胃镜直视下置入支架治疗食管癌性狭窄的临床分析

目的 总结分析胃镜直视下置入自膨式食管支架的方法、疗效及常见并发症的预防及处理.方法 采用无痛内镜技术,在胃镜直视下行狭窄再通及扩张术,然后置入自膨式镍钛加膜记忆支架.结果 46例患者治疗均获成功,达到了改善进食和提高生活质量的治疗目的 ,一次支架置入至再梗阻的时间最短102 d,最长181 d,放置支架最多者为3次3个,共存活750 d.结论 内镜直视下自膨式食管支架的置入技术操作简单,痛苦轻微,疗效可靠,设备简单,手术安全.     

自膨式金属胆道支架治疗不同类型恶性胆道梗阻的支架阻塞原因分析

目的 分析自膨式金属胆道支架治疗不同类型恶性胆道梗阻的支架阻塞原因.方法 84例不同类型恶性胆道梗阻患者接受美国Boston公司Wall-stent白膨式金属胆道支架治疗,其中原发性胆管肿瘤45例,转移性肿瘤39例,记录随访患者支架通畅时间并进行比较,从而分析引起胆道支架阻塞的原因.结果 支架放置成功率100%(84/84),原发性胆管肿瘤的支架通畅时间平均为160d,与转移性肿瘤的180d接近(P＞0.05);引起自膨式金属胆道支架的阻塞原因主要是肿瘤组织通过支架网眼向支架内生长、组织血凝块引起支架阻塞、乳头括约肌炎性组织向支架内生长以及肿瘤组织生长超过支架两端引起支架阻塞、胆泥形成.结论 原发性胆管肿瘤的支架通畅时间与其他肿瘤接近,肿瘤类型对金属支架通畅时间的影响无明显差异.     

Protege GPS自膨式外周血管支架系统

美国ev3公司生产的Protege GPS自膨式外周血管支架系统(Protege GPS Self-Expanding Peripheral Stent System)已于2015年1月21日由FDA获准进入美国市场。该产品是一种细长且具有弹性的网状金属管,可植入动脉中向骨盆及下肢供血。该系统由支架和输送系统两部分组成。其中的支架部分系一种由钛镍合金制成的植入物,并使用激光将其切割为网状。使用时需将支架部分置于一根细长型的管状设备——传输导管之中。Protege GPS自膨式外周血管支架系统的工作原理如     

自膨式带放射性粒子食管支架治疗食管恶性狭窄20例临床观察

食管恶性狭窄是食管癌手术后复发和晚期食管癌的常见症状,患者往往需要多次进行食管狭窄球囊扩张,且狭窄扩开后短时间内易复发.置入支架虽然效果较好,但肿瘤组织往往会自支架缝隙中长入[1-2].2008年我院开始采用自膨式带放射性粒子带膜支架对食管恶性狭窄进行扩张、支撑和近距离放疗.为了探讨自膨式带放射性粒子带膜支架对食管恶性狭窄的治疗效果,我们选择应用自膨式带放射性粒子食管支架治疗的20例患者和传统食管支架治疗的20例患者进行对比分析,现将结果报告如下.     

自膨式支架辅助弹簧圈治疗颅内囊状动脉瘤的效果观察

目的探究自膨式支架辅助弹簧圈治疗颅内囊状动脉瘤的效果。方法选取2011年4月~2013年4月在我院经自膨式支架辅助弹簧圈治疗颅内囊状动脉瘤的27例患者为研究对象,术后统计患者的并发症发生情况,并采用数字减影血管造影(DSA)下全颈脑血管造影检查对患者瘤体完全闭塞率进行检查,并对患者进行三年随访观测患者的治疗效果。结果术中并发症发生率低,且患者后期随访瘤体完全闭塞率检查明显优于术后即可检查结果,差异显著,P<0.05,具有统计学意义。结论采用自彭式支架辅助弹簧圈治疗颅内囊状动脉瘤效果显著,且安全可靠。     

