不同入路静脉输液港理想置管长度与身高的相关性研究

目的探讨不同入路完全植入式静脉输液港(TIVAP)的理想置管长度与患者身高之间的相关性。方法回顾性分析南京大学医学院附属鼓楼医院2017年3月至2018年10月收治的175例不同入路植入TIVAP行化疗的乳腺癌患者的临床资料,根据入路不同将患者分为4组(A组71例经右侧颈内静脉植入,B组29例经右侧锁骨下静脉植入,C组37例经左侧颈内静脉植入,D组38例经左侧锁骨下静脉植入)。通过术中记录的置管长度及术后当日胸片判读计算TIVAP理想置管长度,采用Pearson检验分析各组TIVAP理想置管长度与患者身高的相关关系。结果 A组和B组患者TIVAP理想置管长度(Y)与身高(X)之间存在正相关关系(r=0. 363、0. 845,P <0. 05),回归方程如下:A组Y=0. 09X-0. 57(R~2=0. 132),B组Y=0. 14X-5. 72(R~2=0. 715)。C组和D组患者TIVAP理想置管长度与身高之间不存在线性相关关系(P> 0. 05)。结论推荐经右侧颈内静脉或右侧锁骨下静脉途径行TIVAP植入,通过身高的回归方程计算理想置管长度,可以提高导管头端理想位置的到位率。     

完全植入式静脉输液港在婴幼儿恶性肿瘤患者中的临床应用

目的探讨植入式静脉输液港的手术方法、植入深度和并发症.方法按Seldinger法穿刺右侧锁骨下静脉或左侧锁骨下静脉,在皮下埋入植入式静脉输液港.分析置管深度与年龄、身高及体重的相关性,并作出回归方程.结果20例穿刺右侧锁骨下静脉,其中1例切开置管;2例穿刺左侧锁骨下静脉.1例渗液,予拔除输液港.1例出现血栓,用尿激酶溶栓后能继续使用.导管置入深度(穿刺点至导管尖的距离)与患者年龄、身高及体重呈正相关,相关系数分别为0.7650、0.9376、0.7402.深度与身高的直线回归方程为:长度=0.7663+0.095×身高.结论据此可术前预测导管置入深度,在没有C形臂透视下也可放入合适位置.     

经左右颈内静脉置入胸壁静脉输液港1595例的并发症特点分析

目的分析经左右颈内静脉置入胸壁港的术中及术后并发症发生特点,为临床选择穿刺静脉及预防并发症的发生提供相关参考。方法回顾性分析2017年至2019年我院安置的经左右颈内静脉置入的胸壁输液港的术中及术后不同类型并发症发生情况,并进行比较。结果左侧颈内静脉置入输液港676例,右侧颈内静脉置入输液港919例,左侧发生并发症43例,右侧发生并发症36例,其中穿刺期间送管不顺并发症左侧发生12例,右侧未发生,导管尖端异位左侧发生13例,右侧发生1例,术后使用期间导管颈部成角左侧发生6例,右侧未发生,左右两侧并发症发生率差异有统计学意义(P <0. 05)。术后输液港相关血栓左侧发生2例,右侧发生8例,其中输液港相关血流感染左侧发生5例,右侧发生8例,该并发症两侧发生率差异无统计学意义(P> 0. 05)。结论左右两侧颈内静脉置入输液港并发症发生率有差别,左侧并发症发生率高于右侧,穿刺期间并发症如导管送管不顺、导管尖端异位、使用期间颈部导管成角导致无法输注液体的这三类并发症左侧发生率明显高于右侧,提示输液港置入术首选右侧,若选择左侧置入输液港,术中需加强针对性的预防措施,避免人为因素增加并发症的发生率。     

颈内与锁骨下入路在植入式静脉输液港中的应用比较

目的 观察颈内与锁骨下入路在植入式静脉输液港中的应用,为临床植入式静脉输液港的入路选择提供参考.方法 随机将102例输液港植入术患者分为A组（颈内入路组）与B组（锁骨下入路组）,两组患者均在清醒状态下局部麻醉后穿刺植入输液港,A组取右侧胸锁乳突肌锁骨头外缘,锁骨上1 cm以上任何一点作为穿刺点,穿刺针与躯体冠状面方向10～ 15°,与矢状面35 ～45°,与锁骨成10～15°,针尖指向气管或对侧的锁骨;B组取右侧锁骨外1/3距锁骨下3 cm为穿刺点,穿刺针贴锁骨下缘指向胸骨上窝.观察两组一次置管成功率与并发症（动脉损伤、导管异常）发生率.结果 A组置管成功率（93％）高于B组（77.8％）,差异有统计学意义P ＜0.05;B组并发症发生率（13.3％）高于A组（5.2％）,差异有统计学意义P ＜0.05.结论 颈内静脉入路应作为植入式静脉输液港置管的首选路径.     

