球囊封堵术在产科大出血的临床应用

【摘要】 目的 探讨球囊封堵术治疗凶险性前置胎盘的临床疗效。方法 2015年1月至2016年3月采用球囊封堵术协助产科处理凶险性前置胎盘产妇16例。15例经彩色超声或MRI诊断为中央型前置胎盘并高度怀疑胎盘植入，择期于剖宫产前双侧髂内动脉预置球囊，胎儿取出同时立即充盈双侧球囊对目标血管作临时封堵，根据产科医师止血状况适时撤出球囊；1例行急症腹主动脉临时球囊封堵术，开腹发现胎盘穿透至前壁浆膜下，予子宫切除术。结果 16例球囊封堵术均获成功，平均阻断时间15 min，出血量300～1 200 ml。结论 剖宫产手术前球囊封堵术治疗凶险性前置胎盘安全可靠，可显著减少术中出血、迅速有效止血、为剖宫产提供清晰术野及挽救产妇生命，充分体现产科、介入科等多学科协作的必要性。
     

腹主动脉与髂内动脉球囊阻断在凶险性前置胎盘剖宫产术中应用对比研究

【摘要】 目的 对比研究双侧髂内动脉球囊阻断与腹主动脉球囊阻断在凶险性前置胎盘（PPP）剖宫产术中应用的临床疗效及安全性。方法 2015年9月至2017年9月对33例经彩色多普勒超声和/或MR诊断为PPP伴/不伴胎盘植入产妇剖宫产前行临时动脉球囊阻断术。随机分为两组,双侧髂内动脉球囊阻断17例（A组）,腹主动脉球囊阻断16例（B组）。主要观察透视时间、辐射剂量、手术时间、术中出血量、新生儿Apgar评分及手术相关并发症。结果 33例均成功完成临时球囊阻断术。B组平均透视时间、辐射剂量、术中出血量均低于A组（P＜0.05）,两组间剖宫产时间、新生儿Apgar评分（1、5、10 min）差异均无统计学意义（P＞0.05）。33例子宫均未切除,也未发生手术相关并发症。结论 PPP剖宫产术中双侧髂内动脉临时球囊阻断或腹主动脉临时球囊阻断,可有效减少术中出血量,降低子宫切除概率,但腹主动脉球囊阻断临床效果及辐射防护安全性较优于双侧髂内动脉球囊阻断。
     

Fogarty腹主动脉球囊导管预置阻断术在凶险性前置胎盘产妇中的应用

【摘要】 目的 探讨对凶险性前置胎盘产妇剖宫产术前施行Fogarty腹主动脉球囊导管预置阻断术的临床疗效。方法 回顾性分析12例凶险性前置胎盘产妇剖宫产术前接受Fogarty动脉取栓导管腹主动脉球囊预置术产妇临床资料,评价治疗效果。结果 12例产妇剖宫产术中出血量为平均（1 256±318） ml;9例成功保留子宫,3例出现难治性出血接受子宫切除术（其中1例胎盘穿透至膀胱接受全子宫切除、膀胱修补术）。产后均未发生感染、晚期出血、下肢血栓等并发症。12例新生儿均顺利出生。结论 Fogarty腹主动脉球囊导管预置阻断术可减少术中出血量,有助于保留子宫,是凶险性前置胎盘产妇剖宫产前安全有效的治疗方法。
     

超声导引下腹主动脉球囊预置新方法预防产后出血

【摘要】 目的 探讨超声导引下腹主动脉球囊预置新方法在预防前置胎盘剖宫产术后出血的临床价值。方法 16例孕产妇经彩色超声、MR诊断为凶险性前置胎盘或中央型前置胎盘伴胎盘植入,剖宫产前通过超声导引预置下腹主动脉球囊,术中间歇阻断腹主动脉。记录术中出血量、输血量及子宫缝合时间。结果 16例均成功接受超声导引下预置球囊阻断腹主动脉,剖宫产术中平均出血量（756±222） mL,输血量（440±219） mL,子宫缝合时间（28.4±7.9） min。胎儿娩出后DSA下检查球囊置放位置准确,无明显移位。结论 超声导引下腹主动脉球囊阻断术操作简单、安全,在前置胎盘伴胎盘植入产妇剖宫产术中控制出血效果显著,避免了X射线和对比剂对胎儿的不良影响。
     

