模拟定位机引导下经皮穿刺集束巨能刀射频治疗肺癌的临床应用

为了探讨局部麻醉和模拟定位机引导在集束巨能刀治疗肺癌的射频治疗的适应证、治疗效果以及并发症的预防和处理，采用0．5％普鲁卡因局部浸润麻醉，模拟定位机引导下经皮穿刺集束巨能刀治疗肺癌46例。CT显示条索状瘢痕残余ll例，空洞形成或直径缩小32例，无变化1例，增大2例。治疗中患者均有不同程度的胸腔内热感及短时间内可以忍受的疼痛感。并发症包括气胸7例、皮下气肿5例、发热24例、咯血13例和慢性支气管炎急性发作4例。初步研究结果提示，集束巨能刀射频治疗周围型肺癌疗效满意，尤其适用于直径〈3cm的肿瘤。局部麻醉配合全身止痛药物应用可以很好地解决治疗中的疼痛问题，与全麻相比还具有省时省力、费用低的优势；对于周围型肺癌，模拟定位机引导经皮穿刺定位与CT引导相比，同样准确、安全，但操作更为方便。     

高压脉冲电场对乳铁蛋白抑菌性能的影响

研究了高压脉冲电场(PEF)对乳铁蛋白(LF)的抑菌性能的影响。结果表明,LF质量浓度、电场强度、脉冲频率、脉冲数的增加,有利于LF抑菌能力的增强,而温度的升高会使之减弱。电场强度为35 kV/cm时,LF的抑菌能力达到最大值。LF的质量浓度越高,对电场强度的变化越敏感。当脉冲个数达到744时,LF的相对抑菌能力提高了34%。处理温度为15～55℃时,PEF处理的LF的相对抑菌性能增长了5%左右。当温度升高至65℃时,LF的相对抑菌能力下降显著,降低了约22%。     

射频消融治疗肝肿瘤315例报告

目的总结1999年6月至2003年8月用射频消融（radiofrequency ablation，RFA）治疗315例肝肿瘤病人的病例资料，探索RFA治疗肝肿瘤近远期疗效。方法采用了一次定位、多点穿刺，RFA联合肝动脉栓塞（TAE）、选择性门静脉栓塞（SPVE）治疗直径5～13cm的大肝癌，及经皮经肺经膈肌RFA治疗膈顶部肝癌。结果总并发症发生率为5．1％，无一例住院期间死亡。AFP阳性的169例肝癌病人中，RFA后有124例（73．6％）明显降低，其中有95例（56．2％）转阴。半年生存率为89．5％，1年生存率为80．1％，18个月生存率为61．4％，24个月生存率为48．3％，〉36个月生存率为35．6％。结论采用TAE、SPVE及RFA一次定位多点穿刺法治疗无手术切除指征的中晚期（含大肝癌）的病人，疗效明显，总并发症发生率低。     

Blood flow acceleration in the carotid and brachial arteries of healthy volunteers: respective contributions of cardiac performance and local resistance

Summary— The influence of local resistance and cardiac performance on peripheral blood acceleration was investigated in 14 healthy male volunteers. Steady and pulsatile flow was studied in the brachial and in the common carotid arteries, ie, two territories that exhibit marked differences in resistive characteristics. Instantaneous blood velocity (V), mean blood velocity (V_m) and artery diameter (D) were evaluated at rest by an ultrasonic range-gated pulsed Doppler flowmeter using a double transducer probe, thus allowing the calculation of mean blood flow (Q). Mean local resistance (R) was obtained by dividing the mean arterial pressure by Q. The peak value of the local acceleration of the blood was obtained by computer-assisted calculation of the first derivative of instantaneous blood velocity (G_max = +dV/dt_max). Peak aortic blood acceleration (GAo) was simultaneously measured from the suprasternal notch using a pulsed Doppler velocity meter. In the brachial and the common carotid arteries, G_max was of a similar magnitude (551 ±30 and 555 ± 44 cm/s², respectively) despite major differences in the respective D, V_m, Q and R values. In neither artery was there a relationship between G_max and either resting Q or R. At the brachial artery level, G_max was positively related to GAo ( r = 0.79, P = 0.0008). At the common carotid artery level, there was a weak, although non significant relationship between G_max and GAo ( P = 0.08). Our results indicate that the local acceleration of peripheral blood flow in the brachial artery is related rather to upstream central impulse than to downstream hemodynamics, and suggest some regional differences in the hemodynamic determinants of the local acceleration of peripheral blood flow.     