经新生儿肘部静脉置入中心静脉导管体表测量方法的研究

目的探讨经新生儿肘部静脉置入中心静脉导管的体表测量方法。方法采用随机对照研究方法,将72例需PICC置管并签署知情同意书的新生儿随机分为A、B两组,A组以预穿刺点→胸骨上切迹→第三肋间隙的长度为导管置入长度,B组以预穿刺点至右侧胸锁关节的长度为导管置入长度,比较两组导管末端的上腔静脉到位情况。结果 A组导管异位发生率为72.22%,B组导管异位发生率为30.56%,两组导管末端的上腔静脉到位率差异有统计学意义（χ2=12.51,P〈0.01）。结论从预穿刺点量至右侧胸锁关节的体表测量方法可以显著提高PICC一次置管成功率,降低导管异位的发生率。     

血液透析永久性中心静脉导管早期功能不良影响因素分析

目的 探讨永久性中心静脉导管早期功能不良的影响因素.方法 287例终末期肾病患者,采用颈内静脉置管,术后摄胸片.根据是否发生导管功能不良分为功能良好组和导管功能不良组.考察相应参数对导管功能不良发生的影响.结果 两组透析泵控血流量分别为(260.2±21.3)mL/min、(236.1±36.0)mL/min(P＜0.001);两组间身高分别为(161.9±7.7)cm、(158.9±5.4)cm(P =0.006).左右侧颈内静脉插管导管功能不良发生率差异有显著性(P＜0.001);导管末端在心房与在上腔静脉者功能不良的发生卒差异无显著性(P =0.231).Logistic回归提示血红蛋白(OR=1.028,P=0.004)、白蛋白(OR=0.918,P=0.011)、身高(OR=0.926,P=0.002)及插管左右侧颈内静脉(OR=3.696,P＜0.001)为导管功能不良发生的影响因素.结论 永久性中心静脉置管导管功能不良早期影响因素包括患者身高、血红蛋白与血清白蛋白水平,置管时左右颈内静脉位置的选择也是重要影响因素.     

经胸心脏超声辅助导管尖端定位在儿童完全植入式静脉输液港植入术中的应用效果

目的 探讨儿童完全植入式静脉输液港(以下简称输液港)植入术中经胸心脏超声辅助定位导管尖端的效果.方法 回顾性分析我院2015年3月至2020年6月接受输液港植入术的200例恶性肿瘤患儿的临床资料.根据输液港导管尖端定位方式将患儿分为X线片定位组(105例)和超声定位组(95例).统计分析两组患儿的一般资料、手术时长、导管尖端位置理想率及术后并发症发生情况.结果 两组患儿的年龄、性别、身高、体重、BMI、肿瘤类型差异均无统计学意义(P均>0.05).X线片定位组与超声定位组手术时长分别为(57.79±6.39)min和(49.84±4.34)min,差异有统计学意义(P<0.01).X线片定位组和超声定位组导管尖端位置理想率分别为92.4％(97/105)和96.8％(92/95),差异无统计学意义(P=0.167).两组患儿术后伤口感染、导管相关性血栓形成、导管周围纤维蛋白鞘形成、导管异位、导管相关血流感染、非计划取出输液港的发生率差异均无统计学意义(P均>0.05).结论 在儿童输液港植入术中经胸心脏超声能直观、实时、准确地监测输液港导管尖端位置,且具有无X线辐射、手术时间短、设备要求简单、手术开展方便等优势,值得在临床推广应用.     

经锁骨下静脉与颈内静脉途径置管行血液净化的对比研究

目的:研究比较经锁骨下静脉与颈内静脉置管2种途径建立临时性血液通路在置管及用于血液净化时的优缺点.方法:采取回顾性对照研究,选择102例颈内静脉置管和89例锁骨下静脉置管.比较2种置管途径在首次穿刺成功率、穿刺处渗血及血肿、血流量、导管留置时间、导管相关并发症等方面的差异.结果:颈内静脉组与锁骨下静脉组在首次穿刺成功率、误穿动脉率、穿刺处渗血及血肿、气胸发生率方面的差异无统计学意义(P>0.05).颈内静脉组血流量不足的发生率与锁骨下静脉组差异有统计学意义(P<0.05);锁骨下静脉组的导管留时间明显长于颈内静脉组(P<0.05);颈内静脉组的管腔内血栓发生率与锁骨下静脉组比较差异有统计学意义(P<0.05);导管脱位和导管相关感染率比较差异无统计学意义(P>0.05).结论:颈内静脉或锁骨下静脉穿刺置管在临床应用中各有优势.两者的选择应依据术者穿刺技能的熟练程度和患者的具体情况而定.     