自膨式金属内支架在治疗左半结肠癌梗阻中的临床应用价值

目的 探讨肠镜下置自膨式金属内支架在治疗左半结肠癌梗阻中的临床应用价值.方法 2005年11月～2007年12月,17例左半结肠癌梗阻病人,住院后在肠镜辅助下扩张梗阻狭窄处并置入金属支架,恢复结肠通畅,从而可以按非梗阻性结肠癌的肠道准备方法 行术前肠道准备,准备时间3～10 d.其中15例行Ⅰ期结肠癌根治切除吻合,另外2例因肿瘤晚期,无法手术切除.结果 11例患者行左半结肠切除,4例患者行乙状结肠切除,均Ⅰ期行结肠端端吻合,术后无一例吻合口瘘发生,无创口感染.2例晚期病人解除梗阻,且改善生活质量.结论 肠镜下置自膨式金属内支架为微创治疗结肠梗阻开辟了一条新的途径,支架置入后Ⅰ期切除吻合治疗左半结肠癌梗阻是安全、可行的.     

颈动脉狭窄的血管内支架治疗及并发症分析

目的 探讨颈动脉粥样硬化性狭窄的血管内自膨胀支架治疗的临床价值及并发症分析.方法 经脑血管造影证实的颈动脉狭窄患者16例,应用远端栓子保护装置,球囊预扩张狭窄部位,释放自膨支架.结果 所有支架释放定位准确,狭窄消除,围手术期出现1例脑出血.临床随访1例再发短暂性脑缺血发作,超声示再狭窄.结论 血管内支架成形术是治疗颈动脉狭窄的可行的方法.     

血管内支架成形术治疗颈动脉粥样硬化性狭窄16例报道

本文总结血管内自膨式支架成形术治疗颈动脉粥样硬化性狭窄的临床体会，探讨该技术的适应证、并发症防治及初步疗效。结果，支架定位准确，11例患者狭窄完全消失，4例狭窄程度减少90％以上，1例减少70％。1例术中发生脑梗死，无其他手术并发症发生。临床随访5～18个月（平均9．3）个月，无1例再发生短暂性脑缺血发作或脑梗死，DSA随访10例患者均无再狭窄（6～12个月）。显示血管内自膨式支架成形术是治疗颈动脉狭窄的安全而有效的方法，长期疗效有待进一步观察。     

自膨式带膜支架治疗食管恶性狭窄与食管气管瘘的临床观察

目的:评价自膨式带膜支架治疗晚期食管癌并发食管恶性狭窄或食管气管瘘临床应用价值。方法:对29例晚期食管癌患者在X线电视监视下置入自膨式带膜支架,其中食管恶性狭窄24例,食管气管(支气管)瘘5例。结果:均一次置放成功,全部病例术后吞咽功能立即得到改善,并发食管气管瘘呛咳消失。患者术后能进软食或普食,提高了生活质量。结论:自膨式带膜支架治疗食管恶性狭窄安全有效,并发症少,有效提高生存期。     

食管内放射 NiTi 支架的研制及临床应用结果简

目的：针对食管癌“易发,晚期患者生活质量差”的现状,结合普通NiTi记忆合金覆膜支架技术和近距离放射治疗技术,使用网格自扩张式支架形式,在成形NiTi裸支架表面固化一层含放射性同位素屹^125Ⅰ的医用高分子膜制造成食管内放射NiTi支架。其可设计成局部带放射区域的局部放疗支架,配合带定位功能的输送装置将支架放送到病患部位,达到选择性放疗的目的。方法：通过随机入组的方法招募晚期食管癌或贲门癌患者72例,分别进行普通支架植入（对照组）与食管内放射NiTi支架（试验组）治疗。试验将“消化道梗阻缓解状况”作为主要观察指标,以术后2个月的“消化道梗阻缓解状况”评分下降值作为主要疗效指标。次要观察指标主要为：肉芽组织增生评价、肿瘤大小客观评价、总生存期、血液毒性评价、甲状腺功能评价及产品的使用性能及可操作性评价。结论：125Ⅰ食管内放射NiTi支架的腔内适形放疗,早期临床使用产生了令人鼓舞的肿瘤局部控制率。由于放射性同位素物理剂量在支架表面的均匀分布,避免了近距离治疗的“冷点”或“盲区”,对正常组织的损伤明显降低,与外照射相比,降低了每个照射剂量单位的生物损伤效应。通过对“食管内放射NiTi支架”近百例的临床应用,结果表明治疗效果显著且甲状腺毒性及其他不良反应发生概率与普通NiTi~忆合金食管支架相同,而且此种技术的支架临床使用与普通支架操作一样简单、方便,利于普及。     

