血液透析患者动静脉内瘘钛轮钉吻合术92例体会

进行血液透析的终末期肾功能衰竭患者,有效的血管通路是至关重要的。随着血透血管通路的不断改进,动静脉内瘘已成为长期透析患者血管通路的基本模式。我院自1997～2000年,用钛轮钉血管吻合器在92例血透患者动静脉内瘘应用中,取得满意效果,现报告如下。     

用钛轮钉建立长久性血管通路

随着血液净化技术的发展,目前的血液透析方法已能使尿毒症患者维持生命20年或更长时间。因此对血管通路的要求也相应提高。动静脉内瘘(I-AVF)是患者长期血透的必备条件,其好坏直接影响到透析效果及患者的生存质量。如何制作和保护内瘘,成为血液净化工作者及患者共同关注的问题。我科从1990年开始采用钛轮钉作内瘘术,建立长久性血管通路,至1999年共458例,报道如下:1 材料及方法 458例病人均为慢性肾功衰、尿毒症需长期血     

B超引导颈内静脉留置导管行血液透析18例的护理

血管通路是血液透析患者赖以生存的生命线,自体动静脉内瘘是长期血液透析患者的首选血管通路,但是在临床实践中,老年、糖尿病,长期血透患者由于动脉粥样硬化、血管中层钙化、营养不良等因素给自身动静脉内瘘的建立带来了困难,我科对急诊血液透析患者及非急诊透析患者,开展B超引导颈内静脉穿刺留置导管,现报告如下。     

钛轮钉血管吻合术在长期血液透析病人中的应用

目的：探讨长期血液透析患者用钛轮钉进行血管吻合的临床观察。方法：应用直径2-2.5 mm钛轮钉对我院226例进行血管吻合,观察手术吻合成功率,血管内瘘通畅率。结果：226例患者手术吻合成功率100%,血管内瘘通畅率100%。结论：应用钛轮钉对长期血液透析患者进行血管吻合,可以明显提高血管吻合的成功率,无明显手术并发症。     

彩色多普勒超声监测尿毒症患者动静脉内瘘的临床应用价值

尿毒症是慢性肾功能衰竭的终末阶段,血液透析是终末肾功能衰竭的替代疗法,而血管通路是血液透析的必备条件,长期进行血液透析依赖于血管通路稳定良好的维持.目前临床广泛用于建立血液循环的途径是动静脉内瘘(AVF),常用的造瘘方式为桡动脉一头静脉端端吻合.应用彩色多普勒超声技术监测动脉静脉内瘘,早期发现异常情况并采取相应的临床措施,可提高血透患者的生存率和生活质量.     

血管插入式动静脉内瘘术施行体会

慢性长期血透病人,建立和保护好一条理想长久的血管通路对患者的生存至关重要。Breein等于1966年首创动静脉内瘘术（称经典内瘘）存在吻合口径不易掌握、需要显微外科技术、手术难度大等问题。作者自2003年3月以来,采用血管插入式的动静脉内瘘术建立永久性血管通道,认为该法有术式简单、易掌握、创伤小、并发症少等优点。     

动静脉内瘘术前血管的保护

血液透析(简称血透)是尿毒症病人最重要的治疗手段之一,而动静脉内瘘(AVF)则是血透患者所必需建立的血管通路。1966 年Brescia首创了皮下动静脉内瘘进行血透,至今35年,AVF 已成为长期血透通路的基本模式。我科10年来为慢性肾功能衰竭(CRF)患者建立AVF共476例,成功458例,失败18例。在临床实践中我们发现建立AVF 的成败很大程度上决定于术前血管的保护。现报告如下。1 资料与方法1.1 临床资料 全部病例均为确诊的CRF(慢性肾功能衰竭)患者,均需长期透析治疗。其中男性326     

钛轮钉在动静脉内瘘手术中的应用及护理

钛轮钉在动静脉内瘘手术中的应用及护理解放军２５４医院血液净化中心何兰珍，陶新朝（天津３００１４２）血液净化技术在我国已广泛开展，建立和保护一条动静脉内瘘（ＡＶＦ），越来越受到医学界的重视。我院从１９９１年５月～１９９３年１０月应用钛制吻合轮钉为６２例...     

