比格犬肝门静脉置管并体外留置模型的建立

目的 建立比格犬肝门静脉置管并体外留置模型.方法 将6只比格犬行气管插管吸入麻醉,取右腹直肌切口,定位肠系膜上静脉及肝门静脉主干,游离、切断肠系膜上静脉左侧属支,将中心静脉导管(PICC)插入并置于肝门静脉主干内,结扎固定.导管末端经右侧腹壁皮下引至颈背部穿出并固定.结果 实验组6只比格犬麻醉效果良好,手术全部成功,平均手术时间约1 h,平均出血量约15 ml,术后5~7 d手术切口愈合.结论 比格犬肝门静脉置管并体外留置模型的成功建立,可提高肝脏的靶向性用药药效、减少用药剂量、降低治疗或实验成本并减少药物不良反应;通过置管可直接采集肝门静脉血测得口服药物或毒物在首过消除之前的血药浓度,间接计算胃肠吸收率,为开展相关实验研究提供技术支持.     

犬门静脉高压症食管胃底静脉曲张模型的建立及评价

目的介入栓塞肝静脉建立犬肝后型门静脉高压模型并加以评价,为临床治疗提供可靠、稳定的模型动物。方法 10条健康成年比格犬为研究对象,介入栓塞部分肝静脉建立犬肝后型门静脉高压模型,术后根据肝功能、超声和影像学检查等指标进行评估。结果 10条比格犬8只造模成功,形成门静脉高压模型,与术前相比,肝功能显著异常,门静脉压力明显升高(P<0.01)。经CT强化及门静脉血管成像,6只形成曲张静脉。结论本组所采用的方法简单易行,制备周期明显缩短。模型质量可靠,可形成稳定的食管静脉曲张模型,以用于门脉高压症食管胃底静脉曲张出血的相关研究。     

旁路移植生物材料重建上矢状窦动物模型研究

目的建立比格犬上矢状窦旁路移植模型,探索利用此模型移植生物型材料重建上矢状窦的可行性。方法健康成年雄性比格犬8只,体重12.5～22.0kg,骨窗开颅暴露两侧上矢状窦并阻断后,在显微镜下行移植材料与上矢状窦的端-侧吻合,术后给予抗感染等对症处理。分别于移植后1、24、8、周进行上矢状窦造影和彩色多普勒检查(CDFI),8周时处死动物,行植入材料的组织学检查。结果术后上矢状窦造影和CDFI检查显示,8只犬中2只吻合口轻度狭窄、CDFI流速较高,1只吻合口有少许渗漏、CD-FI流速稍低,另5只上矢状窦造影及CDFI检查均无异常。8周后植入材料和上矢状窦吻合处均有内皮细胞生长,并向移植材料内爬行。结论成功建立了上矢状窦旁路移植模型,近期效果良好,但远期效果尚有待进一步观察。     

可降解输尿管支架对输尿管战创伤后肾功能的保护作用

目的 建立一种新的输尿管战创伤动物模型,研究生物可降解输尿管支架在输尿管战创伤治疗中对肾功能的保护作用.方法 使用自行研制的火器弹片伤制造模具,对模型建立组9只比格犬的随机一侧输尿管制造火器弹片伤后清创缝合,分别于术后40,80,120 d进行静脉肾盂造影、肾图评估.再对阳性对照组9只比格犬的双侧输尿管均制造火器弹片伤,随机一侧放置聚乳酸可降解输尿管支架,另一侧放置双J管,对其结果进行评估.结果 模型建立组损伤侧术后出现肾积水,肾脏浓聚,排泄功能下降.阳性对照组术后双侧均未见明显肾盂、输尿管积水;双肾分浓缩率比值(可降解支架/双J管)上升,半排时间比值(可降解支架/双J管)上升,但差异均无统计学意义;可降解支架侧未见膀胱输尿管反流(vesico-ureteral reflux,VUR),双J管侧有反流.结论 成功建立了比格犬火器弹片伤动物模型.可降解支架与双J管均起到了支撑、引流作用;可降解支架可有效保护输尿管膀胱交界处的抗反流功能.     