Thermal characteristics of clothing ensembles for use in heat stress analysis

The Heat Stress Index was an early model for the assessment of heat stress. The International Organization for Standardization (ISO) standard for required sweat rate is the current generation of heat balance methods for occupational heat stress. The method assumes cotton clothing and works adequately for cotton/polyester blends. To extend the usefulness of the model, the thermal characteristics of a variety of commercially available and prototype protective clothing ensembles have been determined for application in the ISO method. The fundamental principle for assessing thermal characteristics of work clothing is establishing the critical environmental conditions in which test subjects were just able to maintain thermal equilibrium. Critical conditions were found for warm, humid conditions; hot, dry conditions; intermediate conditions of temperature and humidity; and/or moderate conditions in which metabolic rate was increased to a limiting thermal load. Typically, five subjects at each condition for each ensemble were used. Metabolic rate, average skin temperature, and the environmental conditions (air temperature and vapor pressure) were noted at the critical conditions, and the total insulation was estimated for each ensemble. From these values, the total evaporative resistance, the clothing factor for dry heat exchange (CFcl), and the clothing factor for evaporative cooling (CFpcl) were determined. When compared with reports of others on thermal characteristics the results agreed when pumping factors and clothing wetness were considered. The result was higher than expected values for CFcl and lower values for CFpcl.     

两种支架含铜宫内节育器铜离子释放及表面腐蚀的研究

通过两种支架含铜宫内节育器在体外模拟宫腔液中浸泡,来了解铜离子释放的过程及铜丝和支架表面形貌的腐蚀。结果表明,不锈钢支架含铜宫内节育器在浸泡第一周有爆释现象（25~12 mg/d）,后期铜离子释放变得缓慢和均衡。记忆合金支架含铜宫内节育器在两个月的释放过程中较为缓慢和均衡（0.5~5 mg/d）。在200倍光学显微镜下对两个月浸泡前后铜丝表面形貌观察表明,不锈钢支架节育器的铜丝腐蚀情况明显比记忆合金支架的铜丝腐蚀严重。     

Investigation of a dual filter sampling method for gaseous and particulate fluoride.

A two stage filter method designed to separate gaseous and particulate fluoride utilizing an alkaline treated filter to trap gaseous fluoride and post sampling heat treatment of the filters to promote desorption of gaseous fluoride from particulate phase was compared to standard impinger methods for the collection of hydrogen fluoride. Results indicate a high degree of comparability between the two methods. Initial studies involving the recovery of HF from dusted filters by heat treatment suggest recovery rates may vary directly with the amount of HF sampled for a given dust load.     

综合保温措施在PACU全麻术后预防寒战的效果分析

目的：探讨综合保温措施在PACU全麻术后预防寒战的效果,为临床护理工作提供参考。方法：将460例全麻手术患者按照随机数字表法分为常规治疗组220例和综合保温组240例。常规治疗组按常规调节室温22～25℃及覆盖棉被保温。综合保温组在常规治疗组处理的基础上采用升温毯升温,术中、术后使用各种液体、冲洗液、吸痰液,术前消毒液均用温箱加温至37℃等综合保温措施。观察两组患者手术前30 min、手术结束时、在PACU期间和转入病房前10 min的体温,清醒、拔管和离室的时间以及术后寒战发生情况。结果：综合保温组患者手术前30 min、手术结束时、在PACU期间和转入病房前10 min的体温均明显高于同期的常规治疗组,差异均有统计学意义（P〈0.01）。综合保温组低体温发生率明显低于常规治疗组,寒战的分级情况明显优于常规治疗组,且清醒、拔管和离室的时间均明显短于常规治疗组,差异均有统计学意义（P〈0.01）。结论：采用综合保温措施有利于对全麻术后患者的复苏,可有效预防和减轻寒战的发生,值得临床推广应用。     

