即穿型人工血管在维持性血液透析患者中的应用及护理现状

目的了解目前即穿型人工血管在维持性血液透析患者中的应用现状及其护理新进展。方法通过复习国内外文献,从我国维持性血透患者即穿型人工血管的使用现状、并发症及护理方面进行综述。结果即穿型人工血管具有手术后可立即穿刺的优点,在并发症方面与传统聚四氟乙烯膨体人工血管相近,在初级及次级通畅率上差异无统计学意义。结论即穿型人工血管可在术后早期穿刺,避免了中心静脉置管,有效降低导管使用率,保护了中心静脉资源。为了尽可能的减少即穿型人工血管并发症,延长其使用寿命,精心的护理和患者日常维护尤为重要。     

人工血管内瘘拔针方式的研究及护理

目的探讨人工血管内瘘拔针方式对人工血管内瘘的影响。方法选取人工血管内瘘进行血液净化患者8例,采用自身对照法比较传统组拔针方式与改进组拔针方式人工血管内瘘压迫时间及穿刺针口渗血的发生率。结果改进组拔针方式比传统组拔针方式使穿刺针口Ⅰ级渗血发生率由18.26%降至3.85%、Ⅱ级渗血发生率由8.65%降至0.96%、Ⅲ级渗血发生率由5.77%降至0,p<0.05,有明显统计学差异。结论改进组人工血管内瘘拔针方式明显优于传统组,不仅对人工血管的保护起到了重要作用,同时减少医患纠纷,避免护理差错事故的发生。     

下肢动脉旁路术后人工血管感染的预防

目的 探讨下肢动脉旁路术后人工血管感染的处理方法,为预防和治疗患者感染提供参考依据。方法 选取2004年5月-2013年5月在医院接受治疗的下肢动脉旁路术后人工血管感染患者9例;对所有患者进行病原菌培养及药敏试验,根据结果选择抗菌药物,出院后对患者进行定期随访,记录随访结果。结果 9例感染患者术后保肢6例、截肢2例、围手术期死亡1例,死亡原因为并发心肌梗死;8例术后生存患者均进行12~60个月随访,其中1例患者在随访中死亡,死亡原因为脑出血;生存7例,其中3例保留通畅血管,2例去除人工血管未重建血运,2例截肢患者无异常;下肢动脉旁路术后人工血管感染病死率为22.22%、存活率为77.78%、截肢率为22.22%。结论 下肢动脉旁路术后人工血管感染病死率和截肢率较高,临床上一旦发生,大多需要取出人工血管,对于血运通畅者可考虑保留人工血管。     

生物人工血管的生物相容性研究

目的：考察一种新型的生物人工血管的生物相容性。方法：依据G B/T16886医疗器械生物学评价标准规定的细胞毒性、急性毒性试验、皮内刺激试验、致敏试验、溶血试验、亚慢性毒性试验、植入试验和遗传毒性试验方法评价生物人工血管的生物相容性,以验证其安全性和有效性。结果：显示生物人工血管无急性毒性、无皮内刺激作用、无致敏作用,溶血率不大于5%;细胞毒性为0级;皮下植入后1周、4周、12周和26周样品的炎症反应和纤维囊形成与对照无明显差别;遗传毒性采用鼠伤寒沙门氏菌回复突变试验（Ames试验）、体外哺乳动物细胞染色体畸变试验、哺乳动物细胞体外基因突变试验均为阴性,说明生物人工血管无遗传毒性。结论：生物人工血管具有良好的生物相容性,没有观察到不良反应,符合临床使用要求。     

高位肠-腔人工血管架桥术治疗门脉高压症断流术后再出血48例分析

目的：探讨高位肠系膜上静脉-下腔静脉人工血管架桥术（简称高位肠-腔人工血管架桥术）治疗门脉高压症断流术后上消化道再出血的疗效。方法：对郑州大学第一附属医院2005-2011年48例门脉高压症患者行断流术后再次出血的患者行高位肠-腔人工血管架桥术治疗的临床资料回顾性分析。结果：本组患者术后自由门静脉压力平均下降9cmH_2O。1例切口感染,1例腹腔感染,9例发热,2例肝性脑病,1例人工血管内血栓形成,8例出现乳糜漏,以上并发症均通过非手术治疗治愈。1例死于肝肾综合征。结论：门脉高压症断流术后上消化道再出血行高位肠-腔人工血管架桥术,手术创伤小,近、远期疗效好,是一种治疗门脉高压症断流术后上消化道再出血有效的方法。     

下肢动脉人工血管搭桥术的护理体会

回顾性总结16例下肢动脉硬化闭塞症患者行人工血管搭桥术的治疗及护理经验,认为积极妥善的术前、术后护理,可使病人对下肢动脉硬化闭塞症及人工血管搭桥术有充分的认识,从而积极认真地配合手术及术后抗凝治疗。16例下肢动脉硬化闭塞症患者的治疗及护理经验显示,人工血管搭桥术是重建患肢血液循环通道的有效方法,动脉造影是选择正确重建手术方式的必要保证。     

人工血管置换术治疗腹主动脉瘤25例分析

目的 评价人工血管置换术对腹主动脉瘤的治疗效果.方法 总结25例腹主动脉瘤切除、人工血管置换术的经验.结果 25例术后均痊愈出院.围手术期并发症:肺内感染3例、急性心功能不全2例、乳糜漏1例、血小板减少3例.术后1、3.5年生存率分别为97.1%、85.4%、77.2%,随访中未发现与人工血管相关的并发症或死亡病例.结论 人工血管置换术是治疗腹主动脉瘤安全、有效的方法.手术适应证的合理选择、精细的手术操作及严密的围手术期管理均为治疗成功的关键.     

