经桡动脉穿刺老年冠状动脉成形术76例临床分析

为探讨经桡动脉穿刺老年冠状动脉成形术的安全性及成功率,设老年组(76例)和对照组(154例)进行比较.结果老年组桡动脉穿刺及插管成功率为94.7%,冠脉成形术成功率为93.3%,并发症发生率为5.3%;对照组分别为97.4%、94.1%、5.2%,两组间均无显著性差异(P＞0.05).其手术时间、X线照射时间及造影剂用量分别为30.5±12.5与29.5±11.6min、20.6±5.8与19.3±7.5min、90.8±20.3与89.4±21.9ml,两组之间均无显著差异(P＞0.05).提示对于桡动脉搏动好、Allen试验无缺血、不需要大直径旋磨导管旋磨及定向斑块旋切技术治疗的老年患者,经绕动脉穿刺冠状动脉成形术安全、有效.     

经肱动脉穿刺老年冠状动脉成形术106例临床观察

目的　探讨经肱动脉穿刺老年冠状动脉成形术的安全性及成功率。方法　老年组 10 6例 ,对照组 172例 ,两组患者均首选经右侧肱动脉穿刺冠状动脉成形术。观察手术成功率、并发症、手术时间、X线照射时间及造影剂用量等。结果　老年组肱动脉穿刺及插管成功率为 93 4% (99/10 6 ) ,冠状动脉成形术成功率为 91 8% (16 8 183) ,并发症发生率为 5 7% (6 /10 6 ) ;对照组肱动脉穿刺及插管成功率为 94 8% (16 3/172 ) ,冠状动脉成形术成功率为 92 6 % (2 6 2 /2 83) ,并发症为 5 8% (10 /172 )。两组间无显著性差异 (P >0 0 5 )。手术时间 (分 )、X线照射时间 (分 )及造影剂用量 (毫升 )分别为 2 9 5±11 6min与 2 8 6± 10 5min、18 8± 5 5min与 18 6± 5 8min、90 6± 2 1 6ml与 90 4± 2 0 8ml,经统计学处理 ,两组之间均无显著差异 (P >0 0 5 )。结论　经肱动脉穿刺老年冠状动脉成形术安全、可行。     

经桡动脉冠状动脉腔内成形术治疗急性冠状动脉综合征

目的　评价急性冠状动脉综合征的患者采用经桡动脉冠状动脉腔内成形术的可行性。方法　急性冠状动脉综合征的患者 96例 ,经桡动脉穿刺冠状动脉成形术 (TRCA)组 5 3例 ;经股动脉穿刺冠状动脉成形术 (TFCA)组 4 3例。观察两组手术的成功率、并发症等。结果　两组手术过程中均无死亡和心肌梗死并发症发生。两组插管成功率分别为 96 2 %与 97 7% ,两组冠状动脉成形术成功率分别为 94 3%与 95 4 % ;两组间差异无显著性。但出血并发症TRCA组为 0 ,而TFCA组为 7 2 % ,两组间差异有显著性 (P <0 0 1)。术后持续卧床时间两组分别为 0与 (12 8± 5 6 )h ;住院天数两组分别为 (2 5± 0 4 )d与 (3 8± 0 6 )d ;两组比较差异均有显著性 (P <0 0 1)。结论　经桡动脉冠状动脉成形术治疗急性冠状动脉综合征安全有效 ,出血并发症少 ,住院时间短 ,且不影响术后患者活动。     

