持续缓慢低效血液透析治疗老年Ⅱ型心肾综合征的临床观察

目的比较间断血液透析(intermittent hemodialysis,IHD)和持续缓慢低效血液透析(sustained low-efficiency hemodialysis,SLED)两种血液透析方法治疗老年Ⅱ型心肾综合征(cardiorenal syndrome,CRS)的效果。方法回顾性分析2012年1月至2014年7月在我院治疗的62例老年Ⅱ型CRS患者,均采取右侧锁骨下静脉置入中心静脉导管进行血液透析治疗,按照治疗方法分为IHD组和SLED组,2组观察治疗时间为1周,治疗期均避免大量超滤脱水,避免造成肾灌注不足,加重肾损伤。治疗前及治疗后分别测量中心静脉压(central venous pressure,CVP)、心率(heart rate,HR),采用全自动生化分析仪贝克曼奥林帕斯AU2700检测尿素氮(BUN)、血肌酐(SCr),采用ReLIA多功能免疫检测仪检测N-末端脑钠肽前体(N-terminal Pro Brain Natriuretic Peptide,NT-proBNP),采用飞利浦IE33超声诊断仪检测左室射血分数(left ventricular ejection eraction,LVEF)、肺动脉压(pulmonary arterial pressure,PAP)。结果 2组病例均为老年患者,年龄之间无统计学差异(P0.05)。2组患者治疗后BUN、SCr、NT-proBNP均较治疗前明显降低,LVEF较治疗前明显升高,差异均有统计学意义(P0.01)。IHD组治疗后HR、CVP、PAP下降,差异有统计学意义(P0.05);SLED组治疗后HR、CVP、PAP下降,差异有统计学意义(P0.01);SLED组治疗后HR、CVP、PAP较IHD组均降低,差异有统计学意义(P0.01)。结论IHD和SLED这两种血液透析方法对于老年Ⅱ型CRS患者均有良好的治疗效果。SLED缓慢清除体内多余液体和维持内环境的平稳,并可以持续地清除肾脏髓质在血供不足情况下产生的肾素等多余的心毒性物质,且能维持水、电解质及酸碱平衡,相对于IHD治疗在血液动力学方面更稳定。对于老年Ⅱ型CRS患者采取SLED治疗,既能达到IHD治疗紧急清除毒素、迅速纠正酸碱失衡和电解质紊乱,又能获得较好的血液动力学稳定,而且节约医疗资源,治疗效果更优于IHD。     

In vitro assessment of the trackability of neurovascular intermediate catheters: a comparative analysis

The advent of new flexible intermediate catheters facilitated manual aspiration thrombectomy (MAT) for treating neurovascular ischaemic diseases. While these catheters are somewhat flexible, most catheters were not designed specifically for aspiration. Trackability is an important property of catheters facilitating catheter advancement in highly tortuous cerebrovasculature. In this study, a novel in vitro trackability test system has been developed using micro pressure transducers and silicone tubes. The exerted force from the catheter tips were quantitatively evaluated while the catheter passed the curved regions. The trackability of three different types of catheters were compared, i.e. Penumbra 054, Concentric DAC 057 and Reverse Reflex. The exerted forces obtained from the first sensor (Sensor 1) during passing the second curve showed the maximum values through the entire transcatheter procedure. When compared, the exerted forces were least for the Penumbra 054 (0.272?±?0.012?N), representing highly trackable systems in highly tortuous vessel navigation.     

小剂量无水乙醇经皮腔内室间隔化学消融术治疗肥厚型梗阻性心肌病的疗效及安全性评价

目的:评价使用小剂量无水乙醇经皮腔内室间隔化学消融术(PTSMA)治疗肥厚型梗阻性心肌病(HOCM)的疗效和安全性。方法:12例症状明显、药物治疗无效的HOCM患者行PTSMA术,无水乙醇用量均小于2 ml[平均(1.8±0.2)ml],术前、术后7 d、术后6个月行超声心动图检查测定静息左室流出道压力阶差(LVOTG)、室间隔(IVS)厚度、射血分数(EF),同时询问患者主观症状并进行心功能评价。结果:术后7 d、6个月LVOTG分别为(20.6±4.7)mmHg、(17.7±4.3)mmHg,较术前[(67.2±14.1)mmHg]均显著下降(P<0.01);室间隔厚度分别为(18.3±3.8)mm、(14.1±1.5)mm,较术前[(23.4±4.7)mm]均明显变薄(P<0.01);心功能分别为(1.8±0.4)级(、1.4±0.5)级,较术前[(2.6±0.7)级]明显改善(P<0.01)。EF值无明显变化。症状均不同程度减轻或消失,未见Ⅲ度房室传导阻滞发生。结论:使用小剂量无水乙醇行PTSMA治疗HOCM安全有效。     

经胸心脏超声引导心内射频消融11例

目的 评价在心内射频消融中应用经胸二维超声心动图(TTE)作为影像学引导电极导管到位的可行性、安全性、有效性.方法 10例持续性、永久性房颤患者和1例房扑患者以TTE作为影像学指导电极导管置放、靶点标测.结果 TTE成功引导9例患者行房室结阻断术及心脏永久起搏器植入术,1例患者成功进行了房扑消融,1例患者进行了房室结改良.结论 TTE可成功作为影像学指导,部分或全部替代X线透视引导心内射频消融术.