植入式静脉输液港与经外周中心静脉置管在化疗患者中的应用效果对比

目的:比较植入式静脉输液港与经外周中心静脉置管在化疗患者中的应用效果。方法:选取156例行化学治疗的肿瘤患者,按照静脉给药方法的不同分为对照组(经外周静脉穿刺中心静脉置管,94例)和观察组(植入式静脉输液港,62例)。比较两组患者导管留置时间和并发症发生情况。结果:观察组患者导管留置平均时间为(197.64±96.73)d,对照组为(95.01±34.23)d,观察组患者导管留置时间明显较对照组长(P<0.05)。观察组导管相关并发症发生率为4.84%,对照组为14.90%,观察组并发症发生率明显低于对照组(P<0.05)。结论:与经外周中心静脉置管相比,植入式静脉输液港可显著延长化疗患者导管留置时间并减少并发症发生。     

新疆汉族青年胸骨长度与身高的关系

目的：研究新疆汉族青年胸骨长度与身高的关系。方法：采用邵象清的测量方法。结果：按性别、年龄分组，计算出胸骨长和身高的均值、身高与胸骨长的比值，并提出了由胸骨长推算身高的简单公式和回归方程。结论：通过胸骨长可估算身高；胸骨长与身高有显著的直线回归关系。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

CLINICAL SIGNIFICANCE OF SERUM CYTOKINES IL-1β,sIL-2R,IL-6,TNF-α,AND IFN-v IN ACUTE CORONARY SYNDROME

Objectives To explore serum cytokines levels (including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v) and their significance in patients with acute coronary syndrome (ACS) and the subsequent follow-ups, with attempt to estimate the role of various serum inflammatory markers in the diagnosis and assessment of ACS.Methods The study population include 40 patients with acute myocardial infarction (AMI), 40 patients with unstable angina pectoris (UAP), and 40 controls. Among the 80 patients, 60 patients attended a follow up 4 months later. Serum inflammatory markers including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v were measured by enzyme linked immunosorbent assay.Results Serum IL- 1 β, sIL-2R, IL-6, TNF-α were significantly higher in AMI group or UAP group compared to the control group and became significantly lower 4 months later in the follow-up patients. Serum levels of IFN-v shows no significant difference between AMI group or UAP group and controls, also showing no significant change when measured in follow up patients. There was no correlation between serum creatine kinase-MB isoenzyme levels and serum inflammatory markers either in UAP or AMI group. Furthermore, when divided into two subgroups using Wagner's QRS scoring system in the AMI group, there is no difference of each serum inflammatory marker between ≤ 6 scores group and ＞ 6 scores group.Conclusion Serum levels of certain inflammatory markers may have some diagnostic value for ACS, and can be a useful marker reflecting disease stability.     

Possible Spread of adenovirus type 3 from poultry to humans ：indirect evidence from an outbreak in China

Objective:To explore the epidemiology and etiology for an outbreak of acute respiratory tract infection that occurred in one county of Jiangsu Province, China 2004. Methods: Only cases meeting the case definition were included in the study. We reviewed the medical records of the cases who were admitted to the local hospitals, interviewed cases by a standard questionnaire, and then described the epidemiotogic features and analyzed risk factors by means of a case-control study. We collected pharyngeal swab specimens and sent them to different laboratories for isolation and culture. The laboratory used different detection methods such as DIP, PCR, electron microscope examination and microneutralization assay, to identify and then type the positive specimens. Results:A total of 871 cases were reported during the period from April 18 to July 4,2004. The distribution of onset times presented two peaks, one in late May and another in middle June. The epidemic occurred mainly in the elementary and junior high schools in ten townships of one county, and the mean age of the cases was 12 years (range 7 months to 18 years). The course of the disease was acute, and was characterized by fever accompanied with sore throat and tonsillitis. The WBC count of cases was normal or elevated. The mean duration of illness was 5 days (range 2 to 12 days). No fatalities from illness were reported. A case-control study indicated that the possible risk factors were close contact with a case and/or poultry before onset and sharing of towels among members of the family. The typical CPE was observed through inoculating pharyngeal swab specimens into the HEP-2 cell cultures in different laboratories. An infection of adenovirus type 3 was verified by detecting positive specimens in different methods. Conclusion:This investigation demonstrated that the acute respiratory infection in cases was caused by adenovirus type 3. Cases occurred in over 70 schools in ten townships in 2004, and the route of transmission was possibly close contact with cases or droplet transmission.