直接冠状动脉支架置入术的临床观察

目的　探讨直接冠状动脉支架置入术 (DS)治疗非复杂冠状动脉病变的可行性及安全性。方法　根据入选标准将 10 5例病人随机分为无球囊预扩张直接支架置入术 (DS)组和在球囊预扩张的基础上行支架置入术 (对照 )组 ,分别比较两组的支架置入成功率、平均手术时间、平均 X线照射时间、平均造影剂用量、并发症发生率。结果　 DS组支架置入成功率为 91.0 % ,对照组为 95 .7%(P>0 .0 5 )。DS组平均手术时间短于对照组 (2 3.5 0± 13.5 4min vs2 7.96± 15 .2 3min,P<0 .0 5 )。DS组平均 X线照射时间较对照组减少 (6.0 4± 4.13m in vs 6.67± 3.65 min,P<0 .0 5 ) ,而且平均造影剂用量也明显少于对照组 (135± 65 ml vs 15 7± 62 ml,P<0 .0 1)。DS组和对照组住院并发症发生率分别为 1.89%和 3.85 % ,P>0 .0 5。结论　 DS治疗非复杂冠状动脉病变有较高的安全性和成功率 ,而且手术时间、X线暴露时间短及造影剂用量少     

经桡动脉经皮冠状动脉腔内形成术

目的　评价经桡动脉途径经皮冠状动脉腔内成形术 (PTCA)的临床应用价值。方法有选择性对 30 6例患者经桡动脉途径行PTCA ,观察其疗效和血管并发症。结果　 (1)桡动脉穿刺成功率为 97 5 %。 (2 )对 30 6例 412处病变行PTCA ,成功率为 98 3%。于 2 44例 317处病变成功植入支架 332只。狭窄从 (76± 12 ) %降低至 (12± 10 ) % ,最小血管直径由 (0 8± 0 3)mm增加至 (2 9± 0 4)mm。 (3)所有患者术后即拔导管鞘 ,局部压迫 3～ 5h。并发症发生率为 4 9% ,其中最常见并发症为术后桡动脉闭塞 (3 9% )。结论　经桡动脉途径PTCA安全可行 ,可选择性应用于某些冠心病患者 ,其穿刺部位出血并发症少、住院时间短等优点。     

经桡动脉冠状动脉造影术和血管成形术的可行性和安全性分析

目的 探讨经桡动脉行冠状动脉造影术和血管成形术的可行性、安全性和成功率.方法 回顾我院1.495例经桡动脉行冠状动脉造影术和694例经桡动脉行冠状动脉血管成形术患者,并以406例经股动脉行冠状动脉血管成形术患者作为对照,记录患者基本情况和临床资料.结果 经桡动脉行冠状动脉造影术的成功率为95.3%,经桡动脉行冠状动脉血管成形术的成功率为97.3%.经桡动脉冠状动脉血管成形术组手术成功率与经股动脉组(96.7%)差异无统计学意义(P＞0.05),但手术操作时间、X线照射时间较经股动脉组长(54.9±15.2 min比40.1±10.6 min,P＜0.05;20.2±8.3 min比15.1±6.5 min,P＜0.01)、造影剂用量较经股动脉组多(165.2±30.7 mL比143.5±25.1 mL,P＜0.01).大部分(94.5%)患者未出现任何并发症.结论 经桡动脉行冠状动脉造影术和血管成形术虽然手术操作时间和X线照射时间长,造影剂用量多,但手术成功率高、并发症少,具有临床可行性和安全性.     

经皮桡动脉冠状动脉造影及冠状动脉成形术的临床应用

目的 :评价经皮桡动脉冠状动脉造影术与冠状动脉腔内成形术 (PTCA)的临床应用价值。方法 :有选择性的对 37例患者行经皮桡动脉途径冠状动脉造影及冠状动脉成形术 ,观察其疗效和血管并发症。结果 :1 桡动脉穿刺成功率为 93 8% (有 2例失败 )。 2 14例冠状动脉造影正常 ,17例冠状动脉造影显示 2 6处存在≥ 70 %的狭窄病变 ,适合行冠状动脉介入手术。 2 6处病变有 4处PTCA疗效满意 ,2 2处行PTCA +支架术 ,植入支架 31只。狭窄从 (81± 12 ) %降低至 (10 6± 7 4 ) % ,最小血管直径由 (0 86± 0 12 )mm增加至 (3 0 8± 0 32 )mm。 6例病人行冠状动脉旁路移植术。 3 所有患者术后即拔导管鞘 ,局部压迫 4h。术后并发症的发生率为 3 3% (1例术后的桡动脉闭塞 )。结论 :经桡动脉途径行冠状动脉造影及冠状动脉成形术安全可行 ,其具有穿刺部位出血少、住院时间短的特点 ,可选择性的应用于某些冠心病患者。     

