碳—钛组合式人工股骨头临床应用15年随访

自1980年4月至1995年4月,应用碳—钛组合式人工股骨头治疗髋关节疾患319例。随访最短1年,最长15年。随访结果:股骨颈骨折组优良率93％,股骨头无菌性坏死组优良率89.8％。余者2例失败,4例髋关节周围钙化,2例碳质头略大,3例假体下沉,1例类风湿性髋关节强直,术后关节再强直。1例髋臼硬化,4例6髋关节明显疼痛。4例死于心血管疾病。我们体会到碳质材料具有良好的物理、化学性能和生物相容性,是一种优良的人工关节材料。碳—钛组合式人工股骨头是目前优良的人工假体之一。     

Design of a Centrifugal Blood Pump with Magnetic Suspension

Abstract: A new concept blood pump, whose impeller is suspended by permanent magnets and a mechanical pivot without seals or ball bearings, is presented in this paper. The primary aim of the blood pump is an application to implantable artificial hearts. The prototype model is of a centrifugal type with a four-vaned semiopen impeller 50 mm in diameter. Since this mechanism has no seals or ball bearings, flow stagnation or heat generation that might cause blood cell denaturation is expected to be small. The results of performance testing for the prototype model 2 were satisfactory regarding pump head and efficiency. The radial-suspension magnets and the magnetic coupling were stable. As a result, the present mechanism has been verified to be a candidate applicable to implantable artificial hearts.     

A Biomechanical Double Sac (Pericardium-Pebax) for Specially Shaped Artificial Ventricles: A Computerized Study to Evaluate Its Mechanical and Volumetric Properties

Abstract: For original ovoid shaped artificial ventricles. a biomechanical double sac consisting of a biological sac (porcine pericardium) as the blood contact interface and a synthetic sac (Pebax 3533) as the mechanical support to assume systolic-diastolic dynamic constraints was conceived. The volumetric and mechanical properties were assessed with a three-dimensional modeling of Pebax sacs and computerized simulations of their systolic distortions for both right and left ventricular configurations. The stresses and strains of these sacs were represented as quantitative mappings for a maximum end-systolic state and were below the respective threshold values above which the Pebax material is jeopardized for permanent structure impairment. After fatigue tests applied on Pebax strips under the alleged working conditions of Pebax sacs, the material structure was unchanged and maintained its intrinsic mechanical properties. The theoretical maximum stroke volumes were 74.4 cm³ and 62.4 cm for the left and right ventricular configurations, respectively. With these mechanical and volumetric features, the biomechanical double sac concept was considered valid and could be provided for a consequent specific total artificial heart.     

71例初产妇前置胎盘与人工流产相关性分析

目的:探讨初孕人工流产与再孕后前置胎盘发生率的相关性。方法:对1992年1月～2001年12月住院分娩的4046例初孕人工流产进行回顾分析,对影响前置胎盘发生率的因素进行x~2检验。结果:初产妇前置胎盘发生率为1.75％;人工流产次数越多,末次人工流产术后至本次妊娠时间间隔越短;人工流产术后有生殖道感染史者,前置胎盘发生率明显增高。结论:人工流产术是前置胎盘的高危因素,应加强育龄妇女的生殖健康宣传和教育,做到有计划受孕,减少非意愿妊娠的发生。     

Delayed pain response after lumbar discography

Summary The delayed onset of symptomatic pain following lumbar discography (with no immediate pain response) is described in six patients, five with a minimum 2-year follow-up. It is usually seen in patients with nearly normal disc morphology who have incomplete or discrete annular tears that are not filled at the time of injection. Later (2–12 h in this study), dye leakage occurs through these lesions, thereby precipitating the discogenic pain This phenomenon may be missed and is probably more common than previously believed due to early discharge from the hospital, the patient expecting discomfort after the invasive study (hence no complaint is made), and the clinician being unaware of this delayed symptom, thereby not asking about it in follow-up. Close patient questioning regarding a delayed onset of symptomatic pain after discography is, therefore, an essential element in diagnostic information following this study.     

