经尺动脉途径介入治疗冠心病术后半年平板运动试验评估心功能

目的:观察经尺动脉途径介入治疗冠心病术后半年平板运动试验对心功能的评估结果,比较经尺动脉途径和经桡动脉途径介入治疗的可行性。方法:在10例患者中应用经尺动脉途径成功7例,其中5例为冠脉造影,2例为支架植入,与经桡动脉途径病例105例进行比较,并对两组患者中接受经皮腔内冠状动脉成形术(percutaneoustransluminalcoronaryangioplasty,PTCA)及支架植入者进行随访,同时应用活动平板运动试验评估患者心功能情况。结果:经桡动脉途径与经尺动脉途径穿刺及导管操作的平均时间犤冠状动脉造影(60±30)min,PCI(83±24)min犦差异无显著性意义。冠状动脉造影及支架植入的成功率经两种途径差异无显著性意义。7例患者中没有并发症发生,术后随访平板运动试验评价的心功能均得到改善。结论:尺动脉可作为另一个可行的冠状动脉诊断和治疗途径,同时可保留桡动脉用于做外科冠脉搭桥。经尺动脉途径介入治疗冠心病后通过活动平板运动试验检测发现,此种术式能显著改善患者术后的心功能。     

经尺动脉途径介入治疗冠心病术后半年平板运动试验评估心功能

目的：观察经尺动脉途径介入治疗冠心病术后半年平板运动试验对心功能的评估结果。比较经尺动脉途径和经桡动脉途径介入治疗的可行性。方法：在10例患者中应用经尺动脉途径成功7例，其中5例为冠脉造影，2例为支架植入。与经桡动脉途径病例105例进行比较，并对两组患者中接受经皮腔内冠状动脉成形术(percutaneous transluminal coronary angioplasty，PTCA)及支架植入者进行随访，同时应用活动平板运动试验评估患者心功能情况。结果：经桡动脉途径与经尺动脉途径穿刺及导管操作的平均时间[冠状动脉造影(60&;#177;30)min，PCI(83&;#177;24)min]差异无显著性意义。冠状动脉造影及支架植入的成功率经两种途径差异无显著性意义。7例患者中没有并发症发生，术后随访平板运动试验评价的心功能均得到改善。结论：尺动脉可作为另一个可行的冠状动脉诊断和治疗途径，同时可保留桡动脉用于做外科冠脉搭桥。经尺动脉途径介入治疗冠心病后通过活动平板运动试验检测发现，此种术式能显著改善患者术后的心功能。     

用桡动脉进行冠状动脉旁路术：二维及彩色多普勒超声对术前移植血管安 全性的评估

目的　应用桡动脉行冠状动脉旁路术前对桡动脉的条件进行评估 ,作为移植血管的筛选 ;对尺、桡动脉间侧支循环状况进行监测 ,以防术后出现手部缺血。方法　 30例接受用桡动脉进行冠状动脉旁路术患者 ,取左桡动脉 2 8例 ,右桡动脉 2例。应用彩色多普勒超声术前对患者双侧桡动脉内径、内中膜厚度、血流通畅情况进行检测 ,测量在桡动脉受压前后尺动脉血流动力学的变化及拇指动脉和桡动脉掌浅支的血供情况。术后 10～ 2 0d对尺动脉、拇指动脉、桡动脉掌浅支的血流动力学进行检测。结果　桡动脉受压时 ,尺动脉收缩期峰值流速 (PSV)迅速增加 (P <0 .0 1) ,以尺动脉的PSV增加值 >30 %作为血管移植的必备条件 ;桡动脉受压时 ,拇指动脉有血流信号 ,桡动脉掌浅支出现反向血流 ,作为尺、桡动脉间侧支循环完善的标志 ;术后尺动脉流速代偿性增加 ,拇指动脉和桡动脉掌浅支由尺动脉供血。结论　彩超对冠状动脉搭桥术前血管桥 (桡动脉 )的筛选及术后对手掌部血运的评估具有重要的应用价值     

超声刀在冠心病患者外科治疗中的应用

目的 探讨应用超声刀切取桡动脉用于冠状动脉旁路移植术的效果. 方法 冠心病患者60例.使用超声刀改进"不接触"技术切取桡动脉,用于冠状动脉旁路移植术. 结果 共切取桡动脉63条,全部血流良好并成功用于冠状动脉旁路移植术,无并发症发生. 结论 超声刀具有良好的切割止血作用,切取桡动脉简便、快速、安全,可以明显减少对桡动脉的刺激.     

