射频消融治疗室上性心动过速13例报道

目的 :推广应用射频消融治疗快速心律失常。方法 :穿剌动静脉 ,置入刺激和消融电极 ,经多导电生理仪明确消融靶点 ,在局部引入射频电流 ,破坏折返路径。结果 :经电生理检查诊断为室上性心动过速12例 ,特发性室性心动过速1例 ,在20～40W射频功率下经5～200s的放电消融 ,13例均获得成功(成功率100 %)。结论 :射频消融术是治疗室性心动过速 ,室上性心动过速的有效方法 ,且创伤小 ,安全可靠 ,有较高的推广价值     

Hard tissue laser ablation mechanisms

The aim of this work is the experimental and theoretical investigation of the influence of variable laser parameters (wavelength, fluence, pulse repetition rate) and of the optical and thermophysical properties of bone tissue (absorption coefficient, tissue inhomogeneity) as well as of the sample thickness on ablation thresholds and ablation rate. Ablation and perforation experiments were conducted using a semiconductively pre-ionized transverse excitation atmospheric pressure (TEA) carbon dioxide (CO₂) laser (10.6m and a sliding discharge TEA [hydrogen fluoride (HF)] laser (2.9m). The experimental data are discussed with respect to the following ablation mechanisms: thermal melting and vaporization process, pressure oscillation of gases released by the thermal decomposition of collagen and/or apatite, stresses due to the expansion of superheated water.     

心脏介入治疗院内感染的调查分析

目的：对我科心脏介入治疗后的院内感染发生率及易感因素进行回顾性调查分析,并探讨其防治措施。　方法： 我科自１９７３～１９９９年６ 月共收治行心脏介入治疗患者１ １００ 例,按照年龄、性别、手术种类、院内感染发生率及感染部位等资料进行比较分析。　结果：１ １００ 例患者中,术后感染２７例,感染率为２．４５％ 。包括经皮二尖瓣球囊成形术（ＰＢＭＶ）３８０ 例,感染２１ 例,感染率为５．５３％ ;永久性心脏起搏器安置术５２０ 例,感染６ 例,感染率为１．１５％ ;射频消融术２００ 例,无感染发生。最常见的感染为血管相关性感染和切口感染。感染发生与性别无显著相关性。　结论： 心脏介入治疗后院内感染发生率较低,通过严格的无菌操作和抗生素的合理应用,可防止院内感染的发生。     

右侧房室旁道的射频消融治疗

目的：报道２０例右侧房室折返性心动过速（ＡＶＲＴ）的射频消融疗效和体会。　方法：２０例ＡＶＲＴ患者,其中显性右侧旁路１５例,隐匿性右侧旁路５ 例,均给予射频消融治疗。　结果：１５ 例右侧显性旁道１３例消融成功,其中复发１例,再次消融成功;５ 例隐匿性旁路全部消融成功,消融成功率为９０％ ,无并发症。　结论：射频消融是一种治疗右侧ＡＶＲＴ安全而有效的方法。     

房室结折返性心动过速射频消融后的电生理改变与复发率的关系

目的：探讨房室结折返性心动过速（ＡＶＮＲＴ）射频消融术后的电生理改变及不同手术终点与复发率的关系。　方法：本组５６ 例ＡＶＮＲＴ患者慢径消融前、后作各项电生理参数测定,并随访观察远期疗效。　结果：３８ 例慢径消失者（Ａ组）无一例复发,残存慢径１２ 例（Ｂ组）有一例复发（８．３３％ ）,残存慢径有１～２ 个心房回波者６例（Ｃ组）有２例复发（３３．３％ ）。５３ 例无复发者消融前后的房室束最大值（Ａ－Ｈｍ ａｘ ）分别为（２８０±２７）和（１９６±５６）ｍ ｓ（Ｐ＜０．０１）,快径不应期分别为（３３０±４４）和（２８７±３１）ｍ ｓ（Ｐ＜ ０．０１）。而３ 例复发者消融前、后的Ａ－Ｈｍ ａｘ分别为（２８７±３１）和（２６２±３８）ｍ ｓ（Ｐ＞ ０．０５）,快径不应期分别为（３２４±３８）和（３１３±２８）ｍ ｓ（Ｐ＞ ０．０５）。　结论：ＡＶＮＲＴ的复发与慢径残存和Ａ－Ｈｍ ａｘ 及快径不应期无明显改变有关。     