维持性血液透析患者植入人造血管内瘘的护理

目的:为了延长血管内瘘后使用寿命和达到满意的透析效果.方法:对维持性血液透析患者,因自身血管条件限制,不能建立理想的血管通路,利用聚四氯乙烯(pTEE)人造血管移植建立动静脉内瘘,建成永久性血管通路,进行血液透析治疗.结果:通过对人造血管动静脉内瘘实施相应的护理,取得了满意的护理效果.结论:人造血管移植建立的动静脉内瘘,只要掌握其穿刺方法和护理,是可以延长瘘管的使用寿命,并取得满意的透析效果的.     

动静脉内瘘术在西宁地区维持性血液透析患者中的临床应用

目的：总结西宁地区（2260m）前臂自体动静脉内瘘进行血液透析的经验，探讨在其应用过程中的体会和并发症的防治。方法：对采用前臂腕部自体动静脉内瘘术建立血管通路的血液透析患者进行分析，探讨建立前臂内瘘的血管条件、手术方式、近远期通畅率、并发症及临床处理原则等。结果：146例患者中，143例手术成功建立血管内瘘，手术一次成功率98％，内瘘初级通畅率97．9%。内瘘使用后0．5年和1年通畅率分别为97％和96％。结论：前臂腕部自体动静脉内瘘术制作简便，远期通畅率高，是血液透析血管通路的首选．     

Optimization of the system of medical service of students of Cadet Schools of the Ministry of Defense of the Russian Federation

One of the factors of the successful military career guidance Cadet schools students is preserving and promoting their health. Medical support of children and adolescents aged 10-17 years should include the full range of medical and preventive measures defined for this group. The state of providing outpatient care for pupils at the Cadet School in St. Petersburg was studied. These results show that full medical care in accordance with the standards can be based only on children's health clinics. It is important that the organization of medical support pupils cadet schools should be cooperate with civilian health care.     

带状疱疹83例误诊原因分析

带状疱疹是由水痘—带状疱疾病毒引起的皮肤科常见疾病。其主要的病理损害,一是受累神经的严重炎症性浸润,继而导致受侵犯神经节内神经细胞变性、坏死;二是皮肤的水泡。迅速抑制神经节和相应的感觉神经纤维的充血、水肿和坏死,防止粘连形成,达到迅速镇痛、改善皮损,缩短病程及防止后遗症的发生是治疗的关键。因而,尽早明确诊断,     

Estimation of accumulated dose of radiation by method of ESR-spectrometry of dental enamel of mammals

ESR-spectrometry was used to investigate radiation-induced paramagnetic centers in enamel of mammals: carnivores (polar bear and fox), ungulates (reindeer, European bison, moose), and man. Values at half the microwave power saturation of the radiation signal, P_1/2, evaluated at room temperature, was found to range from 16 to 26 mW for animals and man. A new approach to discrimination of the radiation induced signal from the total ESR spectrum of reindeer enamel is proposed. ‘Dose-response’ dependencies of enamel of different species mammals were measured within the dose range from 0.48 up to 10.08 Gy. Estimations of ‘radiosensitivity’ enamel of carnivores and ungulates showed good agreement with radiosensitivity enamel of man by ESR method.     

Analysis of the results of the international comparison of activity measurements of a solution of Fe

The results of an international comparison of activity measurements of a solution of ⁵⁵Fe organized by the BIPM in 2005 are reported and analysed. This exercise, which follows the procedures of the CIPM mutual recognition arrangement to update older comparisons, is a renewal of the comparison organized by the BIPM that took place in 1978. A EUROMET comparison was organized in 1996 specifically to compare activity measurements of a ⁵⁵Fe solution by means of liquid-scintillation techniques. Results of these three comparisons are presented and discussed in this paper.

The radionuclide solution was provided by the NPL, which also distributed the samples to the participants. The activity of the ampoules was measured by 16 laboratories using 12 methods producing 25 results. Some general considerations on uncertainty assessments pertaining to the different techniques used are drawn. The outcome of four different estimators is compared from which the presence of at least one outlier can be confirmed. Further measurements should be made to try to reduce the discrepancy between the results. To date the outcome of the present comparison does not show an improvement to that of the 1996 comparison.     

Evaluation of the results of various technics of non-surgical therapy of varicocele

A new method of non-surgical treatment of varicocele syndrome is described: it consists in sclerotherapy of spermatic vein by trans-femoral percutaneous catheterization with balloon-catheters. In 8 cases venous thrombosis has been induced by direct electric clotting. The techniques and a 6 months follow-up are discussed. It is pointed out that this procedure should be considered as the method of choice for tubular lesions and sub-fertility prophylaxis in young people and in childhood.     

延迟性脾破裂误漏诊原因分析

目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率.