复方中药治疗大连地区高温引发重症中暑的应用及疗效观察

目的探讨复方中药临床治疗高温天气引发重症中暑患者的可行性及临床应用前景。 方法选取2018年8月1日至2018年8月12日在大连大学附属中山医院住院治疗的重症中暑患者20例作为研究对象,其中男性13例,女性7例;年龄61～96岁,平均年龄(77.1±7.78)岁。采用简单随机法将其分为实验组和对照组,每组10例。对照组进行西医常规对症治疗,实验组在西医常规治疗的基础上加用复方中药水煎剂保留灌肠治疗。比较两组患者高热持续时间(腋下测量法,≥39℃)、体温恢复时间、意识恢复时间(可唤醒并清楚回答问题)、住院时间,同时比较两组患者在治疗过程中发生的主要脏器功能损害情况。 结果实验组患者高热持续时间为(1.6±1.02)h、体温恢复时间为(10.6±8.40)h、意识恢复时间为(1.87±2.07)d,平均住院时间为(8.75±5.90)d;对照组患者高热持续时间为(5.83±2.53)h、体温恢复时间为(20.78±12.35)h、意识恢复时间为(7±5.60)d,平均住院时间为(9.67±9.57)d,两组差异均有统计学意义(P均<0.05)。实验组治疗显效4例,有效3例,无效3例,总有效率为70.0%;,对照组治疗显效2例,有效3例,无效6例,总有效率为50.0%,差异有统计学意义(P<0.05)。实验组肝功指标、MODS及病死率均低于对照组(P<0.05)。 结论依据大连地区高温引发的重症中暑的特点,运用清热生津养阴的白虎汤合增液汤加减。在西医常规治疗的基础上,加用复方中药水煎剂保留灌肠治疗重症中暑,能缩短患者高热持续时间、体温恢复时间、患者意识恢复时间及住院时间,降低主要脏器功能的损害、MODS发生率以及病死率,具有临床应用前景。     

Long-term and short-term tolerable work-time in a hot environment: The limit values verification

A group of four efficient mine rescuers at the age of 25-35 years were exposed to a load at a cyclo-ergometer (stage A and B) and a hand ergometer (stage E) in a climate chamber. The total period of work of 120 min was divieded into four work intervals, 30 min each. There were 5-min breaks between the individual intervals. The load at the ergometer was selected in the range of 25-150 W, Tg = 20-40 C, rh = 40-80% and va = 0.2-1.5 m.s-1. The thermal resistance of the working suit was 0.65 clo in the stage A, 1.07 clo in the stage B and 0.81 clo in the stage E. A total of 200 experiments with 50 combinations of the work and climate load were made. Heart rate, oxygen consumption, carbon dioxide production, body temperature, skin temperature, water loss by sweating and perspiration, dry and web bulb air temperature, air velocity and globe temperature were measured during the experiments. The expected production of sweat (SR) and the amount of accumulated heat in the body (Qmax) were calculated for each combination of the work-climate conditions by a computing programme ISO 7933:1989 as well as by our own programme.A good agreement was reached between the measured and predicted SR values, calculated by the ISO programme ( r = 0.871) as well as between the values calculated by the two programmes, respectively ( r = 0.985). The experimental results have shown a good agreement between the predicted and actually measured values of temperature of the body core as an index of short-term tolerable climate load. The values of short-term tolerable time of work calculated at the level of the amount of accumulated heat in the body of 50 W.h.m-2 resulted in the increase of body core temperature by 0.8-1.0 K. The values of heart rate mostly did not exceed 140 min-1, reaching in exceptional (three) cases slightly values above 150 min-1. The authors recommend to limit long-term workheat (climatic) load during a higher metabolic rate ( N > 80 W.m-2 include basal metabolic rate) or acclimatized males and females by the sweat rate SR = 270 g.h-1.m-2, of non-acclimatized persons SR = 206 g.h-1.m-2. The limit for low metabolic rates * M 80 W.m-2) for non-acclimatized and acclimatized persons is proposed for long-term tolerable load SR = 147 g.h-1.m-2. Short-term tolerable load by heat storage within organism for all categories is proposed Qmax= 50 W.h.m-2.     