射频消融术后尿潴留患者的护理

分析86例射频消融术后患者出现尿潴留的不同原因，包括不习惯床上排尿、精神因素、疼痛等。护理对策包括：减少卧床时间，心理护理，变换体位，物理诱导，术后多饮水等，结果81例患者排尿成功，只有5例(5．8％)男性前列腺肥大患者需要导尿。     

Percutaneous recanalization of chronic subclavian artery occlusion using optical coherence reflectometry-guided radiofrequency ablation guidewire.

Subclavian artery lesion that is associated with low complication rate could be treated by percutaneous intervention effectively. However, the success of endovascular therapy for occlusive lesion may be limited by failure to cross with a guidewire. We describe the use of a system using optical coherence reflectometry for navigation and radiofrequency ablation to enable wire passage through subclavian artery occlusion that could not be crossed by conventional guidewires.     

鼻内镜下等离子低温射频治疗常年性变应性鼻炎的临床观察

目的探讨鼻内镜下等离子低温射频治疗常年性变应性鼻炎(PAR)的疗效及其优越性。方法在鼻内镜下用等离子低温射频治疗PAR48例,按照海口会议修订的“过敏性鼻炎诊断和疗效评定标准”,用计分法分别评定其疗效。结果该组48例术后随访半年进行评价,其中显效27.1%(13/48),有效58.3%(28/48),无效14.6%(7/48),总有效率为85.4%。疗效评分显示治疗前平均总分为(9.58±1.69)分,治疗后为(5.63±1.15)分(P<0.05)。结论鼻内镜下等离子低温射频烧灼筛前神经终末区域治疗PAR,具有简便、安全等优点,短期效果显著,特别适用于临床上应用抗组胺类药物及鼻内应用糖皮质激素治疗效果不甚理想及由于各种原因不能长期接受抗组胺类药物及鼻内应用糖皮质激素治疗的患者;但长期疗效有待进一步研究。     

A Decrease in Pulmonary Vein Diameter After Radiofrequency Ablation Predicts the Development of Severe Stenosis

A decrease in ostial pulmonary vein (PV) diameter was observed in patients on the day after radiofrequency ablation of atrial fibrillation (AF). This study examined whether a relative reduction in PV diameter on day 1 (RRPVD1) after the procedure predicts the late development of severe PV stenosis (PVS). The study included 104 consecutive patients (mean age = 55 years, range 46–61, 34 women) with drug refractory AF. Pulmonary vein diameter was measured using MR angiography (MRA) on the day before and on day 1 after the ablation procedure. The MRA was repeated every 3 months after the procedure. Severe PVS was defined as a >70% diameter reduction from the initial ostial diameter. The cut-off of RRPVD1 was prespecified as 25% decrease in initial diameter. The data are presented as medians and interquartile range. A total of 357 PV were treated. The RRPVD1 was 0.0% (0.0–11.1%). Severe PVS was found in 18 PV during a follow-up of 12 months (range 6–13). The log-rank analysis confirmed a strong association between a RRPVD1 ≥25% and the development of PVS (hazard ratio: 7.1; 95% confidence interval 3.8–13.5, P < 0.0001). By multivariate Cox regression model, after adjustment of procedure variables, RRPVD1 was the strongest predictor of development of severe PVS. RRPVD1 ≥25% was a strong independent predictor of development of severe PVS.     

Epicardial radiofrequency ablation for chronic atrial fibrillation undergoing simultaneous on-pump beating coronary artery bypass grafting

Off-pump coronary artery bypass grafting has become an attractive surgical alternative for myocar-dial revascularization because of the advantage of myocardial protection and other benefits of patients. However, it is still regarded as a controversial treatment for the coronary artery disease accompanied by atrial fibrillation (AF). A significant number of patients in need of coronary revascularization have chronic AF. Although the Cox-Maze III procedure is the gold standard for the surgical treatment of AF, few of these patients undergo AF operations at the time of their coronary bypass grafting. We report herein a case of the pulmonary vein isolation to eliminate the AF by means of epicardial radiofrequency ablation combined with 2 vessels coronary artery bypass grafting on the beating heart with the aid of cardiopulmonary bypass.