可降解输尿管支架对输尿管战创伤后肾功能的保护作用

目的 建立一种新的输尿管战创伤动物模型,研究生物可降解输尿管支架在输尿管战创伤治疗中对肾功能的保护作用.方法 使用自行研制的火器弹片伤制造模具,对模型建立组9只比格犬的随机一侧输尿管制造火器弹片伤后清创缝合,分别于术后40,80,120 d进行静脉肾盂造影、肾图评估.再对阳性对照组9只比格犬的双侧输尿管均制造火器弹片伤,随机一侧放置聚乳酸可降解输尿管支架,另一侧放置双J管,对其结果进行评估.结果 模型建立组损伤侧术后出现肾积水,肾脏浓聚,排泄功能下降.阳性对照组术后双侧均未见明显肾盂、输尿管积水;双肾分浓缩率比值(可降解支架/双J管)上升,半排时间比值(可降解支架/双J管)上升,但差异均无统计学意义;可降解支架侧未见膀胱输尿管反流(vesico-ureteral reflux,VUR),双J管侧有反流.结论 成功建立了比格犬火器弹片伤动物模型.可降解支架与双J管均起到了支撑、引流作用;可降解支架可有效保护输尿管膀胱交界处的抗反流功能.     

植入式静脉输液港导管断裂预防与处理

目的 探讨植入式静脉输液港(IVAP)导管断裂及其预防处理.方法 回顾性分析2012年1月至12月单中心878例IVAP植入患者中发生导管断裂7例患者临床资料,结合相关文献对导管断裂原因和预防措施进行讨论.结果 截至2016年11月31日,经颈内静脉植入IVAP术后导管断裂发生率为0.8％(7/878);断裂时间为术后855～1 412 d,平均1 133 d;断裂部位为导管进入颈内静脉交界处、导管与底座接头处和皮下隧道部位.结论 导管断裂是IVAP植入后长期使用过程中严重并发症之一.规范手术操作流程、加强维护和护理宣教、适时取出等措施,有助于降低IVAP导管断裂发生率,保障患者生命安全.     

胶囊内镜用于比格犬上消化道检查方法的建立与初步应用

目的 探索胶囊内镜用于比格犬等较大体型动物上消化道黏膜疾病实时监测的方法及可行性.方法 (1)对PillCam SB2型胶囊内镜进行简单改造,采用4号手术线一端束缚胶囊内镜的腰部做牵引线,另一端从胃管的顶端穿过,从一侧孔穿出胃管,通过拉伸将胶囊内镜顶靠在胃管的前端;(2)麻醉比格犬,胃管辅助胶囊内镜通过比格犬口咽送入食管、胃腔.(3)40％无水乙酸40 ml灌胃,胶囊内镜检查系统观察消化道黏膜变化.结果 (1)改装后的胶囊内镜在胃管的帮助下可以顺利地进入比格犬食管和胃内,并可通过拉伸牵引线将胶囊式内镜顶靠在胃管的前端部,控制胶囊内镜改变拍摄位置和角度.(2)40％无水乙酸40 ml灌胃,成功制造比格犬急性胃黏膜病变模型.(3)胶囊内镜可以清晰拍摄胃腔图像,观察胃黏膜在不同时间点出现的不同表观变化,实现对动物消化道疾病模型黏膜变化的实时监测.结论 成功建立了胶囊内镜实时监测上消化道黏膜急性病变发生发展的方法,将其初步应用于观察体型较大动物比格犬胃黏膜急性损伤过程中的表观变化是可行的.     

我国完成首例微创血管介入手术机器人动物实验

2009年12月27日由中国人民解放军海军总医院、北京航空航天大学机器人研究所和北京医院合作完成我国首例微创血管介入手术机器人动物实验。海军总医院的医生在监控室遥控手术室内的血管介入手术机器人,将导管成功插入实验犬颈动脉。手术时间30min,术后1h,实验犬恢复正常活动。     