射频能量时间递增法治疗房室结折返性心动过速

目的：评估射频能量时间递增法治疗４０ 例房室结内折返性心动过速的疗效及安全性。　方法：标测到理想的慢径路靶点后,从小功率（１０～１５ Ｗ）、短时间（５～１０ ｓ）放电开始,如出现交界区早搏或交界区心律,逐渐增加放电功率（２０～２５ Ｗ）和持续时间（３０～６０ ｓ）,并密切观察房室传导阻滞的迹象和先兆。　结果：临床治愈率９７．５％ ,无一例产生严重并发症。　结论：射频能量时间递增法是一种安全、高效的治疗方法。     

单导管射频消融治疗频发房颤的预激综合征

采用单导管射频消融法治疗１２ 例预激综合征（ Ｗ Ｐ Ｗ） 。１２ 例中８ 例有反复快速性房颤史,３ 例须用同步直流电复律,１ 例伴有晕厥。旁路分别为左侧８ 条,右后间隔２ 条,右后侧及右前间隔各１ 条,右侧者有１ 例并存１ 条左侧隐匿旁路。全部旁路一次消融成功。术中未诱发房颤。随访５ ～１７ 月未见复发。     

微波消融犬室性心动过速的实验研究

观察微波消融犬室性心动过速（简称室速）疗效和微波消融对血液动力学的影响。健康犬４０只,随机分成５组,Ⅰ组（对照组,ｎ＝８）,Ⅱ、Ⅲ、Ⅳ和Ⅴ组（消融组,ｎ＝８）,由股动脉、股静脉穿刺进行血液动力学监测。用０．０１ｍｌ０．０３％乌头碱注入心室壁诱发室性心动过速。消融释放功率和时间Ⅱ组为４０Ｗ×３０ｓ,Ⅲ组为４０Ｗ×６０ｓ,Ⅳ组为８０Ｗ×３０ｓ,Ⅴ组为８０Ｗ×６０ｓ。结果：自发放微波能量至室速终止时间Ⅱ、Ⅲ组为（１０．１±２．４）ｓ,与对照组比,Ｐ＜０．００１;Ⅳ、Ⅴ组为（５．３±１．５）ｓ,与对照组比,Ｐ＜０．００１。消融前后血液动力学各项指标差异无统计学意义（Ｐ＞０．０５）,消融后组间血液动力学各项指标差异无统计学意义（Ｐ＞０．０５）。微波产生的心肌损伤,显微镜下观察均为凝固性坏死,与周围组织存在清晰的界限。结论：微波消融室速具有较好的疗效,消融能量与时间在一定范围内对血液动力学无明显影响,可望成为室速治疗的１种新方法。     

Radiofrequency ablation in children

Radiofrequency (RF) catheter ablation has ushered in a new era in the management of patients with symptomatic tachyarrhythmias. By providing the ability to cure the underlying arrhythmic substrate, RF catheter ablation obviates the need for life-long antiarrhythmic drugs. In the reported series, the success has been high and the complications have been infrequent and relatively minor. Not unexpectedly, RF catheter ablation has become the treatment of choice for patients with symptomatic paroxysmal tachyarrhythmias. The role of radiofrequency catheter ablation in infants and small children remains controversial, and awaits a larger experience and longer follow-up data.     

Multidisciplinary management of metastatic colorectal cancer

When colorectal cancer metastasizes to distant organs, usually multiple sites are involved and treatment consists primarily of systemic chemotherapy and supportive care. Chemotherapeutic agents effective against metastatic colorectal cancer include 5-fluorouracil, often used in combination with leucovorin or methotrexate, and irinotecan (CPT-11). Median survival with optimal chemotherapy regimens ranges from 10 to 15 months. Less frequently, colorectal cancer metastasizes only to the liver or lung. In a minority of these cases, surgical resection can be performed and results in a median survival of 28-46 months for hepatic resections and 24-25 months for pulmonary resections. Five-year survival rates range from 24 to 38% and 21 to 44% for hepatic and pulmonary resections, respectively. For isolated liver metastases that are not surgically resectable, other regional therapies that can be considered are hepatic cryosurgery, radiofrequency ablation, and hepatic arterial infusion chemotherapy. Median survival following cryosurgery is between 26 and 30 months, while median survival following radiofrequency ablation has not been established in large series. Hepatic arterial infusion chemotherapy, especially with newer combination drug regimens, may increase survival in patients with isolated liver metastases compared to systemic chemotherapy, but this must be confirmed in randomized, prospective trials. Colorectal cancer metastases to the brain can be treated with radiation therapy or surgical resection, but median survival with treatment is less than one year.