新型内镜鼻面罩在纤维支气管镜辅助气管插管中的临床应用

目的 探讨新型内镜鼻面罩在纤维支气管镜辅助气管插管中的临床应用。方法 选择60例拟行纤维支气管镜辅助气管插管的患者,随机分为对照组（n=30）和试验组（n=30）: 对照组采用鼻导管供氧右美托咪定联合低剂量丙泊酚静脉麻醉,试验组采用新型内镜鼻面罩供氧右美托咪定联合低剂量丙泊酚静脉麻醉。记录两组患者SPO2＜90%发生率、插管时间及麻醉前（T0）、麻醉后（T1）、纤维支气管镜进入气道即刻（T2）、气管导管送入即刻（T3）、气管插管后5min（T4）各时间点的平均动脉压（mean arterial pressure, MAP）、心率（heart rate, HR）,比较患者不良反应发生情况,评估患者麻醉效果评估。结果 两组患者均顺利完成纤维支气管镜辅助气管插管。试验组SPO2＜90%发生率明显低于对照组（P＜0.05）;两组插管时间差异无统计学意义（P＞0.05）。与麻醉前（T0）相比,两组MAP、HR在T1时点降低（P＜0.05）;组间比较,两组MAP、HR在各时点差异无统计学意义（P＞0.05）;两组不良反应发生率差异无统计学意义（P＞0.05）;两组麻醉效果均较好,差异无统计学意义（P＞0.05）。结论 两组方法均能安全有效地用于纤维支气管镜辅助气管插管。新型内镜鼻面罩可有效防止静脉麻醉所引起的舌根后坠,保障呼吸道通畅,且供氧充分便捷,值得在纤维支气管镜辅助气管插管中推广应用。     

水囊新法打输尿管隧道在宫颈癌根治术中的应用分析

目的探讨水囊新法打输尿管隧道在宫颈癌根治术中的应用价值。方法回顾分析2018年6～12月在我院确诊的宫颈癌患者临床资料,其中用水囊新法处理输尿管16例(A组)、输尿管导管处理输尿管21例(B组)。比较两组患者手术时间、术中出血量、术后尿管拔除时间、尿潴留发生率、输尿管损伤率、术后发热率、尿路感染发生率等。结果 A组手术时间明显短于B组,但差异无统计学意义(P0.05);两组患者术中出血量、术后住院时间、术后尿管拔除时间、术后尿潴留发生率比较差异无统计学意义(P0.05)。A组术后抗生素使用时间明显短于B组,术后发热、尿路感染、术后血尿发生率明显低于B组,差异均有统计学意义(P均0.05)。两组患者术中、术后均未发生输尿管损伤。术后3个月随访过程中,B组患者中4例出现尿路感染,1例出现肾积水,A组患者无尿路感染或泌尿系统损伤的发生。结论在行广泛子宫切除手术时,为避免术中输尿管损伤,术中水囊新法打输尿管隧道是可行的,可有效避免术中输尿管的损伤,不增加患者经济负担,且不增加术后并发症的发生,具有临床推广价值。     

微创经皮肾镜取石术后气囊导尿管作肾造瘘管的优势

目的：评估双腔气囊导尿管在微创经皮肾镜取石术(minimally invasive percutaneous nephrolithotomy,mPCNL) 后作肾造瘘管的优势。方法：前瞻性收集2015年10月至2016年4月明确诊断为上尿路结石且应用mPCNL治疗的137例 患者的临床资料,随机将病例资料分为气囊导尿管组(实验组,n=69)与普通造瘘管组(对照组,n=68)。对照研究两组 术后出血量、出血天数、管道脱落情况、疼痛程度,并总结mPCNL术后肾造瘘管的护理经验。结果：实验组术后出 血量、出血天数明显低于对照组,差异均有统计学意义(均P<0.01)。实验组术后脱管率较对照组明显降低,差异有统 计学意义(P<0.05)。两组术后疼痛评分差异无统计学意义(P>0.05),实验组患者并未由于放置气囊导尿管而出现其他 并发症和不适症状。结论：上尿路结石行mPCNL后,留置双腔气囊导尿管替代普通肾造瘘管是安全的,能有效减少 术后出血,并且可降低术后脱管率,不增加患者术后疼痛,可降低术后护理难度及风险。     

