1 ml注射器辅助法在桡动脉穿刺置管中的应用

目的探讨一种新型穿刺法即1 ml注射器辅助法在桡动脉置管的应用,观察其置管成功率与穿刺所需时间。方法选取300例重大手术需动脉穿刺置管的患者,随机分为两组,Ⅰ组采用直接穿刺置管法,Ⅱ组采用1 ml注射器辅助穿刺法。结果Ⅰ组穿刺成功123例,Ⅱ组穿刺成功141例,两组相比,有显著统计学意义(P<0.01);前者用时(56±10.4)s,后者(34±9.3)s(P<0.01)。结论1 ml注射器辅助穿刺是简单、快速、安全且损伤较小的动脉穿刺方法。     

床旁颈内静脉穿刺置管50例

颈内静脉穿刺置管在临床有着广泛的用途 ,为探讨其成功经验 ,减少并发症 ,对我院近两年来所完成的 5 0例报道如下 :1　资料及方法1.1　一般资料　全部患者均为住院患者 ,其中男 2 1例 ,女 2 9例 ;年龄 2 5～ 74岁 ,平均年龄 42 .3岁 ;各种原因所致急性肾功能衰竭 2 8例 ,慢性肾功能衰竭 2 0例 ,慢性充血性心力衰竭 2例。其中 48例用于血液透析 (HD) ,1例用于静脉输液 ,1例用于放置临时起搏器。1.2　方法　病人取头低足高仰卧位 ( 10～ 2 0°) ,肩胛骨之间用一小枕垫高 ,头转向左侧 (穿刺右颈内静脉 ) ,在胸锁乳头肌内外两头与锁骨形成的三…     

X线导引下锁骨下静脉穿刺置管术

目的　回顾性分析锁骨下静脉第 2段X线解剖特点 ,探讨X线导引下锁骨下静脉穿刺置管技术的要点。资料与方法　在X线实时监视下 ,采用Arrow中央静脉管 ,行锁骨下静脉穿刺上腔静脉置管 180例次 ,包括右侧 110例次 ,左侧 70例次。穿刺点取锁骨中点下 1～ 2cm ,采用改良Seldinger穿刺技术 ,穿刺针对准锁骨头方向斜向内上、紧贴锁骨后缘穿刺 ,Arrow导管头留置于上腔静脉 ,3M敷贴外固定导管。并记录导管进入锁骨下静脉第 2段的解剖位置。结果　锁骨下静脉第 2段一般走行于锁骨内侧中下 1/3处 ,占 80 .6 % (14 5 /180 )。其解剖位置在左右和性别之间无统计学差异 (P >0 .0 5 )。穿刺成功率 10 0 % ,对准锁骨头中下 1/3处 ,一针穿刺成功率达 95 %。无并发症发生。结论　X线导引下锁骨下静脉穿刺上腔静脉置管术安全、微创 ,成功率高。熟悉锁骨下静脉的X线解剖 ,掌握正确的穿刺方向 ,可以提高一针穿刺成功率。     

颈内静脉两种穿刺置管方法比较

通过建立临时血管通路为急、慢性肾衰竭患者进行血液透析治疗,颈内静脉置人双腔导管是临床最常使用的方法。传统颈内静脉以胸锁乳突肌和颈内动脉搏动等体表标记定位,进行盲探式操作,并发症发生率可高达10％,     

应用ARROW导管进行锁骨下静脉穿刺置管的评价

目的：评价应用ＡＲＲＯＷ导管进行锁骨下静脉穿刺置管的方法。方法：应用ＡＲＲＯＷ导管对６０例住院病人进行了锁骨下静脉穿刺置管。结果：穿刺置管成功率为１００％,在一针穿刺成功方面,右侧为８７．２３％,左侧为５７．１４％。结论：应用ＡＲＲＯＷ导管进行锁骨下静脉穿刺置管是一种安全、快捷的方法。     

超声引导在颈内静脉穿刺置管困难时的应用价值

目的探讨彩色多普勒超声实时引导对颈内静脉置管困难患者的应用价值。方法将80例颈内静脉置管困难患者采用完全随机方法分为盲探穿刺组(A组)和超声引导组(B组),观察两组病人的置管率。结果 40例颈内静脉穿刺置管术在盲探穿刺下,27例穿刺成功,13例穿刺失败,置管成功率为67.5%;40例颈内静脉穿刺置管术在超声引导下,39例成功,1例穿刺失败,置管成功率97.5%。结论彩色多普勒超声实时引导颈内静脉置管有重要的应用价值。     