A method to reduce heat strain while clad in encapsulating outerwear

The use of personal protective equipment (PPE) increases the risk of heat related maladies. A means to enhance heat dissipation capacity of individuals clad in PPE would be of benefit. The glabrous skin regions of the hands, face, and feet are portals for direct heat transfer between the body core and the external environment. The effects of PPE outerwear and palmar glabrous skin cooling on heat storage were assessed. Subjects engaged in fixed load treadmill exercise in a thermoneutral environment (T_a?=?20–24°C) or rested in a hot environment (45?±?0.5°C). The use of PPE outerwear increased the rate of core temperature rise by five-fold during vigorous exercise. Palm cooling using a stationary water circulation system attenuated the rate of core temperature rise by 30–60% during rest and light, moderate, and vigorous exercise while wearing PPE outerwear. However, the subjects were tethered to the system. A wearable cooling system was devised that allowed free range of motion and unrestricted mobility. The wearable system provided thermal benefits equivalent to the use of the tethering cooling system. With optimization, this wearable cooling technique could neutralize the negative thermoregulatory effects of wearing PPE while engaged in light workload activities such as those encountered by healthcare professionals working in infectious disease treatment centers. For individuals working at higher workloads, such as firefighters, a wearable glabrous skin-based cooling system could extend work bout duration as well as enhance heat loss during episodic recovery periods.     

Heat stress and strain in an aluminum smelter.

Studies of worker heat stress and strain in aluminum smelters have found that heat exposure likely to exceed the American Conference of Governmental Industrial Hygienists' threshold limit value (TLV) and that the dose-response relationship between heat stress and strain was weak. A heat stress model based on climatic data and a task analysis indicated exposures to heat stress in excess of the TLV during the July/August study period. To study the impact of working above the TLV, heat strain data (i.e., oral temperature, recovery heart rate, average heart rate) were collected. Recovery heart rates indicated high strain most of the time, and oral temperatures after peak demands were above the no-strain threshold of 37.5 degrees C about a quarter of the time, indicating that heat stress had an effect. About 95% of the readings were below 38.0 degrees C, the acute oral temperature threshold for a safe exposure. Average heart rates over 6- and 12-hour intervals were generally below acceptable limits of 120 and 110 bpm, respectively. Oral temperature and average heart rates indicated good control of heat stress exposures. Because recovery heart rates were high, some employees were working near their individual limits. The dose-response relationship for recovery heart rate and oral temperature were examined against the level of heat stress above the TLV. There was no relationship between oral temperature and heat stress level. There was an apparent trend toward higher recovery heart rates with heat stress. The lack of a dose-response relationship may be explained by brief periods of very high wet bulb globe temperatures that drove the time-weighted average up out of proportion to the physiological response.     

一起重症职业性中暑病例的调查分析

作者对一起职业性重度中暑病例的临床症状、体征和诊治过程以及现场劳动卫生学进行调查,结果发现,缺乏预防措施和病例处置不当是该病例发生的主要原因。并进一步通过调查提出高温作业场所中暑防治的对策。     

A field study of thermal stress and recovery using thermoregulatory behavioral and physiological indicators

Summary A field study to optimize the work/rest regimen among foundry welders performing a light to medium work load and welding red-hot items was undertaken during the morning shift. Three work/rest regimens were tested, viz.: work(2h)/rest(1 h) with a team of three welders per shift work(1 h)/rest(1 h) with a team of four welders per shift work(2h)/rest(2h) with a team of four welders per shift.Pulse frequency and core temperature were measured at short intervals during working periods. Thermal alliesthesial reactions (used as a thermoregulatory behavioral indicator) were quantified by the aid of a 5₈ peripheral temperature stimulus of 15, 20, 25, 30, 35 and 38°C on hand, forehead, and back of neck. For each stimulus the subject voted his pleasantness sensation on a five point scale ranging from +10 for very pleasant to -10 for very unpleasant. Temperature stimuli were applied using a Peltier thermode 5.5 x 2.7 cm² in area. The subject also voted his most pleasant temperature on back of neck by voluntary control.The results confirmed previous studies that thermoregulatory behavioral indicators are more sensitive than physiological (e.g., core temperature) indicators in revealing the thermal comfort state of man. The results indicated that the work(2h)/rest(2h) regimen was the most satisfactory of the three regimens tested and was associated with full recovery from thermal stress after the 2 h resting break. This work(2 h)/rest(2 h) regimen was then tested during afternoon and night shifts. The results indicated that the morning shift was more advantageous than the two other shifts with respect to cardiovascular load and thermal strain during working periods, although recovery from thermal stress was achieved after the 2 h resting break in all of the three shifts. Improvement of resting place ambient thermal conditions was proposed to shorten the downtime per man per shift. Radiation shielding of resting place was viewed as economic and effective under these conditions.This work was supported by The European Coal and Steel Community, Luxembourg