经桡动脉与股动脉入径直接经皮冠状动脉介入治疗急性心肌梗死的对比研究

目的　对经桡动脉与股动脉入径直接经皮冠状动脉介入 (TRA pPCI与TFA pPCI)治疗急性心肌梗死 (AMI)的临床可行性、安全性及其疗效进行对比研究。方法　 2 0 0 0年 9月至 2 0 0 2年 8月期间 ,2 0 8例 [男性 159例 ,女性 49例 ,平均年龄 (58 9± 11 9)岁 ]发病在 12h内的AMI患者 ,随机分为TRA pPCI组 10 6例 ,TFA pPCI组 10 2例。比较两种入径 pPCI各操作时程和疗效及术后出血、血栓 /栓塞和血管并发症 ;观察桡动脉痉挛发生率并评价药物预防和解痉效果。并随访比较TRA pPCI组术后 1个月双侧桡动脉内径和血流速度及桡动脉血管并发症。结果　TRA pPCI组和TFA pPCI组各 2例患者因入径血管困难而交叉调组。TRA pPCI组PCI处理病变血管 10 6支 ,其中完全闭塞病变 2 8支。TFA pPCI组PCI处理病变血管 10 2支 ,完全闭塞 3 4支。两组患者在桡 /股动脉穿刺时间、指引导管置入时间、病人到达医院至球囊开始扩张时间、总pPCI时程无明显差异 [(18 3± 3 3 )s比 (16 9± 4 2 )s ;(6 0± 1 6)min比 (5 8± 0 9)min ;(45 3± 19 6)min比 (42 8± 2 2 7)min ;(49 2± 2 4 1)min比 (46 5± 2 6 4)min ,P均 >0 0 5]。两组一次入径血管穿刺成功率、梗死相关动脉 (IRA)开通率和PCI成功率亦相似 (93 4%比 96 1% ;10 0 %比 1     

冠状动脉旋磨术联和低压球囊成形术治疗冠状动脉钙化病变

目的 :通过联合应用冠状动脉旋磨术及低压球囊成形术对冠状动脉钙化病变患者进行治疗 ,探讨其对治疗钙化病变的安全性及有效性。方法 :对冠状动脉造影证实冠心病患者 2 6例共 2 8处钙化病变行冠状动脉旋磨术 ,并辅以低压冠状动脉球囊成形术 ,观察其手术成功率 ,术后随访 12个月。结果 :冠状动脉旋磨术的手术成功率为 92 8% ,管腔狭窄由术前的 88%± 9%减少至 45 %± 10 %。有 2 5处钙化病变需补充性经皮冠状动脉腔内成形术 (PTCA) (88 3 % ) ,有 3处因旋磨术后残余狭窄 <3 0 %而未行补充治疗。包括补救性治疗在内经皮冠状动脉内旋磨术 (CRA)手术成功率为 10 0 %。术中无主要并发症发生 (包括死亡、Q波心肌梗死、急症冠状动脉搭桥术 ) ,有 3例术中出现血管痉挛 ,术后 72h内有 1例病人出现心肌酶学升高 ,符合无Q波心肌梗死。所有病人平均随访 (10 4± 7 6)个月 ,有 11例心绞痛复发或蹬车试验阳性 ,无心肌梗死和死亡病例。 5例病人行重复冠状动脉造影 ,均为再狭窄。结论 :旋磨术联合低压球囊扩张虽然可取得很高的即刻成功率 ,是治疗钙化病变安全、有效的方法。但其术后再狭窄率仍然较高 ,其确切效果需临床实验结果进一步证实     