应用头皮针桡动脉穿刺采血的方法

我们在临床进行动脉血气分析穿刺采血时,多以桡动脉为主,其位置表浅,能通过接触准确定位,内侧为绕侧腕屈肌腱,外侧为肱动脉,没有血管、神经与之比邻,十分安全,不易误入静脉或损伤深层神经,穿刺成功率高,贴近桡骨,压迫止血容易。常规方法采用7号针头、2ml注射器进行穿刺,往往成功率不高,痛苦大,患者不易接受。近3年来,我们改用一次性5号头皮针进行穿刺新方法,与常规方法进行比较,新方法效果明显优于常规法,现介绍如下：     

颈外静脉与颈内静脉穿刺置管的临床应用比较

目的通过对颈外静脉穿刺置管与颈内静脉穿刺置管进行比较,探讨中心静脉置管的最佳途径。方法对40例需行中心静脉置管病人随机分为两组,分别行颈外静脉穿刺置管与颈内静脉穿刺置管,记录总成功率、一次成功率、并发症发生率、穿刺完成时间。结果采用颈外静脉穿刺置管较颈内静脉穿刺一次进针成功率高,且完成时间短。结论颈外静脉穿刺置管具有操作简便、一次穿刺成功率高、完成时间短、并发症少等优点,与颈内静脉穿刺置管比较,它是一种安全实用的中心静脉置管方法。     

经皮穿刺置管负压吸引治疗腹腔脓肿84例

我院1984～1996年实施经皮穿刺置管治疗腹腔感染性脓肿84例,取得令人满意的疗效。1　临床资料1.1　一般情况　男53例,女31例;年龄14～75岁,平均21岁。脓肿部位:肝脏17例,左膈下43例,右膈下12例,右下腹9例,肠间隙3例。合并中毒性休克5例。感染原因:原发性肝脓肿17例,选择性远端脾-肾静脉分流术5例,脾切除后门-奇静脉断流术8例,胃癌根治术12例,腹区外伤术后14例,肝脏术后8例,右侧脓胸致右膈下脓肿5例,阑尾炎穿孔9例,门脉高压、腹水严重感染6例。1.2　操作方法　穿刺前采用B型超声波定位。然后选择脓肿距皮肤最近的安全区做好穿刺标记。可采取…     

一种无创检测桡动脉脉搏波速度的新方法

目的:提出一种同步采集肱动脉脉搏波信号和指尖脉搏波信号无创检测桡动脉脉搏波速度的新方法.方法:用二次函数对起跳点波段按最小二乘法原理逼近计算出脉搏波先后传播到肱动脉和指尖这段距离的时间.结果:大量的病例分析和临床测试表明:脉搏波传导速度与年龄的正相关性为r=0.46,与脉压的正相关性为r=0.622.该算法能够解决波谷...     

Embolization of the Internal Iliac Artery: Cost-Effectiveness of Two Different Techniques

The purpose of this study was to compare the cost-effectiveness of coils versus the Amplatzer Vascular Plug (AVP) for occlusion of the internal iliac artery (IAA). Between 2002 and January 2006, 13 patients (mean age 73 ± 13 years) were referred for stent-grafting of abdominal aortic aneurysm (n = 6); type I distal endoleak (n = 3), isolated iliac aneurysm (n = 3), or rupture of a common iliac aneurysm (n = 1). In all patients, extension of the stent-graft was needed because the distal neck was absent. Two different techniques were used to occlude the IIA: AVP in seven patients (group A) and coil embolization in six patients (group C). Immediate results and direct material costs were assessed retrospectively. Immediate success was achieved in all patients, and simultaneous stent-grafting was successfully performed in two of six patients in group C versus five of seven patients in group A. In all group A patients, a single AVP was sufficient to achieve occlusion of the IIA, accounting for a mean cost of 485 €, whereas in group C patients, an average of 7 ± 3 coils were used, accounting for a mean cost of 1,745 €. Mean average cost savings using the AVP was 1,239 €. When IIA occlusion is needed, the AVP allows a single-step procedure at significant cost savings.     

Renal Stenting from the Radial Artery: A Novel Approach

Purpose: To describe the technique and feasibility of renal artery angioplasty and stenting from the radial artery. Methods: A series of 19 patients were evaluated for transradial renal artery intervention. Procedures were performed using carbon dioxide gas (CO₂) as the preferred angiographic contrast agent. Intervention was performed through a 5 Fr radial artery sheath using low-profile balloons and balloon-expandable stents. Results: Nineteen patients with 26 stenosed renal arteries were considered for treatment via the radial route. A negative Allens test precluded radial puncture in two (11%). In one patient the descending aorta could not be catheterized. Stenting from the radial route was successful in 22 renal arteries in 16 patients. On an intention-to-treat basis 16 of the 19 (84%) were treatable from the radial route. In the 17 patients with radial access technical success was 94% (16 of 17) patients and 91% (21 of 23) of renal arteries. One patient experienced a cerebrovascular event during intervention. Conclusion: Transradial renal artery intervention is technically feasible using low-profile angioplasty balloons and stents. This route offers advantages in renal arteries with a caudal angulation and in patients with diseases or tortuous iliac arteries.     

