冠心病介入诊疗中透视与电影辐射剂量率对比分析

目的：研究冠心病患者介入诊疗中DSA设备显示的实时辐射剂量率,为医务人员合理控制辐射剂量提供依据。方法随机抽取2014年9月采用美国通用公司DSA机介入诊疗的冠心病患者30例,对术中DSA机由透视模式转换为电影模式时各自序列显示的辐射剂量率进行对比分析。结果透视辐射剂量率为18．5～212．0 mGy/min,均值为（114．7±42．1） mGy/min;电影辐射剂量率为216～1691 mGy/min,均值为（970．1±298．4） mGy/min。透视与电影辐射剂量率总体均值之比为1︰8．5。数字平板探测器面积越大,辐射剂量率均值越大,电影辐射剂量率均值较透视辐射剂量率均值增高趋势越明显;透视辐射剂量率均值较电影辐射剂量率均值低,差异显著。结论医务人员在冠心病介入诊疗中应合理选择 DSA 设备类型,密切观察动态实时显示的辐射剂量率,及时调整检查模式及可控参数,即刻评估可能致患者放射损伤的剂量水平,合理控制辐射剂量,以降低电离辐射对人体健康产生的辐射效应。     

Extracorporeal CO2 removal as bridge to lung transplantation in life‐threatening hypercapnia

In patients awaiting lung transplantation (LTX), adequate gas exchange may not be sufficiently achieved by mechanical ventilation alone if acute respiratory decompensation arises. We report on 20 patients with life‐threatening hypercapnia who received extracorporeal CO₂ removal (ECCO2‐R) by means of the interventional lung assist (ILA®, Novalung) as bridge to LTX. The most common underlying diagnoses were bronchiolitis obliterans syndrome, cystic fibrosis, and idiopathic pulmonary fibrosis, respectively. The type of ILA was pumpless arteriovenous or pump‐driven venovenous (ILA activve®, Novalung) in 10 patients each. ILA bridging was initiated in 15 invasively ventilated and five noninvasively ventilated patients, of whom one had to be intubated prior to LTX. Hypercapnia and acidosis were effectively corrected in all patients within the first 12 h of ILA therapy: PaCO₂ declined from 109 (70–146) to 57 (45–64) mmHg, P < 0.0001; pH increased from 7.20 (7.06–7.28) to 7.39 (7.35–7.49), P < 0.0001. Four patients were switched to extracorporeal membrane oxygenation due to progressive hypoxia or circulatory failure. Nineteen patients (95%) were successfully transplanted. Hospital and 1‐year survival was 75 and 72%, respectively. Bridging to LTX with ECCO2‐R delivered by arteriovenous pumpless or venovenous pump‐driven ILA is feasible and associated with high transplantation and survival rates.     

药护协同管理在急性心肌梗死患者溶栓治疗中的实践

目的 探讨药护协同管理在急性心肌梗死患者溶栓治疗中的实践效果.方法 将100例急性心肌梗死溶栓治疗的患者按数字随机法分为常规组(n=50)和协同管理组(n=50),常规组按照常规护理,协同管理组在此基础上实施药护协同管理,干预6个月后比较治疗效果.结果 两组入院后明确诊断至开始溶栓时间、冠脉有效灌注率和住院天数比较,协同干预组显著优于常规组,48h内恶性心律失常发生例数协同组显著少于常规组,差异有统计学意义(均P＜0.05).两组患者溶栓治疗后12h、24 h、48 h、7d的LVEF值比较,差异有统计学意义(均P＜0.05);出院后6个月心脏不良事件发生比例比较,差异无统计学意义(P＞0.05).结论 药护协同管理能够有效缩短急性心肌梗死患者入院后至溶栓的时间,提高冠脉有效灌注,减少48 h内恶性心律失常发生和缩短住院天数,促进心功能恢复.     

核苷(酸)类似物在经肝动脉介入治疗乙型肝炎病毒相关性肝细胞癌中的作用

目的探讨核苷(酸)类似物在乙型肝炎病毒(HBV)相关肝细胞癌(HCC)经肝动脉介入治疗(TAIT)中的应用价值。方法入组60例HBsAg阳性且不能手术切除的HCC患者,配对分为核苷(酸)类似物治疗组(A组)和常规保肝降酶组(B组),每组30例。对两组进行常规TAIT同时,给予常规保肝降酶治疗,A组同时联合核苷(酸)类药物行抗病毒治疗。比较两组的生存率,分析预后影响因素。结果 A组核苷(酸)类似物抗病毒初始治疗药物选择:恩替卡韦14例,拉米夫定8例,阿德福韦酯8例,其中4例患者出现病毒学突破,经加用另一核苷(酸)类似物后实现病毒持续抑制。B组中,13例(13/30,43.33%)患者分别在第1~9次TAIT后发生病毒学突破,中位突破时间为5.52个月(4次TAIT后)。两组共死亡48例,其中A组20例,B组28例,中位生存期分别为29.63、14.77个月(χ2=7.51,P=0.01)。A组和B组中BCLC分期C期患者中位生存期分别为23.63、8.07个月(2χ=7.11,P=0.01)。Cox回归模型分析显示:患者是否行核苷(酸)类似物抗病毒治疗、肝功能分级、肝癌BCLC分期影响患者预后。未发生核苷(酸)类药物相关严重不良反应。结论采用TAIT治疗HBV相关HCC时联合应用核苷(酸)类药物安全、有效。     