用桡动脉进行冠状动脉旁路术∶二维及彩色多普勒超声对术前移植血管安全性

目的 应用桡动脉行冠状动脉旁路术前对桡动脉的条件进行评估,作为移植血管的筛选：对尺、桡动脉间侧支循环状况进行监测,以防术后出现后部缺血。方法 ３０例接受用桡动脉进行冠状动脉旁路术患者,取左桡动脉２８例,右桡动脉２例。应用彩色多普勒超声术前对患者双侧桡动脉内径、内中膜厚度、血流通畅情况进行检测,测量在桡动脉受压前后尺动脉血流动力学的变化及拇指动脉和桡动脉掌浅支的血供情况。术后１０￣２０ｄ对尺动脉、拇指动脉、拇指动脉、桡动脉掌浅支的血流动力学进行检测。结果 桡动脉受压时,尺动脉收缩期峰值流速（ＰＳＶ）迅速增加（Ｐ〈０．０１０,以尺动脉的ＰＳＶ增加值〉３０％作为血管移植的必备条件;桡动脉受压时,拇指动脉前血流信号,桡动脉掌浅支出现反向血流,作为尺、桡动脉间侧支循环完善的标志;术后尺动脉流速代偿性增加,拇指动脉和桡动脉     

超低出生体重儿有创血压监测使用尺动脉置管的可行性研究

目的探讨超低出生体重儿有创血压监测使用尺动脉置管的可行性及效果。方法将我科125例超低出生体重儿分成4组,A组19例采用尺动脉置管,B组55例采用桡动脉置管,C组35例采用肱动脉置管,D组16例采用胫后动脉置管,比较4组患儿一次性穿刺成功率、留置时间及并发症发生率。结果桡动脉穿刺成功率最高,维持时间长,但其并发症高,而尺动脉及肱动脉穿刺成功率及维持时间相当,胫后动脉的置管率及维持时间较短。结论选择尺动脉进行穿刺获得成功,可作为新生儿动脉穿刺失败的补充途径。     

桡动脉冠状动脉旁路移植术患者血浆血栓调节蛋白水平与早期预后的相关性分析

目的分析桡动脉冠状动脉旁路移植术患者血浆血栓调节蛋白(TM)水平与早期预后的相关性。方法将193例桡动脉冠状动脉旁路移植术患者根据术后24 h血浆TM水平分为TM低水平组97例和TM高水平组96例。根据出院6个月心脑血管事件发生情况,将患者分为预后良好121例和预后不良72例。采用ELISA法检测血浆TM水平,分析2组一般资料、手术情况、合并疾病情况及预后情况,分析影响桡动脉冠状动脉旁路移植术患者早期预后的因素。结果与TM低水平组比较,TM高水平组体质量指数(BMI)较高、左室射血分数(LVEF)较低、吸烟史例数较多,差异均有统计学意义(P 0.05)。与TM低水平组比较,TM高水平组合并2型糖尿病、新发及陈旧性心肌梗死例数较多,差异均有统计学意义(P 0.05)。TM高水平组预后良好率低于TM低水平组,差异有统计学意义(P 0.05)。多因素Logistic回归分析显示,TM、新发及陈旧性心肌梗死是影响冠心病患者桡动脉冠状动脉旁路移植术后发生不良预后的独立危险因素(P 0.05),LVEF是影响冠心病患者桡动脉冠状动脉旁路移植术后发生不良预后的保护因素(P 0.05)。结论血浆TM水平与患者术前身体状况有一定联系,TM高水平患者术后不良心脑血管事件发生率高于低水平患者,TM水平变化对评估冠心病患者预后有重要意义。     

经桡动脉行冠状动脉旁路移植术病人围术期护理

经桡动脉行冠状动脉旁路移植术是目前较为推崇的搭桥手术。桡动脉内膜较薄，血管腔具有很好的收缩性和舒张性，且桡动脉有足够的长度、适中的口径及取材容易，作为冠状动脉搭桥的桥管远期通畅率高。但是，桡动脉肌层较厚，易发生痉挛，取材前后患肢的护理、桥管的保护是手术前后的护理要点．我科2004年5月-2005年1月经桡动脉行冠状动脉旁路移植术16例，均取得良好疗效。     

桡动脉途径失败后经同侧尺动脉途径行冠脉介入诊疗42例分析

目的：探讨桡动脉穿刺及置管失败后经同侧尺动脉途径行冠脉介入诊疗的可行性。方法：总结了2004—03／2009—0542例经桡动脉途径失败后改为同侧尺动脉穿刺行冠脉介入诊疗的临床资料。结果：经同侧尺动脉穿刺均获成功,其中41例置管成功并完成冠脉介入诊疗。结论：桡动脉途径失败后经同侧尺动脉途径行冠脉介入诊疗是安全可靠的。     

非体外循环冠状动脉旁路移植术患者术后活化凝血时间监测对伤口引流量的影响

传统意义上将循环冠状动脉旁路移植术分为体外和非体外两种。体外循环冠状动脉旁路移植术相对非体外循环冠状动脉旁路移植术风险更低[1]。非体外循环冠状动脉旁路移植术是一种比较复杂且难度比较高的手术,但随着医疗水平的提高,以及医生手术水平的提高,现已成为比较普遍的手术[2-3]。本研究通过对60位进行非体外循环冠状动脉旁路移植术患者术后伤口引流量进行监测。     

Unexpected Giant “V” waves during pulmonary artery catheterization

Two cases of catheterization of the pulmonary artery, in which the hemodynamic findings were very different from the initial clinical diagnosis, are presented. The importance of verifying the adequate position and motion of the pulmonary artery catheters with two consecutive chest x-rays is discussed. In particular, attention is brought to the possible misinterpretation that occurs in patients with very elevated pulmonary artery mean pressure.     