球囊临时阻断技术在凶险性前置胎盘剖宫产术中的应用

范文龙  杨正强  夏金国  周卫忠  施海彬 《工业加热》2018,(10):928-931

腹主动脉球囊阻断在剖宫产术中应用及相关问题探讨

【摘要】 目的 探讨腹主动脉球囊阻断在凶险型前置胎盘（PPP）伴胎盘植入剖宫产术中的应用价值,分析技术重点及相关问题处理。方法 对97例PPP伴胎盘植入产妇行球囊阻断腹主动脉辅助下剖宫产（观察组）,同时对97例PPP伴胎盘植入产妇直接行剖宫产（对照组）。观察组剖宫产术前预置球囊导管于髂动脉分叉上方腹主动脉,胎儿头娩出后充盈球囊阻断腹主动脉,剥离胎盘并缝合剥离面止血,创面充分缝合仍出血行子宫动脉栓塞,栓塞后再出血则行子宫次全切除。记录观察组术中出血量、手术时间、子宫保留与否、胎儿X线辐射剂量、术后并发症等情况。结果 观察组97例均成功预置腹主动脉球囊,辅助剖宫产完成分娩,保留子宫96例,次全切除1例;对照组97例中11例切除子宫。观察组、对照组平均出血量分别为（1 238.0±139.2） mL、（3 373.0±196.3） mL（P＜0.001）,手术时间分别为（70.6±3.6） min、（128.6±6.2） min（P＜0.000 1）。观察组胎儿辐射剂量为（6.1±1.4） mGy;术后5例产妇发生髂股动脉血栓形成,溶栓后血栓消失,未出现肾功能损伤、血管破裂、下肢缺血等严重并发症。结论 球囊阻断腹主动脉辅助PPP伴胎盘植入产妇剖宫产手术,可明显减少术中出血量,缩短手术时间,显著降低子宫切除风险。对术中胎儿辐射、球囊置放、动脉血栓等问题应有充分认识,严格控制适应证,尽量避免并发症发生并及时处理。

     

球囊阻断腹主动脉控制凶险性前置胎盘并胎盘植入剖宫产术中出血22例

【摘要】 目的 应用球囊导管阻断腹主动脉后再行胎盘的剥离,探讨其对减少凶险性前置胎盘并胎盘植入的剖宫产术中出血的临床意义。方法回顾性分析22例凶险性前置胎盘并胎盘植入的剖宫产患者。所有患者均接受术前放置球囊导管,凶险性前置胎盘剖宫产术中先娩出胎儿,断脐后立即给予球囊阻断。结果 所有患者均证实为凶险性前置胎盘并胎盘植入,包括3例穿透性胎盘植入患者。该方法的技术成功率为86.3％（19/22）。19例患者成功接受手术并保留子宫。子宫切除率约13.7%（3/22）。术中出血量为（686±355） ml。22例患者中仅3例穿透性胎盘植入的患者术中输血,其余19例患者均未输血,术中球囊阻断时间以及胎儿的辐射剂量分别为（25.4±7.2） min和（30.2±8.9） mGy。术后和随访期间并无介入相关的并发症。结论 腹主动脉球囊阻断术能够有效控制凶险性前置胎盘并胎盘植入患者胎盘剥离时引起的术中大出血,降低输血需求及子宫切除率。

     