经肱动脉穿刺冠状动脉腔内成形术278例临床观察

目的探讨经肱动脉穿刺冠状动脉腔内成形术的安全性及成功率.方法经肱动脉穿刺冠状动脉成形术(TBCA)组278例,采用经右侧肱动脉穿刺途径.经股动脉穿刺冠状动脉成形术(TFCA)组144例,采用经右侧股动脉穿刺途径.观察两组手术的成功率、并发症等.结果两组穿刺插管及冠状动脉成形术成功率分别为94.2% 与100% 及92.3% 与94.3%,两组间P＞0.05.两组并发症分别为5.8%与5.6%,P＞0.05.术后持续卧床时间两组分别为0与(11.4±4.6)h,有显著差异(P＜0.001).结论经肱动脉穿刺冠状动脉成形术安全、有效,不影响术后患者活动.     

Research and Evaluation of the Influence of the Construction of the Gate and the Influence of the Piston Velocity on the Distribution of Gases into the Volume of the Casting

Distribution of gasses to the cast volume and volume of pores can be maintained within the acceptable limits by means of correct setting of technological parameters of casting and by selection of suitable structure and gating system arrangement. The main idea of this paper solves the issue of suitability of die casting adjustment—i.e., change of technological parameters or change of structural solution of the gating system—with regards to inner soundness of casts produced in die casting process. Parameters which were compared included height of a gate and velocity of a piston. The melt velocity in the gate was used as a correlating factor between the gate height and piston velocity. The evaluated parameter was gas entrapment in the cast at the end of the filling phase of die casting cycle and at the same time percentage of porosity in the samples taken from the main runner. On the basis of the performed experiments it was proved that the change of technological parameters, particularly of pressing velocity of the piston, directly influences distribution of gasses to the cast volume.     

Weighing the QT Intervals with the Slope or the Amplitude of the T Wave

Objective: The reproducibility of QT interval measurements is low, even for the mean QT interval based on the standard ECG. In this study we analyzed whether the reproducibility of the mean weighed QT interval was better than the simple mean QT interval. The weighing was based on the amplitude of the T wave or the slope of the steepest tangent on the terminal part of the T wave. Material and methods: 12‐lead ECGs of 130 postmyocardial infarction patients were obtained. The QT intervals were measured by the tangent‐method on two occasions by the same observer Mismatch QT intervals were defined as QT intervals that were measured at only one occasion. Sixteen ECGs were rejected. The data were split into 34 and 80 ECGs for optimization and validation of the weighing, respectively. The weighed QT dispersion was calculated as the weighed mean of the three longest minus the weighed mean of the three shortest QT intervals. Results: Weighing with the slope increased the reproducibility by 41% (P = 3 10^‐6), but weighing with the amplitude reduced it by 20% (P = 0.02). However, if measurements with errors above 75 ms were rejected, weighing with the slope or the amplitude increased the reproducibility with 26% and 20% (P = 0.02), respectively. Weighing did not change the reproducibility of the weighed QT dispersion. Conclusion: Weighing with the slope improved the reproducibility of the mean weighed QT interval. However, if measurements with errors above 75 ms were rejected, weighing with the amplitude also increased the reproducibility. Weighing did not change the reproducibility of the weighed QT dispersion. Weighing is particularly efficient at reducing the negative impact of mismatch QT intervals on the reproducibility. A.N.E. 2002;7(1):4–9     

