经左锁骨下动脉插管在肝癌TAE中的意义

目的：研究经左锁骨下动脉入路插管对某些非正常型血管分布的肝癌患者在ＴＡＥ技术操作中的意义。方法：１０５例均为首次经股动脉插管未能超选择插管成功者。其中Ａ组，即腹腔动脉（ＣＡ）干长于２．５ｃｍ者５８例，Ｂ组即肝动脉开口于肠系膜上动脉（ＳＭＡ）者４０例，Ｃ组即开口于ＣＡ的肝总动脉已闭塞，由源于ＳＭＡ的胰十二指肠下动脉侧支供血者７例。经左锁骨中外１／３交点下２ｃｍ处向内上方向约３０°角穿刺左锁骨下动脉，用ｓｅｌｄｉｎｇｅｒ法把导管顺向引入肝固有动脉或侧支供血动脉，然后再行ＴＡＥ。结果：由于自上而下插管，易克服长ＣＡ或ＳＭＡ对导管短攀的反向力度，故１０５例均获超选择成功。结论：Ａ、Ｂ二组患者已占全部肝癌患者约４０％～５０％，熟悉经左锁骨下动脉途径插管对提高超选择技术有意义。     

经导管祛栓术治疗急性肺动脉栓塞

目的：探讨经导管栓子祛除术治疗急性肺动脉栓塞的临床疗效。方法：对24例急性肺动脉栓塞的病人，经肺动脉造影明确诊断，通过旋转猪尾导管碎栓、抽吸导管抽吸和局部溶栓来开通肺动脉。观察临床症状、动脉血氧分压（PaO2)、肺动脉平均压（PAPm）和肺动脉开通情况。结果：术后症状即刻缓解者23例，完全开通者20例，与术前相比PaO2明显升高（P＜0．05），PAPm明显降低（P＜0．05），并发脑出血1例，死亡2例，22例病人存活。结论：经导管栓子祛除术治疗急性肺动脉栓塞是安全有效的方法。     

肝移植术后中心静脉导管相关性脓毒症的危险因素分析

目的 分析肝移植术后中心静脉导管相关性脓毒症（CRS）的发生情况及危险因索。方法 回顾性分析260例肝移植患者的临床资料。选取围手术期25个独立变量，经单变量分析及Logistic回归分析，筛选与术后CRS相关的危险因素。结果 肝移植术后CRS的感染率为9．2％。最常见的致病菌是表皮葡萄球菌和金黄色葡萄球菌等革兰阳性球菌。置管时间、术后白细胞减少和术前肝功能Child—Pugh分级是影响肝移植术后CRS发生的独立危险因素。结论 肝移植术后CRS的感染率较高，针对危险因素采取有针对性的预防措施将有助于降低CRS的发生率。     

长期颈内静脉留置导管对透析充分性的影响

目的 观察长期颈内静脉留置导管对透析充分性的影响。探讨定期尿激酶治疗对改善导管功能和透析充分性的作用。方法颈内静脉插管时间小于3个月及大于3个月的维持性血液透析患者各12例，记录透析前后体重、脱水量、透析血流速，检测透析前后、透析结束后1h血尿素氮，计算尿素清除指数（Kt／V）、溶质清除指数（SRI）。每2周重复尿激酶封管，3个月后复查上述指标。结果颈内静脉导管留置时间超过3个月者，透析血流速下降、Kt／V、SRI降低；经过定期尿激酶治疗，透析血流速、Kt／V、SRI与近期插管透析者无差异。结论颈内静脉导管留置3个月以上，会出现导管功能不良，透析充分性下降;定期尿激酶治疗，可以有效保持导管功能，提高透析效率。     

