新型Envoy DA导引导管在神经介入治疗中的应用经验

目的:总结新型远端通路导引导管(Envoy DA)在神经介入治疗中的应用技术及适应证。方法:回顾我中心2年内神经介入治疗中使用新型Envoy DA的50例患者的临床资料,分析Envoy DA导管是否顺利输送到目标位置,是否能够为后续血管内治疗提供满意支撑,评估手术即刻临床及影像结果及有无围手术期导引导管相关并发症,总结Envoy DA在神经介入治疗中应用的适应证。结果:50例患者共计使用50根Envoy DA,其中46例(92.0%)顺利到达治疗所需支撑位置;2例(4.0%)未达目标位置,支撑效果不理想,经反复操作技术调整后完成手术;2例(4.0%)支撑失败后撤出,更换长鞘配合中间导管支撑完成治疗。1例(2.0%)患者术中发生导引导管相关夹层伴导管口血栓形成,1例(2.0%)患者发生导引导管相关颈动脉海绵窦瘘,围手术期导管相关并发症率4.0%。所有目标病变最终成功完成目标病变手术,手术技术成功率100%。结论:使用新型Envoy DA进行神经介入治疗需合理选择病例、正确操作才可发挥其在适度径路迂曲病变提供足够支撑且操作简捷的优势。     

Flow quantitation by radio frequency analysis of contrast echocardiography

Contrast echocardiography has the potential for measuring cardiac output and regional blood flow. However, accurate quantitation is limited both by the use of non-standard contrast agents and by the electronic signal distortion inherent to the echocardiographic instruments. Thus, the aim of this study is to quantify flow by combining a stable contrast agent and a modified echo equipment, able to sample the radio frequency (RF) signal from a region of interest (ROI) in the echo image. The contrast agent SHU-454 (0.8 ml) was bolus injected into anin vitro calf vein, at 23 flow rates (ranging from 376 to 3620 ml/min) but constant volume and pressure. The ROI was placed in the centre of the vein, the RF signal was processed in real time and transferred to a personal computer to generate time-intensity curves. In the absence of recirculation, contrast washout slope and mean transit time (MTT) of curves (1.11–8.52 seconds) yielded excellent correlations with flow: r=0.93 and 0.95, respectively. To compare the accuracy of RF analysis with that of conventional image processing as to flow quantitation, conventional images were collected in the same flow model by two different scanners: a) the mechanical sector scanner used for RF analysis, and b) a conventional electronic sector scanner. These images were digitized off-line, mean videodensity inside an identical ROI was measured and time-intensity curves were built. MTT by RF was shorter than by videodensitometric analysis of the images generated by the same scanner (p<0.001). In contrast, MTT by RF was longer than by the conventional scanner (p<0.001). Significant differences in MTT were also found with changes in the gain setting controls of the conventional scanner. To study the stability of the contrast effect, 6 contrast injections (20 ml) were performed at a constant flow rate during recirculation: the spontaneous decay in RF signal intensity (t1/2=64±8 seconds) was too long to affect MTT significantly.In conclusion, the combination of a stable con trast agent and a modified echocardiographic instrument provides accurate quantitation of flow in anin vitro model; RF analysis is more accurate than conventional processing as to flow quantitation by contrast echocardiography.Abbreviations RF radio frequency - ROI region of interest - MTT mean transit time     

JL指引导管用于右冠状动脉慢性闭塞硬病变介入治疗

目的探讨右冠状动脉慢性闭塞硬病变的介入治疗（PC I）方法,对比分析经桡动脉和股动脉途径采用JR、JL和AL指引导管介入治疗右冠状动脉慢性闭塞硬病变的适应证和并发症。方法2003年1月至2005年7月右冠状动脉慢性闭塞行PC I者305例,分别采用桡动脉JR,AL/JL导管法和股动脉JR/AL导管法PC I。观察指引导管置入成功率,钢丝通过率,球囊扩张成功率和支架置入成功率及各种并发症的发生率。结果上述3种方法的指引导管放置成功率均很高,但钢丝通过率、球囊扩张和支架置入成功率,桡动脉JL/AL导管法（99%,98%,98%）显著高于桡动脉JR（75%,63%,63%）和股动脉JR/AL导管法（83%,77%,77%,P<0.05）。无严重并发症发生。结论右冠状动脉慢性闭塞硬病变介入治疗JL/AL指引导管法优于桡动脉和股动脉JR指引导管法,并发症发生率没有增加。     