县级以下综合医疗机构医务人员对现代结控知识的认识现状调查

目的本文旨在了解医务人员现代结控知识掌握的现状及培训效果?方法于培训前后进行问卷调查,内容包括:病例发现?结核病诊断及化疗?结果培训前疫情报告和转诊,回答正确者占75.2%?71.7%;对临床表现?查痰和诊断依据,回答正确者占83.5%?42.5%?40.8%;抗痨药物?用药方法?化疗原则?短化方案?短化疗程?治愈标准六项,回答正确者占58%?14.4%?20.8%?9.2%?17%?24.3%?培训后再次调查发现,90%以上医务人员对现代结控基本知识已掌握?结论各级医务人员现代结控知识是很贫乏的,因此,对其进行系统培训是极为必要的,此项工作省时?省力?投入少,可收到事半功倍的效果。     

大骨节病病区水,粮实验对动物的骨和软骨中化学元素组成的影响

用质子激发 X 线荧光分析方法(PIXE)测定了大骨节病病区和非病区的水、粮以及用该水粮喂养的大白鼠的肋软骨和硬骨中22种化学元素的含量。结果发现水粮中存在差异的元素反应在用该水粮喂养的大白鼠的骨、软骨中也存在差异,含量都低的元素有 P、Mn、Cu、As、Zn。都高的有铅。其中锌低在水、粮、硬骨和软骨中都完全一致呈非常显著性差异(p<0.01)。提示病区水、粮中化学元素对骨质的影响不是单一元素缺乏或过多所致,而是多种元素的复合因素。     

Assessment of the Soft-Tissue Seal at the Interface between the Base of the Fixed Denture Pontic and the Oral Mucosa

Fixed dentures (bridges) are often selected as a treatment option for a defective prosthesis. In this study, we assess the contact condition between the base of the pontic and oral mucosa, and examine the effect of prosthetic preparation and material biocompatibility. The molars were removed and replaced with experimental implants with a free-end type bridge superstructure after one week. In Experiment 1, we assessed different types of prosthetic pre-treatment: (1) the untreated control group (Con: mucosa recovering from the tooth extraction); (2) the laser irradiation group (Las: mucosa recovering after the damage caused by a CO₂ laser); and (3) the tooth extraction group (Ext: mucosa recovering immediately after the teeth extraction). In Experiment 2, five materials (titanium, zirconia, porcelain, gold-platinum alloy, and self-curing resin) were placed at the base of the bridge pontic. Four weeks after the placement of the bridge, the mucosa adjacent to the pontic base was histologically analyzed. In Experiment 1, the Con and Las groups exhibited no formation of an epithelial sealing structure on the pontic base. In the Ext group, adherent epithelium was observed. In Experiment 2, the sealing properties at the pontic interface were superior for titanium and the zirconia compared with those made of porcelain or gold-platinum alloy. In the resin group, a clear delay in epithelial healing was observed.     

高胆红素血症对肿瘤标志物测定的影响探讨

目的探讨高胆红素血症对Ca19-9、Ca24-2和CEA检测的影响.方法对320例胆管、胆囊良恶性疾病病人,15例胆囊炎病人的胆汁和血清以及10例肝硬化、10例黄疸肝炎病人进行Ca19-9、Ca24-2和CEA检测.结果在良性胆管、胆囊疾病中,Ca19-9的假阳性最高;在胆红素增高的良性疾病中,Ca19-9假阳性率达46.7%;15例胆汁和血清以及10例肝硬化和10例黄疸肝炎病人中,Ca19-9的假阳性率分别为93%、20%、80%和80%.结论高胆红素血症对Ca19-9检测影响最明显,胆囊、胆管良恶性疾病鉴别时,以Ca24-2和CEA检测为佳.     

Echocardiography in the Emergency Department: From the Perspective of the Emergency Physician and the Cardiologist

Echocardiography performed in the emergency department must adapt to this new setting for noninvasive diagnostic testing. Emergency physicians require echocardiography to provide rapid diagnosis in life-threatening emergencies. New initiatives are being proposed by emergency physicians in the delivery of this test. Cardiologists now use echocardiography in the emergency-department to make the diagnosis of heart disease earlier and with greater accuracy.