纳米膜单铆型室间隔缺损封堵器动物实验研究

目的：在室间隔缺损（VSD）犬模型中评价新型纳米膜单铆型VSD封堵器经导管植入的可行性、安全性和有效性,为临床应用提供实验依据。方法取健康成年犬26只,在开胸X线导引下通过右心室游离壁穿刺室间隔方法制备VSD模型;分为实验组（n=13,植入纳米膜单铆型VSD封堵器）和对照组（n=13,植入镍钛合金双铆型VSD封堵器）。术后1、2、3、6个月分别通过心脏大体标本、光镜、电镜检测及血镍离子浓度测定等评价新型封堵器植入后内皮化过程,观察有无残余分流、血栓形成等并发症。结果对26只犬成功建立开胸小切口 VSD 模型。实验组纳米膜单铆型 VSD 封堵器植入成功率为100%,对照组镍钛合金双铆型VSD封堵器植入成功率为91．7%。术后1、2、3、6个月分别取出25只犬心脏大体标本,观察显示两组封堵器位置均无移位,无合金丝断裂,盘面未见血栓形成和赘生物附着。术后1个月实验组封堵器双侧盘面可见薄层透亮组织覆盖,病理和电镜检查证实为纤维组织和内皮细胞;至术后6个月,盘面组织逐渐增厚,封堵器边缘与周围心脏组织融合。结论纳米膜单铆型VSD封堵器设计科学,与镍钛合金双铆型VSD封堵器相比并发症少,完全内皮化时间缩短,可有效封堵VSD,具有良好的临床应用前景。     

HPLC-MS/MS测定比格犬血浆中非诺贝酸浓度及其药代动力学研究

目的建立快速有效的HPLC-MS/MS方法测定比格犬血浆中非诺贝特的代谢物非诺贝酸,并探讨其在比格犬体内的药代动力学。方法 4只健康雄性比格犬随机分为两组,在禁食状态下口服给药〔非诺贝特片（纳米）和对照药Tri-cor〕,HPLC-MS/MS测定非诺贝酸浓度。流动相为甲醇-水（0.1%甲酸）,在200μl.min-1流速下梯度洗脱,地西泮为内标,色谱柱为Thermo Syncronic-C8,柱温：20℃。质谱测定利用多离子监测扫描模式,电离方式为ESI正离子模式,检测离子反应非诺贝酸为m/z 319.10→232.86,地西泮为m/z 285.04→193.04。血药浓度数据经Origin Pro 7.5与WinNonlin Phoenix软件处理,计算主要药动学参数。结果本方法中非诺贝酸在5～1000 ng.ml-1范围内线性良好（r2〉0.98）,定量下限为5 ng.ml-1。方法的精密度准确度,专属性,绝对回收率,稳定性和基质效应均符合要求。非诺贝特纳米片和Tricor在比格犬体内的主要药动学参数：tmax为（1.50±1.16）和（1.94±2.48）h、t1/2为（8.58±3.41）和（8.02±2.08）h、Cmax为（5857.20±3563.44）和（6697.56±3912.92）ng.ml-1、AUC为（25 328.13±16 009.09）和（26 379.89±17 392.47）ng.h.ml-1。结论建立了准确、灵敏的HPLC-MS/MS检测方法用于比格犬血浆中非诺贝特代谢产物非诺贝酸的含量测定;研究了非诺贝酸在比格犬体内的药代动力学,结果显示非诺贝酸在比格犬体内的代谢动力学过程呈单室模型,该结果为不同来源非诺贝特片的生物等效性研究奠定了基础,为非诺贝特临床安全合理用药提供参考依据。     

放射性液体球囊剂量分布的影响因素探讨

目的研究放射性液体球囊在血管组织内剂量分布的影响因素。方法用模拟实验和理论计算两种方法估算注射压力对球囊的扩张能力、球囊内气泡、导管内核素对血液的不必要照射等影响因素。结果不同注射压力下球囊对血管组织产生的剂量不同，在压力大于4个大气压后，达到最大平衡。球囊内的气泡体积随着压力的增加而减少，对血管剂量的影响也变小。导管内的液体对血液组织有一定剂量的照射。结论用放射性球囊治疗患者时，注射压力、球囊内气泡和导管内的液体对剂量分布有影响。     

Tantalum labelling in vivo of cardiac ventricular chambers in dogs

Demarcating fixed points in cardiac ventricles in the dog by catheter placement of tantalum coils has been shown to provide an excellent physiologic model. A new method emplying direct ventricular puncture has been developed for implanting these markers. The method has several advantages over an earlier peripheral catheter technique. Apical approach allows easier screw placement near the aortic and pulmonary valves. Peripheral vessels are left intact and pressure monitoring as well as contrast medium injection can be performed through the same catheter.     