经导管肝动脉栓塞治疗肝癌

采用seldinger方法,施行肝动脉栓塞术治疗肝癌43例。用医用TH胶、碘化油、明胶海绵作为栓塞剂。使用TH胶病人反应大,并发症多,碘化油、明胶海绵较为安全。由于栓塞术后死亡率为4.7％,出现严重并发症为9.3％,肝动脉栓塞有一定的危险性,必须严格选择病例。本组一年累计生存率43.9％,故肝动脉栓塞仍是中、晚期肝癌有效的姑息性治疗方法。本文还对有动静脉短路患者能否作肝动脉栓塞术进行详细讨论。     

Conservative Treatment of Patients with Neurogenic Bladder

ObjectivesTo review the up-to-date literature of the mostly used conservative treatment modalities in patients with neurogenic bladder.Methodsmaterial from literature on conservative management in patients with neurogenic bladder was reviewed. Pubmed search results and recent books were consulted.ResultsThe conservative treatment is in almost all cases the first and will remain the primary choice in the majority of patients with neurogenic bladder. Treatment will depend on the type of underlying disease, on the bladder dysfunction, its natural evolution but also on the patients’ general condition, and the available resources. Behavioural training, catheters, external appliances, drugs and electrical stimulation are presented, their indications and limitations.ConclusionsConservative treatment is the mainstay in neurogenic bladder management. It offers different methods which permit to successfully treat most symptoms and conditions in this prevalent LUT pathology.     

An improved method for chronic catheterization of the rat spinal subarachnoid space

A method for chronic catheterization of the rat spinal subarachnoid space is described. The catheters are simple to make and the catheterization procedure circumvents many of the problems associated with earlier published technics.     

经皮穿药盒留置术治疗中晚期肝癌

35例中晚期肝癌病人利用左锁骨下动脉埋置的药盒,经肝动脉行长期间歇化疗灌注,采用的方案为F.A.D,即ADM60mgD1,5—FU0.5gD1—5,CDDP60mgD5,每四周重复一次,结果是一年生存率33.3％,最长一例至今已达一年半,化疗毒副作用也比经静脉的全身化疗轻。作者认为弥漫型肝癌和转移性肝癌是此一方法的良好适应症,对埋药盒的方法和并发症亦作了介绍。     

MR-guided balloon angioplasty: In vitro demonstration of the potential of MRI for guiding,monitoring, and evaluating endovascular interventions

The purpose of this study was to demonstrate the potential of MRI for guiding, monitoring, and evaluating endovascular interventions. This was done by investigating the feasibility of MR-guided balloon angioplasty in a stenosed vessel model. Catheters and guidewires were prepared for susceptibility-based MR visualization by incorporating paramagnetic markers into their walls. Near real-time monitoring (up to 1 image/sec) of the interventional procedure was achieved by using a dynamic two-dimensional gradient-echo technique. Devices were localized by on-the-fly subtraction of a baseline image from consecutive dynamic images and by merging the subtraction images with a previously acquired road map. All steps involved in balloon angioplasty, from the introduction and placement of a guidewire to the positioning of a catheter across the stenosis, inflation of the balloon, and dilatation of the stenosis could adequately be monitored with MR fluoroscopy. The beneficial effect of dilatation could be substantiated by a reduction of stenosis-related hypointensities and hyperintensities in the posttreatment MR angiogram as compared to the pretreatment angiogram and by a posttreatment increase of the volumetric flow rate.     

肿瘤患者PICC自我管理能力及影响因素调查

目的了解肿瘤患者PICC自我管理现状,分析其影响因素。方法应用肿瘤患者PICC自我管理能力调查问卷,对上海市2所三级甲等医院的209名PICC置管肿瘤患者进行调查。结果患者自我管理能力总分为(151.37±18.55)分,62.2%处于较好水平。自我效能、社会支持及居住地是患者自我管理能力的影响因素,可解释自我管理能力总变异量32.8%。结论肿瘤患者PICC自我管理能力较好,但在导管日常观察、信息获取方面有待提高。护理人员应重视患者的自我效能、社会支持,对来自农村的患者给予更多关注和指导,提高其PICC自我管理能力。