品管圈提高脑室引流患者引流瓶高度设置准确率的作用

目的 探讨品管圈在脑室引流患者引流瓶高度设置准确率的应用效果。方法 2016年9月至2017年3月，宿迁市第一人民医院重症医学科按照品管圈十大步骤进行操作，调查脑室引流患者引流瓶高度设置不准确的原因，制定对策并实施。结果 脑室引流患者引流瓶高度设置准确率由品管圈活动实施前的45%提高至实施后的76%（P﹤0.001）。圈员能力也得到提高。结论 品管圈活动能够提高脑室引流患者引流瓶高度设置的准确率，同时在活动过程中增强了护士的综合能力。     

Intervention for arch obstruction after the Norwood procedure: Prevalence,associated factors,and practice variability

Objective

Arch obstruction after the Norwood procedure is common and contributes to mortality. We determined the prevalence, associated factors, and practice variability of arch reintervention and assessed whether arch reintervention is associated with mortality.

Cardiovascular magnetic resonance tagging of the right ventricular free wall for the assessment of long axis myocardial function in congenital heart disease

Background

Right ventricular ejection fraction (RV-EF) has traditionally been used to measure and compare RV function serially over time, but may be a relatively insensitive marker of change in RV myocardial contractile function. We developed a cardiovascular magnetic resonance (CMR) tagging-based technique with a view to rapid and reproducible measurement of RV long axis function and applied it in patients with congenital heart disease.

Methods

We studied 84 patients: 56 with repaired Tetralogy of Fallot (rTOF); 28 with atrial septal defect (ASD): 13 with and 15 without pulmonary hypertension (RV pressure > 40 mmHG by echocardiography). For comparison, 20 healthy controls were studied. CMR acquisitions included an anatomically defined four chamber cine followed by a cine gradient echo-planar sequence in the same plane with a labelling pre-pulse giving a tag line across the basal myocardium. RV tag displacement was measured with automated registration and tracking of the tag line together with standard measurement of RV-EF.

Results

Mean RV displacement was higher in the control (26 ± 3 mm) than in rTOF (16 ± 4 mm) and ASD with pulmonary hypertension (18 ± 3 mm) groups, but lower than in the ASD group without (30 ± 4 mm), P < 0.001. The technique was reproducible with inter-study bias ± 95% limits of agreement of 0.7 ± 2.7 mm. While RV-EF was lower in rTOF than in controls (49 ± 9% versus 57 ± 6%, P < 0.001), it did not differ between either ASD group and controls.

Conclusions

Measurements of RV long axis displacement by CMR tagging showed more differences between the groups studied than did RV-EF, and was reproducible, quick and easy to apply. Further work is needed to assess its potential use for the detection of longitudinal changes in RV myocardial function.     

Ultrasound identification of lateral ventricular asymmetry in the human neonate

Sonography was used to investigate left-right asymmetries of the brain in 66 human neonates with gestational ages of 28-44 wk. The body of the left lateral ventricle was larger than the right in 21 infants (31.8%), whereas the right was larger than the left in only four infants (6.1%)(p less than 0.001). Asymmetry of the lateral ventricles can be detected in the normal neonatal brain using sonography.     

超声组织追踪和应变率显像技术评价冠心病左室收缩功能

目的探讨超声组织追踪成像(TTI)和应变率成像(SRI)评价冠心病患者左室收缩功能的临床价值,比较TTI和SRI两种方法评价左室收缩功能敏感性的差异.方法A组22例健康人群,B组20例左前降支和18例右冠状动脉狭窄的冠心病患者,应用组织速度成像(TVI)技术于心尖四腔切面、心尖两腔切面、心尖左室长轴切面上显示后间隔、下壁、前壁及前间隔的图像,并应用TTI及SRI定量测量并分析左室11个节段收缩期峰值位移值及收缩期最大应变率.结果B组各节段的各项指标较A组明显减低.冠心病组总节段数为208个,TTI、SRI检出异常节段数分别为141、126个,检出比例分别为67.79%、60.58%.结论TTI和SRI技术能准确地定量评价冠心病患者的左室收缩功能,对左室收缩功能评价TTI与SRI结果之间无明显统计学差异.     

二维超声心动图对右室双出口诊断与鉴别诊断的探讨

本文报道应用二维超声心动图(简称2-DE)加声学造影对右室双出口(简称DORV)的诊断与鉴别诊断的探讨,作者认为DORV是一种复杂紫绀型先天性心血管畸形。研究重点:超声诊断除常规切面探查外,要注重多切面的移行探查;以明确室间隔缺损是左心室的唯一出口。两大动脉的起源根据房室瓣所在心室的形态、结构来识别其为右心室外,还必须明确形态学或功能的左、右心室的空间位置及其与两大动脉的连接。还可用声学造影鉴别其他大血管转位等先天畸形。根据本组病例研究认为主动脉明显前移,且≥75%起源右心室,即可视为SDD型DORV。     

术中超声在脑外伤后脑室穿刺中的应用

目的探讨术中超声在脑外伤后脑室穿刺中的应用价值。方法选取脑外伤后需接受侧脑室穿刺术的患者68例,随机均分为2组,对研究组实施超声引导下侧脑室穿刺术,对照组实施传统盲穿术,分别记录每例穿刺成功所需时间、单次穿刺成功情况及每组的术后并发症情况,并对两组结果进行比较。结果研究组一次穿刺成功率为100％（34／34）;手术时间5-12min,平均（6．35±1．51）min;术后无并发症发生。对照组24例一次穿刺成功,成功率70．59％（24／34）;手术时间5-17min,平均（11．21±3．10）min;术后8例（8／34,23．53％）出现并发症,分别为穿刺道出血4例、误穿入对侧脑室2例、反复穿刺致使窦道形成1例及脉络丛损伤1例。研究组与对照组间的一次穿刺成功率、穿刺手术时间及术后并发症发生率差异均有统计学意义（P均〈0．05）。结论在脑外伤患者的脑室穿刺术中,超声引导法穿刺成功率明显优于传统盲穿法,手术时间明显短于传统盲穿法,并可减少并发症的发生,可在临床推广应用。     

Percutaneous approach to a stent-based ventricle to coronary vein bypass (venous VPASS): comparison to catheter-based selective pressure-regulated retro-infusion of the coronary vein.

AIMS: Percutaneous stent-based ventricle-to-coronary vein bypass (venous VPASS) is a new approach to chronic venous arterialization as a treatment modality in an otherwise no option patient with coronary artery disease. In this study, the efficacy of venous VPASS was compared with catheter-based selective pressure-regulated retro-infusion of arterial blood during acute ischaemia. METHODS AND RESULTS: In seven pigs, venous VPASS was established using a percutaneous ultrasound-guided puncture from the anterior cardiac vein to the left ventricle, with subsequent implantation of an ePTFE-covered stent graft. During left anterior descending artery (LAD) occlusion, coronary venous pressure in the distal anterior cardiac vein increased to 55+/-4 mmHg under conditions of venous VPASS compared with 78+/-5 mmHg during selective pressure-regulated retro-infusion. Significant preservation of regional myocardial function was observed during venous VPASS (67+/-6% baseline) and during selective retro-infusion (83+/-4%) compared with control LAD occlusion (0.4+/-2%). CONCLUSION: Percutaneous implantation of a PTFE covered stent (venous VPASS) was feasible and associated with significant preservation of regional myocardial function during acute ischaemia in pigs at reasonable levels of mean coronary venous pressure to avoid tissue damage during chronic application.