Ultrasound catheter placement for deep posterior compartment pressure measurements in chronic compartment syndrome

Medial shin pain, often referred to as shin splints, is a common but difficult to diagnose entity in many athletes. Chronic deep posterior compartment syndrome as a cause of medial leg pain is still controversial. The problems of deep posterior compartment pressure measurement contribute to this controversy. These problems include safety of catheter insertion and the possibility that the patient has more than one deep posterior compartment. In this paper, we present a new technique for catheter placement in which continuous ultrasound guidance is used. This technique allows for the safe placement of the catheter into the deep posterior compartment and for documentation of catheter tip location.     

Hybrid treatment with angiographic catheter in massive pulmonary embolism: mechanical fragmentation and fibrinolysis

PURPOSE: Massive pulmonary embolism is a severe clinical condition that requires prompt therapeutic intervention. We report our experience with a hybrid treatment involving systematic fragmentation of the embolus with an angiographic catheter associated with fibrinolytic therapy over the following days. MATERIALS AND METHODS: From 1999-2005 we treated 164 patients with massive pulmonary embolism. We used the same angiographic catheter for mechanical fragmentation and for administration of the fibrinolytic agent (24-72 h). Results were assessed on the basis of changes in mean pulmonary artery pressure. RESULTS: After fragmentation with the angiographic catheter, we observed four types of haemodynamic behaviour: in 61 patients (41.4%), mean pulmonary artery pressure fell rapidly below 30 mmHg; in 38 patients (23.1%), two passes were required to achieve the same result; in 32 patients (19.5%) three passes were required. In the remaining 26 patients (15.8%), at no time did the mean pulmonary artery pressure fall below 35 mmHg. The only two deaths occurred in this last group. CONCLUSIONS: Mechanical fragmentation with the angiographic catheter and administration of fibrinolytic agents effectively brought about a rapid improvement in patients' clinical status by moving the embolus towards the periphery.     

Hepatic venous pressure measurements: comparison of end-hole and balloon catheter methods

PurposeTo determine the difference in hepatic venous pressures measured with the use of an end-hole diagnostic catheter versus a balloon catheter.Materials and MethodsA total of 92 patients underwent transjugular hepatic venous pressure measurements with a 5-F diagnostic end-hole catheter and a balloon catheter, with the catheter type used initially determined randomly. With both catheters, free and wedged systolic, diastolic, and mean pressures were collected. Hepatic venous pressure gradients were calculated from each pressure set. Eighty-five patients (92%) also underwent concurrent transjugular biopsy after pressures were recorded. Demographic, histologic, and specific procedural information were also collected.ResultsThe study included 47 men and 45 women, with a mean age of 52.7 years (range, 19–84 y). For the entire population, there were statistically significant differences in mean measurements between the two catheters in wedged systolic (P = .004), diastolic (P = .021), and mean (P = .036) pressures. However, the differences between the means were only 0.783, 0.609, and 0.207 mm Hg, respectively. A subanalysis based on histologic stage revealed no difference between catheter types for normal or cirrhotic livers, but a significant (P = .017) difference in systolic wedged pressure (absolute difference of 0.67 mm Hg) in patients with mild to moderate fibrosis (stages 1–3). In all differences, the balloon catheter had the greater pressure reading.ConclusionsThere was a significant difference in wedged pressure measurements between the two catheter systems in the overall population and among patients with a histologic grade indicating fibrosis. However, the absolute value differences between the two systems were comparatively small (< 1 mm Hg).     

273例水溶性造影剂子宫输卵管造影的技术因素分析

目的：探讨子宫输卵管造影过程中，技术因素对造影影像质量及造影成功率的影响。方法：对273例不孕症，用76％泛影葡胺采用传统通液管法和球囊导管并加压注射法两种方式作子宫输卵管造影检查。结果：采用传统通液管法造影154．例，成功149例(96．75％)，其中125例(83．89％)双侧输卵管显示；采用球囊导管并适时加压注射法造影119例，造影成功119例(100％)，111例(93．28％)双侧输卵管显示。结论：数字点片、利用球囊导管以及加压注射，可以提高造影成功率，并明显提高输卵管的显示效率。     

Clogging of drainage catheters: quantitative and longitudinal assessment by monitoring intracatheter pressure in catheters and rabbits

