临床输液监控系统的设计

本文针对临床输液过程中出现的漏、停、输液速度改变等各种问题，讨论了一由单台微机和多个单片机通讯实现的多床输液自动监控、自动反应、自动报答系统的可行性，并给出了主要部分的硬件、软件设计方法。     

深静脉高营养（TPN）预防食管癌切除术后吻合口瘘的临床研究

本研究收集食管癌行食管癌切除胃代食管术病例２６５例，分为未用深静脉高营养组（ＮＴＰＮ）和深静脉高营养组（ＴＰＮ）。分别对各组临床资料进行比较分析，结果显示：ＴＰＮ组葡萄糖供给量（８．３７±２．１２ｇ／ｋｇ／２４小时）显著高于ＮＴＰＮ组（２．７７±０．７１ｇ／ｋｇ／２４小时）（Ｐ＜０．０１），（０．３０±０．１４ｇ／ｋｇ／小时）Ｐ＜０．０５。吻合口瘘发生率ＴＰＮ组（２．１％）则显著低于ＮＴＰＮ组（１５．２％）Ｐ＜０．００１。结果提示ＴＰＮ组可明显降低吻合口瘘发生率。作者于ＴＰＮ促进吻合的愈合，预防吻合口瘘发生的有关机理进行了讨论。     

Bileaflet Aortic Valve Prosthesis Pivot Geometry Influences Platelet Secretion and Anionic Phospholipid Exposure

The clinical histories of the Medtronic Parallel (MP) and St. Jude Medical (SJM) Standard valves suggest pivot geometry influences the thrombogenic characteristics of bileaflet prostheses. This work studied the effects of various pivot geometries on markers of platelet damage in a controlled, in vitro apparatus. The Medtronic Parallel valve, two St. Jude Medical valves, and two demonstration prostheses were used to study the effects of bileaflet pivot design, gap width, and size on platelet secretion and anionic phospholipid expression during leakage flow. A centrifugal pump was used to drive blood through a circuit containing a bileaflet prosthesis. Samples were taken at set time intervals after the start of the pump. These samples were analyzed by cell counting, flow cytometry, and enzyme-linked immunosorbant assay. No significant differences were observed in platelet secretion or anionic phospholipid expression between experiments with the SJM 27 Standard regular leaker, the SJM 20 regular leaker, and the MP 27 valves. Significant differences in platelet secretion and anionic phospholipid expression were observed between a SJM 27 Standard regular leaker and a SJM 27 high leaker valve. These studies suggest that leakage gap width within bileaflet valve pivots has a significant effect on platelet damage initiated by leakage flow. © 2001 Biomedical Engineering Society. PAC01: 8719Uv, 8719Tt, 8380Lz, 8768+z     

高频手术设备检定方法

高频手术设备在临床使用中容易引发安全医疗事故,为保证高频手术设备在临床应用中使用安全,提出了加强技术管理、检测措施的必要性,介绍了高频手术设备主要技术指标的检测方法.     

Ability of new obturation materials to improve the seal of the root canal system: A review

New obturation biomaterials have been introduced over the past decade to improve the seal of the root canal system. However, it is not clear whether they have really produced a three-dimensional impervious seal that is important for reducing diseases associated with root canal treatment. A review of the literature was performed to identify models that have been employed for evaluating the seal of the root canal system. In vitro and in vivo models are not totally adept at quantifying the seal of root canals obturated with classic materials. Thus, one has to resort to clinical outcomes to examine whether there are real benefits associated with the use of recently introduced materials for obturating root canals. However, there is no simple answer because endodontic treatment outcomes are influenced by a host of other predictors that are more likely to take precedence over the influence of obturation materials. From the perspective of clinical performance, classic root filling materials have stood the test of time. Because many of the recently introduced materials are so new, there is not enough evidence yet to support their ability to improve clinical performance. This emphasizes the need to translate anecdotal information into clinically relevant research data on new biomaterials.     

Sealability of MTA and calcium hydroxidecontaining sealers

Objectives

The aim of this study was to evaluate the apical sealability of Fillapex^®, Endo-CPM-Sealer^® and Sealapex^®.

Material and Methods

Ninety-four freshly extracted single-rooted teeth were selected and decoronated. All teeth were radiographed to confirm the existence of a single and straight root canal, which was prepared using Protaper Universal and 2.5% sodium hypochlorite. The teeth were randomly divided in groups of 10 specimens each according to the sealer, and the canals were filled using the single cone technique and one of the sealers. Four additional teeth were used as controls. The teeth were submitted to dye leakage with Rhodamine B for 24 h but using vacuum on the initial 15 min. Thereafter, they were cut longitudinally and the leakage was measured in a linear fashion from apex to crown. Data were analyzed by ANOVA and Tukey''s tests at 5% significance level.

Results

Fillapex^® and Sealapex^® showed significantly less dye leakage than Endo-CPM-Sealer^® (p<0.05).