不同部位静脉注射对无痛人工流产术的影响

目的 :观察不同部位静脉注射对无痛人工流产术的影响。方法 :随机将 2 0 0例要求行无痛人工流产术的患者分成二组 ,一组静脉注射部位为手背静脉组 ,另一组静脉注射部位为肘部浅静脉 (贵要静脉或肘正中静脉 )组 ,观察静脉推注异丙酚时患者的注射部位有无疼痛症状。结果 :肘部浅静脉注射部位疼痛感明显轻于手背静脉 ,肘部浅静脉注射部位的麻醉起效时间快于手背静脉 ,两组差异有显著性 (P <0 0 5 )。结论 :选择肘部浅静脉注射异丙酚可减轻患者注射部位的疼痛 ,可在短时间内取得理想的麻醉效果。     

Invasive ventilation in the emergency department: Part 2: Implications for patient safety

The use of mechanical ventilation in the Emergency Department requires adequate resources in order to maintain patient safety and avoid potential risks. Moreover, developments in technology require increased knowledge of mechanical ventilation techniques to address the complexity of decision-making involved. Organisational issues and system factors have the potential to negatively impact on the ability of the emergency service to provide optimum care to patients receiving mechanical ventilation. These issues include staffing and skill-mix, demand on emergency services, role-delineation, scope of practice, and current mechanisms for monitoring of quality and safety. Furthermore, in response to advances in ventilator technology, current education programs for both nursing and medical staff require review to ensure that they provide comprehensive information about the types of ventilation techniques now available and the relative risks and benefits associated with their application.This article is the second in a two-part series and explores the educational and organisational factors that impact upon safety and quality of care delivered to patients receiving mechanical ventilation in the emergency department. Recommendations for future policy development, curriculum review and reporting mechanisms to support further research in the application of mechanical ventilation in the emergency department are made.     

骨水泥型人工股骨头假体治疗高龄股骨颈骨折

目的报告骨水泥型人工股骨头假体治疗高龄股骨颈骨折的疗效。方法131例患者(新鲜骨折101例,陈旧性骨折30例按Garden分型:Ⅱ型23例,Ⅲ型62例,Ⅳ型46例),取后外侧切口安置骨水泥型人工股骨头,术后药物预防静脉血栓。结果随访0.5～8年,优良率96.4%。结论骨水泥型人工股骨头假体置换术具有手术简单,术后恢复快等优点,适用于高龄股骨颈骨折患者。     

Cora Rotary Pump for Implantable Left Ventricular Assist Device: Biomaterial Aspects

Abstract: Our group is developing a left ventricular assist device based on the principle of the Maillard-Wankel rotative compressor: it is a rotary, not centrifugal, pump that produces a pulsatile flow. Stringent requirements have been defined for construction materials. They must be light, yet sufficiently hard and rigid, and able to be machined with high precision. The friction coefficient must be low and the wear resistance high. The materials must be chemically inert and not deformable. Also, the materials must be biocompatible, and the blood contacting surface must be hemocompatible. We assessed the materials in terms of physiochemistry, mechanics, and tribology to select the best for hemocompatibility (determined by studies of protein adsorption: platelet, leukocyte, and red cell retention: and hemolysis, among other measurements) and biocompatibility (determined by measurement of complement activation and toxicity, among other criteria). Of the materials tested, for short- and middle-term assistance, we chose titanium alloy (Ti₆AI₄V) and alumina ceramic (Al₂O₃) and for long-term and permanent use, composite materials (TiN coating on graphite). We saw that the polishing process of the substrate must be improved. For the future, the best coating material would be diamond-like carbon (DLC) or crystalline diamond coating.     

The effects of inverse ratio ventilation on intracranial pressure: a preliminary report

Objective: To determine the effects of pressure control inverse ratio ventilation [PC-IRV], as compared with volume controlled normal ratio ventilation [VC], on the intracranial pressure [ICP] of patients with severe head injury. Design: A prospective study with unblinded intervention. Setting: The Intensive Therapy Unit of a base hospital. Patients and participants: Nine cases of head injury requiring mechanical ventilation and intracranial pressure monitoring were studied. Interventions: Patients were twice transferred from VC (I:E ratio 1:2) to PC-IRV (I:E ratio 2:1). Firstly, tidal volume was maintained at an equal value. Secondly, end tidal CO₂ was maintained at an equal value. No other changes were made to ventilation, vasopressor therapy or ICP control. Measurements and results: Measurements were taken of ICP, mean arterial pressure (MAP) end tidal CO₂ and respiratory parameters. In the first observation, there were significant changes in peak inspiratory pressure (PIP), mean airway pressure (Paw) and intrinsic positive end expiratory pressure (PEEP) but not for ICP, end tidal CO₂, MAP and cerebral perfusion pressure (CPP). The correlation between change in ICP and change in end tidal CO₂ was r=–0.74. In the second observation there were significant changes in tidal volume, PIP, Paw and intrinsic PEEP but not for ICP, MAP and CPP. The correlation between the change in ICP and the change in Paw was insignificant. Conclusions: PC-IRV has a minimal net effect on ICP. Changes in ICP correlate more strongly with changes in CO₂ than changes in Paw. Received: 16 January 1996 Accepted: 2 September 1996