成熟．但其高昂成本难以在短期内普及用于国内临床。而研究较少且成本相对较低的被动导管系统．则为国内的研究和应用展示了广阔的开发前景。     

In situ breakage of a totally implanted venous access system

Totally implantable systems for venous access are now in wide clinical use. They have been shown to have several advantages when compared with earlier systems. However, the advantages of total implantation also contain risks for new complications. In situ breakages may have disastrous results when unnoticed. In situ separations have been reported with systems consisting of a separate reservoir and catheter. A case is reported where in situ breakage occurred in a system with prefixed catheter. The catheter migrated into pulmonary artery and was removed with Odman catheter and foreign body extractor. The precise cause for the separation could not be ascertained. It is emphasized that during insertion the silicone catheter should not be handled with surgical instruments and that the continuity of the system should be checked prior to use.     

Intravascular Embolization of Venous Catheter—Causes,Clinical Signs,and Management: A Systematic Review

Background: Intravascular embolization of device fragments is a rare but potentially serious complication. Method: A systematic search of the PubMed and MEDLINE databases for all articles pertaining to central catheter related embolization published in English between 1985 and 2007 was made. Results: A total of 215 cases of intravenous catheter embolization were identified. There were 143 totally implanted venous devices (TIVD) or port catheters and 72 percutaneous venous catheters (PVC). Sites of catheter fragments following embolization were the superior vena cava or peripheral veins (15.4%), the right atrium (27.6%), right ventricle (22%), and pulmonary arteries (35%). Clinical signs of catheter embolization included catheter malfunction (56.3%), arrhythmia (13%), pulmonary symptoms (4.7%), and septic syndromes (1.8%), but 24.2% of cases were asymptomatic. The causes of intravascular catheter embolization were pinch‐off syndrome (40.9%), catheter injury during explantation (17.7%), catheter disconnection (10.7%), and catheter rupture (11.6%). In 19.1% of cases, the cause of catheter embolization could not be identified. Most embolized catheter fragments (93.5%) were removed percutaneously. In 4.2% of cases, fragments were retained in the vascular bed; in 2.3%, embolized fragments were removed surgically via thoracotomy. Conclusion: Intravascular catheter embolization can go undiagnosed for prolonged periods. Patients might be asymptomatic or may develop severe systemic clinical signs. The mortality rate is 1.8%. There were no significant differences in clinical features of embolization between TIVD and PVC groups.     

"Walking-mode maps" based on slip/non-slip criteria

"Walking-Mode Maps", based on Slip/Non-Slip criteria, are proposed. Slip/Non-Slip criteria are expressed as follows: for a slip to occur: |F(h)/F(n)|(h) > or = mu(s) or |F(h)/F(n)|(t) > or = mu(s); for no slip to occur: |F(h)/F(n)|(h) < mu(s) or |F(h)/F(n)|(t) < mu(s). |F(h)/F(n)|(h) and |F(h)/F(n)|(t) are the maximum peak value of the traction coefficient at heel-strike and toe-off respectively, and mu(s) is the static friction coefficient between shoe sole and walkway. The "Walking-Mode Map" for the level-surface shows the possible regime of each walking mode as Slip, Slip possible or No slip. Our results, which are based upon a small population and strictly-specified test conditions, indicate that a static friction coefficient higher than 0.47 will prevent both forward and backward slips under our test conditions and under a range of step lengths of 0.55 to 0.95 m and walking speeds of 1.0 to 1.9 m/s. We also found that shorter steps reduce the chance of a slip. A "Walking-Mode Map" for inclined-surface ambulation has also been developed. The inclined-surface results show the friction and inclination-angle-related regime of each walking mode: Slip, Forward slip at heel-strike phase in descending, Backward slip at toe-off phase in ascending, or No slip. Again, extreme caution must be taken in generalizing these small-sample results (n=1, for the inclined tests) to the general population.     

The effects of 10% front load carriage on the likelihood of slips and falls

The objective of the present study was to evaluate if anterior load carriage would increase the likelihood of slips or falls while walking over a slippery floor surface. The study hypothesized that anterior load carriage may alter spatial-temporal characteristics, such as heel contact velocity, walking velocity (i.e., the whole body center-of-mass velocity), and step length, as well as friction demand characteristics at shoe-floor interface. Additionally, the study hypothesized that alterations in these gait parameters may influence slip initiation characteristics while ambulating over a slippery floor surface. Total of 10 subjects participated in the study: 5 younger (18-28 yr old) and 5 older adults (65 and older). A mixture was used to manipulate the coefficient of friction (COF) of the floor surface. All participants were unexpectedly introduced to a slippery surface while walking with and without a load. To evaluate slip severity, slip distance I and II were evaluated to assess whether a subject fell or not. Three-way repeated measure ANOVA (mix-factor design) was performed: Age factor: between-subject, Load and Floor factors: within-subject. Overall, older adults' heel contact velocity was slower while carrying a load. Additionally, all participants exhibited shorter SL while carrying a load. No significant friction demand characteristic differences were observed for all subjects while carrying a 10% front load. The results from the present study suggest that carrying 10% of the body weight in front should not intensify the slip propensity and severity although appears to influence spatial-temporal gait characteristics.     

牙釉质和牙本质的磨损特性研究

目的探讨牙釉质和牙本质磨损特性。方法选用正畸拔除的前磨牙制作牙釉质和牙本质样本,进行摩擦磨损实验。记录摩擦力矩数,测量磨斑宽度;扫描电镜（SEM）观察磨斑形貌;能谱仪（EDS）分析元素变化。结果摩擦系数-时间曲线图发现牙釉质波动幅度大于牙本质。磨斑宽度润滑时牙釉质（5.92±0.67）mm,牙本质（7.40±0.38）mm,干摩擦时牙釉质（8.71±0.44）mm,牙本质（11.02±1.02）mm,磨斑比较差异有统计学意义（P〈0.05）;维氏显微硬度值牙釉质（300.6±60.7）高于牙本质（48.6±4.0）（P〈0.05）。SEM观察主要犁沟和磨粒,牙釉质偶见组织碎片。EDS发现铁元素的出现。结论牙釉质和牙本质具有良好的磨损特性,牙釉质优于牙本质。     

内窥镜手术器械力传递系数测试装置设计

目的:设计一种可测试内窥镜手术器械力传递系数的装置。方法:基于对内窥镜手术器械的结构分析及医生的临床使用情况,分模块设计搭建测试装置,并进行测试,对测试结果进行不确定度评定。结果:使用该测试装置测量到的力传递系数参数可以指导内窥镜手术钳类产品的加工工艺,也可以为临床医生选择合适的内窥镜手术器械提供依据。     

基于小波变换的不同影像设备肺部DR图像的物理特征研究

在临床应用中,我们发现不同的设备配有不同的图像后处理软件,因此在使用操作、处理效果上存在明显的差异。以数字胸片为主要研究对象,通过对图像进行小波变换,根据不同通道的子图像提取纹理和能量特征,进行物理特征分析,对比不同设备所产生的DR图像在主观观感上的特点。