Contemporary management and outcomes of infective tunnelled haemodialysis catheter-related right atrial thrombi: a case series and literature review

INTRODUCTIONInfective haemodialysis catheter-related right atrial thrombus (CRAT) is a complication of tunnelled catheter use. Management recommendations are based mainly on published case series prior to 2011. We report our institution’s recent experience in managing infective haemodialysis CRAT and correlate treatment with outcomes.METHODSWe conducted a retrospective analysis of haemodialysis CRAT cases diagnosed on transthoracic echocardiography between 1 January 2011 and 31 December 2017. Clinical outcomes, including mortality at 180 days post diagnosis and thrombus resolution, were traced from electronic medical records.RESULTSThere were 14 cases identified. The median age was 59 (range 47–88) years and 11 (78.6%) were male. Sepsis was the most common reason for hospitalisation (71.4%). Blood cultures identified Staphylococcus aureus in seven cases, of which two were methicillin-resistant. Three had coagulase-negative Staphylococcus. All cases received antibiotics with infectious disease physician input. Seven were treated with catheter removal alone, of which three died within 180 days. Both cases treated with catheter removal plus anticoagulation survived at 180 days. Of the two cases who had anticoagulation without catheter removal, one died within 180 days and the other did not have thrombus resolution. Three underwent surgical thrombus removal, of which two died postoperatively and the last required repeated operations and prolonged hospitalisation. Mortality at 180 days post diagnosis was 42.9%.CONCLUSIONCatheter removal and anticoagulation are modestly effective. Surgery is associated with poor outcomes. Despite contemporary management, infective haemodialysis CRAT still results in high mortality. Prospective studies are needed to identify the optimal management.     

新型双球囊导管在经皮选择性隔离肝脏灌注化疗中的应用

目的探讨自制双球囊导管在经皮选择性肝脏隔离灌注化疗(PSIHP)中的应用效果。方法实验猪12头,利用介入放射学方法进行双球囊导管选择性隔离肝脏灌注化疗结合血液灌流。化疗药物选用5-FU。比较灌注及未灌注区域肝细胞形态和凋亡指数。结果灌注区域肝细胞损伤明显,肝细胞凋亡指数(51.82%±5.34%)明显高于未灌注区域肝细胞凋亡指数(4.12%±0.84%)(P<0.01)。结论自制新型双球囊导管能有效隔离肝脏,对未灌注区域肝组织有良好的保护作用,是一种理想的隔离肝脏灌注化疗的球囊导管。     

球囊辅助阻断下腔静脉治疗肾肿瘤合并下腔静脉瘤栓

目的探讨球囊辅助阻断下腔静脉治疗肾肿瘤伴下腔静脉瘤栓的疗效。方法总结2005年5月至2006年5月收治的肾肿瘤伴下腔静脉瘤栓患者9例,其中男性6例,女性3例;年龄20—76岁,平均年龄53岁;右肾肿瘤8例,左肾肿瘤1例。对患者在球囊辅助下阻断下腔静脉,行患肾切除下腔静脉取栓。结果手术均单纯经腹切口完成,取出下腔静脉内瘤栓平均长度5．0cm（3．0～6．7cm）,术中血压、心率平稳,术后无并发症,随访6～18个月,死亡1例,存活8例。结论应用球囊辅助阻断下腔静脉,极大地方便了Ⅱ型、Ⅲ型瘤栓手术的操作,降低了手术创伤和风险,具有临床推广价值。     