16层螺旋CT后处理方法在评价冠状动脉狭窄中的应用价值

目的 探讨16层螺旋CT各种后处理方法在诊断冠状动脉中度以上狭窄中的价值。资料与方法 41例患者均行16层螺旋CT冠状动脉成像以及传统冠状动脉造影（CAG）,将CT横轴位图像以及后处理图像多平面重建（MPR）、最大密度投影（MIP）、容积重建（VR）以及仿真内镜（VE）分别与CAG对照,分析评价不同后处理图像在诊断冠状动脉中度以上狭窄中的应用价值。结果 MPR、MIP、VR、VE判断冠状动脉中度以上狭窄的敏感度、特异度、阳性预测值、阴性预测值分别为84．5％、94.4％、90．9％、90．3％;45.1％、82．4％、62．7％、69．5％;57．7％、87．0％、74．5％、75．8％;52．1％、85．1％、69．8％、73.0％。结论 MSCT多种后处理方法各有其优缺点,在诊断中应以横轴位图像结合MPR为主,VR、MIP和VE为辅,能准确、立体、直观地显示并判断冠状动脉病变。     

Radial Artery Coursing Behind the Biceps Brachii Tendon: Significance for the Transradial Catheterization and a Clinically Oriented Classification of the Radial Artery Variations

In routine clinical practice the variations of the radial artery are the main reason for technical failure during transradial catheterization. If these variations are well documented, however, they do not represent a problem in the transradial approach. Therefore, we report here a rare case of the radial artery which is very strange but potentially valuable for the clinical practice: it arises at a right angle from the brachial artery and passes behind the biceps brachii tendon. Based on our findings and on an extensive literature review, we propose for the first time a clinically oriented classification of the variations of the radial artery. This classification is related to the catheterization success at the usual access site of the radial artery at the wrist.     

桡动脉与股动脉行冠脉介入诊疗术的不良反应与并发症比较

目的对比经桡动脉与经股动脉行冠脉介入诊疗患者术后不良反应与并发症发生情况。方法将504例次行冠脉介入诊疗的患者分为A组(经桡动脉组)270例次、B组(经股动脉组)234例次,并观察、记录、对照二者的不良反应、并发症发生情况。结果 A组患者穿刺侧肢体疼痛、烦躁失眠、腰背疼痛、排尿困难或尿潴留、局部皮肤损伤等发生率明显低于B组(P<0.05或0.01),而动脉痉挛或畸形需更换入路或放弃的情况明显高于B组(P<0.05或0.01);手术并发症,A组患者拔管迷走神经反射、出血、血肿等情况的发生率明显低于B组(P<0.05或0.01),而动脉瘤、动脉闭塞、骨筋膜室综合征的发生率两组比较无统计学差异(P>0.05)。结论经桡动脉途径创伤小、并发症及不良反应少、卧床时间短、术后处理相对方便、安全,给患者带来的心理压力小,术后体位舒适,患者容易接受。     

不同剂量对比剂多层螺旋CT正常犬肾动脉成像比较

目的 探讨不同剂量对比剂在多层螺旋CT (MSCT)犬肾动脉成像上的可行性.材料与方法 6只健康家犬按随机数字表法平均分为碘海醇1.62、2.02、2.40ml/kg组.每只犬每一剂量各扫描3次,共计54次,每次扫描间隔时间至少48h.根据轴位及后处理图像,对3种剂量肾实质显影情况、肾动脉清晰程度及肾动脉分支显示情况进行评分,测量肾动脉主干及分支不同部位CT值与腹主动脉信噪比.结果 3种剂量肾实质显影程度较低,差异无统计学意义(P＞ 0.05);3种剂量均能清晰显示肾动脉主干及3级分支,显示程度评分各组间差异无统计学意义(P＞0.05);3种剂量测得肾动脉主干及分支不同部位CT值组间差异均无统计学意义(P＞0.05);3种剂量腹主动脉信噪比组间差异无统计学意义(P＞ 0.05).结论 使用较低剂量对比剂( 1.62ml/kg)行MSCT犬肾动脉成像可以获得良好且符合临床诊断的图像.     

Transient and Regional Ischemia Related to Continuous Saline Solution Infusion during Radial Artery Access

This case series illustrates a radial access complication seen in 7 of 9 consecutive patients (age range, 44–53 y) undergoing uterine artery embolization in May and June 2017. Demonstrative images and videos identify a transient and clinically consequential skin ischemia caused by intraprocedural saline solution infusion through the occlusive radial artery sheath. All complications documented were classified as mild adverse events (class A) according to Society of Interventional Radiology criteria. Complication severity ranged from transient blanching to ischemic necrosis of the skin. Operator cognizance of this phenomenon with appropriate adjustment of saline solution infusion rates will prevent tissue ischemia and necrosis in radial access cases.