Radial artery catheterization by surgical exposure in infants

56 radial arteries were cannulated by cutdown technique in 54 critically ill infants (age (mean±SD) 12.2±25.9 days, weight 2710±910 g) for continuous pressure monitoring and repeated blood sampling. 30 patients survived their illness, 24 died. The mean catheterization time in the survivors was 8.1±4.1 in the non-survivors 6.9±5.6 days. Most cannulae were removed electively. 27 of the surviving infants were followed up after 10.5±5.1 months. 25 (86%) vessels were patent, 4 (14%) occluded. No trophic changes of hands or fingers were noted. We conclude that radial artery cannulation by cutdown in infants is a quick and safe technique and is suitable in patients with severe peripheral vasoconstriction.     

经股动脉途径Wistar大鼠选择性肝动脉插管及造影技术

目的 探讨经股动脉途径Wistar大鼠选择性肝动脉插管及造影技术,为大鼠泡状棘球蚴病肝动脉灌注治疗提供可靠的实验方法。 方法 采用雄性Wistar大鼠30只,分别切开腹部及右侧腹股沟区,在直视下行经股动脉选择性肝动脉插管及造影术。 结果 30只Wistar大鼠,26只插管成功,24只造影成功。插管和造影的成功率分别为86.67%(26/30)和80.00%(24/30)。造影图像较为满意,可见动脉期早期肝动脉增宽、纡曲,可见"抱球征",毛细血管期可见病灶呈环形染色,中央染色变淡。 结论 经股动脉途径Wistar大鼠肝动脉插管及造影技术简便易行,成功率较高,可提高大鼠泡状棘球蚴病肝动脉灌注治疗研究的可靠性与准确性。     

Ultrasound-guided radial artery catheterization and the modified Allen's test

In this case report, ultrasound-guided radial artery catheterization and a modified Allen's test were performed by Emergency Department (ED) physicians to facilitate the management of an intubated, critically injured patient. Ultrasound was demonstrated to be a valuable tool in determining collateral circulation and guiding radial artery cannulation in a patient unable to cooperate with the traditional Allen's test. Ultrasound guidance may reduce the risk of radial artery catheterization in severely injured patients.     

Fatal right-sided nonbacterial endocarditis associated with pulmonary artery catheterization

Pulmonary artery (PA) catheterization is now a routine procedure in the care of critically ill patients. We report a case in which a pulmonary artery catheter was a major factor in the demise of a patient who developed adult respiratory distress syndrome following a septic abortion.     

变异支气管动脉超选择性插管的介入治疗

目的：评价在变异支气管动脉的情况下，行超选择性插管栓塞治疗各种病因咯血的技术和价值。方法：在9例支气管动脉变异的肺癌、支气管扩张咯血患者中，右支气管动脉与第3、4、5右肋闯动脉共干4例；左右支气管动脉共干1例；右下支气管动脉与左下支气管动脉共干2例；左支气管动脉由左第6肋间动脉约7cm处呈“T”形垂直发出1例；右支气管动脉由右锁骨下动脉发出1例。采用Seldinger经皮穿刺技术插管，先送入5F或6F的型号的Cobra导管行支气管动脉造影，继选择微导管对病变供血的支气管动脉分支逐支行超选择性插管造影，采用明胶海绵颗粒＋超液化碘油或／和PVA颗粒栓塞剂进行栓塞。结果：9例患者均插管成功，术后咯血停止及病情得到控制。无严重并发症发生。结论：应用微导管技术，行超选择性相关支气管动脉逐支插管，采用明胶海绵＋超液化碘油和／或PVA的介入方法，对变异的支气管动脉介入治疗是安全有效的。     

Guide wire-sheath technique for pulmonary artery catheterization and central vein cannulation

The combination of a spring guide wire with a sheath introducer system has been successfully used for the routine placement of pulmonary artery and central venous catheters. The method, which is described is simple, quick, and safe. It is applicable to the initial placement of the catheter, to any necessary alterations in its position and to its eventual replacement with a central venous cannula.     

Pulmonary artery catheterization.

After two decades, hemodynamic invasive monitoring using a flow-directed, balloon-tipped, pulmonary artery (PA) catheter has established itself as a significant component of acute clinical care. In spite of continued recommendations for limitations, restrictions, moratoria, and even abandonment, growth in catheter use continues. Attempts to replace it by competing technologies for routine clinical practice have not been successful thus far. More than one million PA catheters are inserted in the United States annually. The clinical utility and value of the pulmonary artery catheter depend largely on the interpretation of information obtained. Clinical interpretation of data is influenced by an understanding of cardiopulmonary hemodynamics, technical skills, and professional integrity of the physician using the device. After a brief history, this article focuses on the technical aspects of the insertion procedure, choice of hardware, and acquisition and analysis of information. Indications, contraindications, and clinical utility are briefly described. Major complications from PA catheterization reported in the literature since clinical introduction of the catheter are summarized.