腹主动脉预置球囊辅助前置胎盘伴胎盘植入剖宫产临床应用

【摘要】 目的 探讨腹主动脉预置球囊辅助前置胎盘伴胎盘植入剖宫产的临床应用价值。方法 对72例前置胎盘伴胎盘植入产妇腹主动脉预置球囊辅助剖宫产，其中33例为凶险性前置胎盘（A型），36例为瘢痕子宫、前置胎盘伴胎盘植入（B型），3例为无剖宫产史前置胎盘伴胎盘植入（C型）。记录剖宫产术中出血量、子宫切除情况、球囊预置术中X线辐射量及介入操作相关并发症。结果 剖宫产术中A型、B型、C型产妇平均出血量分别为1 461 ml、947 ml、533 ml；9例子宫大部切除，32例子宫修补；2015年17例、2016年55例球囊预置术中平均X线辐射量分别为（28.5±14.1） mGy、（3.7±2.5） mGy；住院期间发生右股浅动脉血栓1例，右下肢静脉血栓1例，皮下血肿2例。结论 腹主动脉球囊预置辅助前置胎盘伴胎盘植入产妇剖宫产，可有效减少术中出血量，明显降低子宫切除率；手术操作简便，X线辐射时间短；熟练操作，能进一步减少介入操作相关并发症。
     

髂内动脉球囊临时置入在五例凶险性前置胎盘剖宫产中的应用

【摘要】 目的 探讨髂内动脉球囊临时置入在凶险性前置胎盘剖宫产中的临床应用。方法 5例均经超声和磁共振诊断为凶险性前置胎盘伴胎盘植入患者，在剖宫产术前行髂内动脉球囊临时置入，待胎儿娩出脐带结扎后充盈球囊，剖宫产术后24 h去除球囊，记录所受射线剂量、出血量，并观察有无并发症发生。结果 5例髂内动脉球囊临时置入，均获得成功。出血量 ＜ 500 ml者3例，＞ 1 000 ml者2例。3例保留子宫，2例因难治性出血，行子宫全切1例，子宫次全切1例。以上5例均未发生球囊置入并发症。结论 髂内动脉球囊临时置入可减少凶险性前置胎盘剖宫产出血量，并降低了子宫切除风险。
     

火电厂节能工作浅析

本文探讨了火电厂节能基本程序和工作方法,分析节能工作要从基础工作、技术创新、设备整治、燃烧管理等方面入手的论述.     

浅析磨合期汽车的使用

如何合理使用磨合期的汽车，使其摩擦机件的磨损量能够平稳、均匀地磨合而不至于过度磨损，对汽车实际使用寿命有着重要的意义。从机器磨合期的特点和磨损机理出发，对汽车磨合期如何正确使用进行了有实际意义的探讨。     

Geothermal energy in agriculture in Yugoslavia

SFR Yugoslavia has natural hot water springs practically all over its territory, indicating the presence of geothermal reservoirs underground. There is no final estimate of how much energy can be expected from this new resource, except for figures based on the results of studies and investigations.The first use of geothermal energy in Yugoslavia in numerous spas dates back to the 19th century. Some remarkable examples of central heating are known, but the most widespread use is in agriculture (in greenhouse heating, farm heating and drying of agricultural products).     

Energy conservation measures in an institutional building in sub-tropical climate in Australia

In this study, various energy conservation measures (ECMs) on heating, ventilating and air conditioning (HVAC) and lighting systems for a four-storied institutional building in sub-tropical (hot and humid climate) Queensland, Australia are evaluated using the simulation software called DesignBuilder (DB). Base case scenario of energy consumption profiles of existing systems are analysed and simulated first then, the simulated results are verified by on-site measured data. Three categories of ECMs, namely major investment ECMs (variable air volume (VAV) systems against constant air volume (CAV); and low coefficient of performance (COP) chillers against high COP chillers); minor investment ECMs (photo electric dimming control system against general lighting, and double glazed low emittance windows against single-glazed windows) and zero investment ECMs (reset heating and cooling set point temperatures) are evaluated. It is found that the building considered in this study can save up to 41.87% energy without compromising occupancies thermal comfort by implementing the above mentioned ECMs into the existing system.     