肝移植术后缺血性胆道病变的介入治疗探讨

目的探讨肝移植术后缺血性胆道病变(ITBL)患者接受介入治疗的安全性及疗效。方法回顾性分析2006年1月至2014年2月在中山大学附属第三医院介入血管科接受介入治疗的76例肝移植术后ITBL患者的影像及临床资料。按胆道造影表现分为3组:肝门区狭窄组(28例),肝内多发狭窄组(42例),胆汁瘤组(6例)。治疗方式包括单纯经皮经肝胆管引流术(PTBD)、PTBD配合球囊扩张、PTBD配合球囊扩张及胆道内支架术。引流方式包括胆道外引流及胆道内外引流。术后随访并观察疗效及胆道并发症。结果 76例患者的PTBD首次成功率为97%(74/76)。介入治疗的总体治愈率、好转率及无效率分别为21%(16/76)、51%(39/76)、28%(21/76)。其中,肝门区狭窄组治愈10例(36%),好转16例(57%),无效2例(7%),治疗有效22例(93%);多发性狭窄组治愈6例(14%),好转21例(50%),无效15例(36%),治疗有效27例(64%);胆汁瘤组好转2例(2/6),无效4例(4/6)。肝门区狭窄患者的疗效优于多发性狭窄患者(P0.05),多发性狭窄患者的疗效优于胆汁瘤患者(P0.001)。引流管期间主要并发症为胆道感染,其中外引流及内外引流胆道感染发生率分别为20%(13/64)及67%(8/12),比较差异有统计学意义(P0.001)。结论 PTBD是治疗肝移植术后ITBL的安全、有效手段之一。结合球囊扩张及内支架置入可有效改善患者症状,提高生存质量。采用胆道外引流可显著降低胆道感染发生率。     

动脉介入化疗栓塞在晚期上皮性卵巢癌中的应用

目的:探讨动脉介入化疗栓塞在晚期上皮性卵巢癌治疗中的意义。方法:1999年12月1日至2012年5月31日在我院实施肿瘤细胞减灭术的晚期上皮性卵巢癌患者共100例,按术前是否行动脉介入化疗栓塞分为2组,即动脉介入化疗栓塞组(治疗组)和初次肿瘤细胞减灭术组(对照组)。治疗组27例,对照组73例,治疗组术前予1~2疗程动脉介入化疗栓塞后再行肿瘤细胞减灭术,对照组行初次肿瘤细胞减灭术,对其进行回顾性分析,比较2组患者临床各项指标、相关预后因素及累积生存率。结果:治疗组分级高、期别晚者所占比例高,但达到满意的肿瘤细胞减灭术者所占比例比对照组高,两者比较差异无统计学意义(P>0.05)。多因素生存分析显示手术病理分期及手术满意度是影响患者总的生存率的独立预后因素(P=0.010及P=0.011)。治疗组3年和5年累积生存率分别为64%和48%,对照组为62%和40%,差异无统计学意义(P>0.05)。结论:术前估计难以达到满意的肿瘤细胞减灭术的晚期上皮性卵巢癌患者,行动脉介入化疗栓塞可能提高手术的成功率,但不能提高患者总的生存率。     

The Impella Microaxial Flow Catheter Is Safe and Effective for Treatment of Myocarditis Complicated by Cardiogenic Shock: An Analysis From the Global cVAD Registry

Background

Myocarditis complicated by cardiogenic shock remains a complex problem. The use of acute mechanical circulatory support devices for cardiogenic shock is growing. We explored the utility of Impella transvalvular microaxial flow catheters in the setting of myocarditis with cardiogenic shock.

Transcatheter closure of atrial septal defects in adults with the Amplatzer septal occluder

OBJECTIVE—To assess the efficacy and complications of device occlusion of atrial septal defects in adults, using the Amplatzer septal occluder (ASO).
DESIGN—A prospective interventional study.
SETTING—Paediatric cardiology departments in two European teaching hospitals.
PATIENTS—The first 20 patients accepted for atrial septal defect device occlusion, on the basis of transoesophageal echocardiography. Sixteen patients had larger defects with right heart dilatation, while the primary indication for closure in four was a history of early paradoxical embolism.
INTERVENTIONS—Transcatheter atrial septal defect occlusions performed under transoesophageal echocardiography and fluoroscopic guidance between December 1996 and June 1998.
OUTCOME MEASURES—Success of deployment of ASO devices, procedure and fluoroscopic times, complications, and symptoms.
RESULTS—The ASO device was successfully implanted in all 20 patients (14 female), median age 44.2 years, with no complications. Of the 16 patients with right heart dilatation, the median Qp:Qs was 2.5:1. Defects measured 11-22 mm (median 18) on transoesophageal echocardiography, with balloon sized diameter (and device size) of 13-28 mm (median 20). For all 20 patients, the procedure time ranged from 38-78 minutes (median 61), and fluoroscopy 8.4-24.7 minutes (median 15.2). There were residual shunts in three patients at the end of the procedure, which were trivial ( 1 mm) as assessed by transoesophageal echocardiography, and persisted for more than six months in only one patient. Follow up ranged from 0.1-1.5 years (median 0.7). There have been no late complications.
CONCLUSIONS—The ASO device can be used successfully to close selected oval fossa defects in adults, with minimal procedural morbidity and excellent early results.


Keywords: atrial septal defect; interventional cardiac catheterisation; Amplatzer septal occluder