11例带涤纶套长期静脉留置导管患者行血液透析的护理体会

目的观察带涤纶套长期静脉留置导管的护理、留置时间、并发症及其处理,延长导管的使用时间。方法观察11例留置带涤纶套的双腔导管进行维持性血液透析患者的护理情况,总结护理办法。结果 11例患者透析时血流量均能保证透析充分。结论良好的护理是延长导管使用寿命和防治并发症的必要条件。     

Feasibility and efficacy of placement of continuous sciatic perineural catheters solely under ultrasound guidance in children: a descriptive study

Background: Placement of sciatic catheters with ultrasound and stimulating catheters is known. Literature regarding catheter placements with only ultrasound is limited. We aimed to investigate the feasibility of performing continuous sciatic nerve block exclusively with ultrasound guidance and minimal equipment. Method: Forty ASA 1 and 2 patients aged 8 months–10 years posted for congenital talipoequinovarus surgery were included in the study. Continuous sciatic catheters were placed under ultrasound guidance with 18‐ gauge Tuohy needle at the infragluteal fold. Then, 0.25% of bupivacaine 0.5 ml·kg^?1 bolus was injected followed by continuous infusion later. Half the volume of the drug was injected prior to catheter insertion to improve visibility. The sciatic nerve, needle tip and shaft, catheter tip and the drug spread were visualized. The efficacy of the block intraoperatively and postoperatively was evaluated. Results: The sciatic nerve, needle shaft, and tip were well visualized in all 40 patients. The catheter tip was seen in 72.5% of patients. The effect of block was complete intraoperatively and postoperatively. Clinically significant complications were absent. Conclusion: We conclude that in children, continuous sciatic catheters can be accurately and efficaciously placed with minimal equipment with ultrasound alone.     

非体外循环冠状动脉旁路移植术患者FloTrac-Vigileo系统与肺动脉导管技术监测心指数的一致性

目的 评价非体外循环冠状动脉旁路移植术患者FloTrac- Vigileo( FV)系统与肺动脉导管(PAC)技术监测心指数(CI)的一致性.方法 拟行非体外循环冠状动脉旁路移植术患者43例,年龄53～75岁,身高150～ 183 cm,体重46～100 kg,ASA分级Ⅱ或Ⅲ级.静脉注射咪达唑仑、舒芬太尼、异丙酚和罗库溴铵行麻醉诱导,麻醉维持:静脉输注异丙酚和瑞芬太尼,间断静脉注射阿曲库铵.于锯胸骨后至搭桥开始前和搭桥完成后至闭合胸骨前,吸入1 MAC七氟醚,其余时间不吸入七氟醚.采用FV系统和PAC技术监测CI.于锯胸骨后未吸入七氟醚时、吸入七氟醚5、15 min时,冠状动脉搭桥完成后未吸入七氟醚时、吸人七氟醚5、15 min时记录两种方法监测的CI数据对,进行一致性分析.结果 FV系统和PAC技术测定CI共计258次配对数据,配对数据平均值的均数(2.8±0.6)L·min- ·m-2.配对数据差值的均数(平均偏差)为0.23 L· min-1·m-2,一致性限度(- 0.57,1.02)L·min-1·m-2,百分误差为28.6％,Kappa系数为0.546.结论 FV系统与PAC技术监测CI的一致性尚可,可替代PAC技术用于非体外循环冠状动脉旁路移植术患者CI的监测.     

输尿管镜下尿道置管治疗尿道球部断裂疗效观察（附13例报告）

目的：探讨输尿管镜下尿道置管术治疗尿道球部断裂的方法与安全性。方法：回顾性分析应用输尿管镜下尿道置管术治疗前尿道断裂患者13例的临床资料。结果：拔管后正常排尿11例,一次性手术治愈占84．61％,最大尿流率（MFR）为（14．7±3．2）ml／S,平均手术时间为（17．7±3．2）min;术后尿道出血2例,占15：38％;6个月年后因尿道狭窄行开放手术1例,占7．69％。结论：在有效地控制治疗适应证的前提下,输尿管镜下尿道置管术治疗尿道球部断裂是安全、有效的方法。