Leading-edge Technologies in Hydropower Development in China

After the implementation of the Reform and Opening-up Policy for a period of 40 years, the exploitation of China’s hydropower resources developed significantly. Through vast amounts of scientific and technological research and construction practices, China has accumulated abundant engineering experience with respect to the construction technologies required for 300-meter-high concrete arch dams, 200-meter-high roller-compacted concrete gravity dams, 200-meter-high concrete face rockfill dams, and 250-meter-high earth core rockfill dams, large-flow discharge and energy dissipation, huge underground cavern group constructions, complicated foundation treatments for high earth and rockfill dams and high and steep slope reinforcements. These series of technologies have now reached an international leading level. In the near future, these technical improvements will likely have broader application prospects and make greater contributions toward hydropower development both in China and across the world.     

Viscous heating in liquid flows in micro-channels

Many experimental works on forced convection through micro-channels evidenced that when the hydraulic diameter is less than 1 mm, conventional theory can no longer be considered as suitable to predict the pressure drop and convective heat transfer coefficients. This conclusion seemed valid for both gas and liquid flows. Sometimes the authors justified this claim by invoking “new” micro-effects. On the contrary, in this paper the explanation of the experimental results obtained for micro-channels in terms of friction factors will be researched inside the conventional theory (Navier-Stokes equations). In particular, this paper will focus on the role of viscous heating in fluids flowing through micro-channels. A criterion will be presented to draw the limit of significance for viscous dissipation effects in micro-channel flows. The role of the cross-sectional geometry on viscous dissipation will be highlighted and the minimum Reynolds number for which viscous dissipation effects can no longer be neglected will be calculated as a function of the hydraulic diameter and of the micro-channel geometry for different fluids. It will be demonstrated how viscous effects can explain some experimental results on the Poiseuille numbers in micro-channels, which recently appeared in the open literature.     

Solar drying in sludge management in Turkey

Two main wastewater treatment plants in Bursa city in Turkey will start to operate and produce at least 27,000 tons of dry solids per year by the end of 2006. The purpose of this study was to investigate an economical solution to the sludge management problem that Bursa city would encounter. The general trend in Turkey is mechanical dewatering to obtain a dry solid (DS) content of 20%, and liming the mechanically dewatered sludge to reach the legal landfilling requirement, 35% DS content. This study recommends limited liming & solar drying as an alternative to only-liming the mechanically dewatered sludge. Open and covered solar sludge drying plants were constructed in pilot scale for experimental purposes. Dry solids and climatic conditions were constantly measured. Faecal coliform reduction was also monitored. The specially designed covered solar drying plant proved to be more efficient than the open plant in terms of drying and faecal coliform reduction. It was found that, if the limited liming & solar drying method was applied after mechanical dewatering instead of only-liming method, the total amount of the sludge to be disposed would be reduced by approximately 40%. This would lead to a reduction in the transportation, handling, and landfilling costs. The covered drying system would amortize itself in 4 years.     

Uncertainties in decarbonising heat in the UK

Heating is arguably one of the most difficult sectors to decarbonise in the UK's energy system. Meeting the 80% greenhouse gas emission reduction target by 2050 is likely to require that heat related emissions of CO₂ from buildings are near zero by 2050, and there is a 70% reduction in emissions from industry (from 1990 levels). Though it is clear that the use of the natural gas network will reduce over time, recent modelling suggests a limited residual role for gas by 2050 to help meet peaks in heat demand. High levels of uncertainty about the way in which heat will be decarbonised present a number of challenges to policy makers. This paper will explore the risks and uncertainties associated with the transition to a low carbon heat system in the UK as outlined by the 4th carbon budget review. The potential impact of key uncertainties on the levelised costs of heat technologies and the development of energy networks are explored using a sensitivity analysis approach. Policy changes required to decarbonise the heat sector are also examined.     

Energy consumption in rural transportation in India

Energy consumption in rural transportation has been computed, taking into account the energy embodied in vehicles or bullocks, as well as the fuels or feeds and food (of operators). Bullock cart transport consumes over four times more energy than vehicles. However, animal transport will continue to be preferred because of its availability.