PURPOSE: To develop a method for the quantitative and longitudinal assessment of clogging in drainage catheters and to confirm the validity of the method. MATERIALS AND METHODS: Intracatheter pressure was measured during the infusion of saline at a rate of 0.1-3.0 mL/sec in nine catheters with different internal diameters. With the data obtained, a fitting equation between the intracatheter pressure and internal diameter was derived on the basis of the Poiseuille law. To confirm the validity of this measurement method, four drainage catheters were inserted into the peritoneal cavity in each of 15 rabbits. Intracatheter pressures at infusion rates of 0.1 and 0.5 mL/sec were monitored for 14 days, while the degrees of catheter clogging were graded on the basis of the different frequencies of manual irrigation: one, two, or three times per day. Repeated measures analysis of variance was used to determine the statistical significance of differences in pressure between different irrigation frequencies. RESULTS: Pressure was measured successfully throughout the experiment except in three rabbits with dislodged catheters. Three to 14 days after catheter insertion, the pressures were significantly lower in catheters with higher irrigation frequencies than in those with lower irrigation frequencies (P <.05). The effective internal diameter of each catheter could be monitored by means of the derived fitting equation. CONCLUSION: This method can be used to quantitatively measure the degree of clogging of a drainage catheter. It can also be used for comparative or longitudinal in vivo studies concerning the effectiveness of drainage procedures or catheter development.     

Pressures during retrograde pyelography

Model experiments were conducted to simulate the conditions of injection rate and pressure during retrograde pyelography. Pressures at the upper and lower end of a Ch. 5 and Ch 6. ureteral catheter were determined with 30% and 45% sodium meglumine diatrizoate and water and with different needles allowing leakage of the injected medium from a reservoir at the upper end of the catheter. It is concluded that the pressure at the upper end of the catheter may be kept within physiologic range if (1) the contrast medium is injected slowly, (2) the contrast medium leaks back around the ureteral catheter into the bladder and (3) a contrast medium with a low viscosity is used. It is advisable to use a Ch. 5 ureteral catheter instead of a Ch. 6 for retrograde pyelography.     

Catheter fragmentation of acute massive pulmonary thromboembolism: distal embolisation and pulmonary arterial pressure elevation

The aim of this study was to evaluate the relationship between pulmonary arterial pressure and distal embolisation during catheter fragmentation for the treatment of acute massive pulmonary thromboembolism with haemodynamic impairment. 25 patients with haemodynamic impairment (8 men and 17 women; aged 27-82 years) were treated by mechanical thrombus fragmentation with a modified rotating pigtail catheter. After thrombus fragmentation, all patients received local fibrinolytic therapy, followed by manual clot aspiration using a percutaneous transluminal coronary angioplasty (PTCA) guide catheter. Pulmonary arterial pressure was continuously recorded during the procedure. The Friedman test and Wilcoxon test were applied for statistical analysis. Distal embolisation was confirmed by digital subtraction angiography in 7 of the 25 patients. A significant rise in mean pulmonary arterial pressure occurred after thrombus fragmentation (before: 34.1 mmHg; after: 37.9 mmHg; p<0.05), and this group showed a significant decrease in mean pulmonary arterial pressure after thrombus aspiration (25.7 mmHg; p<0.05). No distal embolisation was seen in 18 of the 25 patients, and a significant decrease in mean pulmonary arterial pressure was confirmed after thrombus fragmentation (before: 34.2 mmHg; after: 28.1 mmHg: p<0.01), and after thrombus aspiration (23.3 mmHg; p<0.01). In conclusion, distal embolisation and a rise in pulmonary arterial pressure can occur during mechanical fragmentation using a rotating pigtail catheter for the treatment of life-threatening acute massive pulmonary thromboembolism; thrombolysis and thrombus aspiration can provide partial recanalization and haemodynamic stabilization. Continuous monitoring of pulmonary arterial pressure may contribute to the safety of these interventional procedures.     

双刃导管切割肺动脉瓣的临床应用

用可折叠的双刃导管切割狭窄的肺动脉瓣,可缓解右室排血的受阻。在多次动物实验,证实其可行性和安全性后,即进行临床应用。3例手术前后的右心室压力分别从85,100和120mmHg降至42,60和90mmHg。最后一例年龄13岁,圆锥部狭窄较重,术后造影显示狭窄口已扩张,但右室压力下降不明显,再用球囊导管作瓣口成形术,右室压力降至48mmHg。