基于中医传承辅助平台的治疗变应性鼻炎方剂组方规律分析

目的:基于中医传承辅助平台2.0软件,分析和总结中国期刊全文数据库(CNKI)中以中医药治疗变应性鼻炎的用药规律。方法:收集CNKI中运用中医药方剂治疗变应性鼻炎的文献,筛选并建立方剂数据库,运用中医传承辅助平台软件挖掘其中的用药规律。结果:筛选治疗变应性鼻炎方剂182首,涉及中药177种。方中益气固表、祛风通窍药物使用频率最高,出现频率最高的药物组合为黄芪-防风,占总方剂的63.2%。演化得到核心组合22个,新处方11首。结论:通过中医传承辅助平台对CNKI数据库筛选出的治疗变应性鼻炎的方剂进行分析,得出组方以益气固表、祛风通窍为主,进而揭示组方规律,为临床治疗提供参考。     

国家标准《针灸技术操作规范》制定原则与方法

国家标准《针灸技术操作规范》是一项分部分标准,至今已制定22个部分。在制定过程中,曾遇到一系列共性及个性问题,本文从标准制定原则、制定方法及对某些问题的思考3个方面分别阐述。制定原则主要包括:针灸技术分类原则及技术要素的选择与规定。制定方法主要包括:以文献研究为基础,以临床实践为依据,以专家论证为指导。     

First Principles Study on Electronic Structure and Optical Properties of Ternary GaAs:Bi Alloy

The electronic structure and optical properties of ternary GaAs:Bi alloy are investigated by first principles calculations. It is found that the band gap of GaAs_1-xBi_x decreases monotonously with the increasing of Bi concentration, resulting in the fundamental absorption edge and main absorption peaks of GaAs_1-xBi_x shifting toward lower energy with the increase of the Bi content. The optical constants of GaAs_1-xBi_x, such as the optical absorption coefficient, refractive index, extinction coefficient and optical conductivity, are greater than those of pure GaAs when x > 3.1%, but less than those of pure GaAs when x < 3.1%, which is primarily decided by the intraband level repulsions between Bi-induced states and host states on the valence bands; the contribution of Bi-6s, Bi-6p orbitals and Ga-4p, Ga-4s orbitals on conduction bands is also crucial. Bi doping plays an important role in the modulation of the static dielectric constant and the static refractive index. These results suggest a promising application of GaAs_1-xBi_x alloy as a semiconductor saturable absorber.     

护理人员排班满意度的调查及其影响因素

目的分析护士排班的满意度及其影响因素。方法 2011年10月,采用便利抽样法选择鼓楼医院1138名护理人员为研究对象,采用自制的护士一般情况调查表、排班满意情况调查表及积蓄性疲软症状量表对其进行调查,并分析影响护士对排班满意度的因素。结果护士对排班情况非常满意235名,占20.65%;满意488名,占51.67%;一般271名,占23.81%;不满意32名,占2.81%;非常不满意12名,占1.05%。在1138名护士中,疲劳发生率为80.14%,其中有慢性症状者最多,为739名,占64.94%。影响护士排班满意度的因素主要有护士疲劳度、护士人数是否充足、排班能否做到护士能力搭配、排班能否做到护士性格搭配、排班能否满足护士的个人意愿、各护士班次的轮换是否公平、各护士法定节假日休假次数是否公平等(均P0.05)。结论护士排班需根据患者需要、互补增值、公平公正、稳定机动、弹性、人性化的原则,建立信息化电子排班系统,科学配置人力资源,从而提高护士对排班的满意度,为患者提供更好地服务。