Conclusions

It was concluded that Fillapex^® and Sealapex^® were able to prevent apical dye leakage differently from Endo-CPM-Sealer^®.     

经皮椎体成形术后骨水泥渗漏的回顾性分析及预防策略

目的 回顾性分析我院152例187节胸腰椎骨折椎体成形术后患者(PVP或PKP)骨水泥渗漏的发生率及预防措施.方法 2007年5月～2012年5月共152例骨质疏松性胸腰椎体压缩性骨折(187节椎体)患者施行经皮椎体成形术(PVP)75节或经皮椎体后凸成形术(PKP)112节,术后对责任椎常规复查CT,统计显示骨水泥渗漏共65节(34.76%),其中PVP术38节(50.66%),PKP术27节(24.11%),渗漏至椎管内15节(8.02%,PVP术9节,PKP术6节)、椎间隙内13节(6.95%,PVP术7节,PKP术6节)、穿刺针道内8节(4.28%,PVP术4节,PKP术4节)、椎间静脉渗漏5节(2.67%,均为PVP节)、椎体周缘(椎体前缘、椎体旁)23节(12.30%,PVP术12节,PKP术11节)、神经根管内1节(0.53%,为PVP术),观察术后疗效,总结造成骨水泥渗漏的原因及预防方法.结果 所有患者术后疼痛明显减轻,出现骨水泥渗漏并发症的患者中,1例渗漏至神经根管内患者出现神经压迫症状,减压术后症状缓解,其余患者术后均无明显神经压迫症状.结论 椎体成形术后渗漏发生率较高(34.76%),以椎体周缘渗漏(35.38%)最为常见,但因渗漏而有临床症状者较少(1.53%).骨水泥渗漏与术前检查是否充分、术前阅片是否仔细、手术操作是否熟练密切相关.     

剂量分布仪对医用电子直线加速器X射线泄漏辐射检测方法的探讨

目的：测量与分析医用电子直线加速器的泄漏辐射水平,探讨使用剂量分布仪等剂量扫描装置检测加速器泄漏辐射水平。方法：依据国家标准“电子加速器放射治疗放射防护要求”中提供的方法,以一台医用电子直线加速器为对象,使用IBA公司生产的Startrack型剂量分布仪对该加速器M区域内X射线泄漏辐射进行检测分析。结果：M区域内X射线泄漏辐射与最大吸收剂量点比值为0.07%,平均吸收剂量与最大吸收剂量比值为0.04%。结论：研究探讨使用剂量分布仪等剂量扫描装置进行加速器的X射线泄漏辐射检测具有十分重要的意义。     

T管周围胆汁渗漏的处理及预防措施（附25例报告）

目的 分析T管周围胆汁渗漏发生的原因,探讨预防措施和治疗方法.方法 回顾分析2010年3月至2014年7月治疗的25例T管周围胆汁渗漏病例,其中男性8例,女性17例,平均年龄56.6岁（25～82岁）,年龄≥65岁者19例.全部病人均行胆管探查术后放置T管.合并肝内胆管结石行肝左外叶切除7例,其中4例合并肝切除术后胆漏;合并急性化脓性胆管炎3例;术中诊断Mirizzi综合征2例,Ⅰ型及Ⅱ型各1例.分别行T管周围扩创置管引流、滴水双套管冲洗、经皮穿刺置管引流（PCD）、经胆道镜腹腔灌洗、腹腔置管引流、再次剖腹手术引流.结果 25例病人均痊愈出院.其中24例保守治疗痊愈,1例经再次剖腹手术获得治愈.结论 胆管探查术后T管周围胆汁渗漏发生原因很多,围手术期正确处理可降低其发生的概率.渗漏发生后均需行妥善引流,必要时再次手术,可以获得满意的治疗效果.     

国产外置式自动多叶准直器控制设计及其临床性能测试分析

目的：设计一款高位移精度的国产外置式医学用自动多叶准直器（Multi Leaf Collimator,简称MLC）,同时验证和测试该MLC在放射治疗临床使用中的辐射野精度、半影、漏射率、适形度等重要指标数据。方法：控制设计方面,采用直流电机模糊控制算法、位移精度控制、漏射优化等关键方案实现MLC的核心功能。测试方面采用柏co治疗机作为放射源,国产MLC形成射野,使用三维水箱系统和二维剂量探测器对剂量分布进行测量,并根据测量结果计算MLC性能指标数据。结果：射野数字指示与辐射野精度误差测试中,在叶片运动方向上位移误差在0．2mm～1．6mm之间;漏射率测试中,最大漏射率小于2％;半影测试中,半影随射野增大而增大,在10cm~10Clll射野时,叶片运动方向半影为8．6mm适形度测试中,MLC形成射野和TPS定制适形度值在99．7％以上。结论：国产外置式MLC各项指标符合食药总局检验标准,完全满足临床治疗需求。