主动脉瘤外科治疗的新进展

主动脉瘤表现为主动脉血管的瘤样扩张,象鼻技术是治疗巨大的、范围广泛的主动脉瘤的最新外科手术技术。它是在完成主动脉瘤人工血管置换术后,将一段人工血管置入并漂浮于下游主动脉内,为后期下游的主动脉置换提供便利条件。采用象鼻技术分期修复巨大的、范围广泛的主动脉瘤效果良好。     

Konno手术治疗室间隔缺损合并主动脉瓣关闭不全时主动脉瓣置换术中的应用

目的报告4例采用Konno手术治疗室间隔缺损(VSD)合并主动脉瓣关闭不全(AI)的主动脉瓣置换术的手术结果。方法应用Konno法切开主动脉瓣环至VSD,用二片人工血管补片修补VSD,并扩大主动脉瓣环,植入人造瓣膜,其中一片人工血管扩大升主动脉,另一人工血管补片修复右室流出道。结果4例修补直径8~15 mm VSD,扩大主动脉瓣环直径5~8 mm,植入19~21 mm人工机械瓣,无手术死亡,随访6~43个月,患者心功能恢复良好。结论Konno手术在扩大主动脉瓣环时可同时修补VSD,较适用于需要行主动脉瓣置换的干下型VSD。     

破裂腹主动脉瘤的外科诊治及死因分析

[目的]探讨破裂腹主动脉瘤的诊断、治疗方法及死亡原因.[方法]回顾分析我院1999年4月～2007年12月外科手术治疗破裂腹主动脉瘤27例,男性20例,女性7例,年龄35～80岁,平均年龄66岁,自知有腹主动脉瘤者6例,有腹部搏动性包块者6例,15例通过术前急诊彩超或CT确诊,采用急诊腹主动脉瘤切除人工血管移植术,其中分叉型人工血管17例,直型人工血管10例.[结果]破裂腹主动脉瘤行急诊腹主动脉瘤切除人工血管移植手术30d围手术期死亡率33.3%(9例),死亡原因为出血性休克所致急性肾功能衰竭4例,多器官功能衰竭3例,呼吸循环衰竭2例.[结论]手术治疗是对破裂腹主动脉瘤的有效治疗,快速早期确定破裂腹主动脉瘤诊断、紧急外科手术治疗,尽快控制出血,术后加强围手术期管理是降低破裂腹主动脉瘤死亡率的关键.急性心脑血管疾病、急性肾功能衰竭及肺部并发症是术后的主要并发症及死亡原因.     

Esophageal prosthesis

Curative surgery of oesophagus cancer is often challenged because of local and regional extension or metastasis or an impaired health in patients often elderly. Authors report result of palliative endoscopic treatment of dysphagia by prothesis in 11 patients. Improvement of dysphagia occurs in all patients. No death occurs by this technic. Global migration is observed in 44% because of low seat in 50% of cases, cardial seat in 25%, and finally important dilatation until 18 mm before putting prothesis. In conclusion, oesophagus prothesis is a palliative treatment that permit an alimentary comfort in patients with oesophagus cancer of 1/3 medium.     

Mitral valve replacement with a bileaflet prosthesis: results of 112 cases

We report 112 cases of mitral valvular replacement with bileaflet prothesis. The mean age is 40 ans +/- 3.4 years (9-74 years). 71 (65%) are men and 45 (35%) are women, the main éthiology of mitral disease is rheumatic fever (94.74%). The Saint Jude prothesis is implanted in 70.4% cases. The early post operator mortality is 1.8% it is related on low cardiac output. With a mean follow-up of 110 months, the late mortality is 5.5%. The survey is 97% at 5 years and 94% at 10 years. The rates of thromboembolic and hemorrhagic complications are 6.3% and 9%. We report only one case of infective endocarditis. The rate of réintervention is 5%. By echocardiography the hemodynamic profile of bileaflet prothesis is excellent even with the small size.     

人工髋关节置换术的疗效分析

目的：探讨人工髋关节置换的手术适应证与手术相关的问题。方法：对1998—2004期间有完整临床随访资料的、行人工髋关节置换术的132例进行总结分析。结果：随访1～5a,按照Harris评分标准,术前平均49分,术后平均85分;优96例,良28例,中6例,差2例,优良率93%。并发症：假体松动下沉2例,关节脱位1例,假体柄下端穿出股骨1例,感染3例,无下肢深静脉栓塞、坐骨神经损伤,亦无其他全身性严重并发症发生。结论：只要选择好手术适应证,术前准备充分,术中操作熟练,术后处理得当,人工髋关节置换可使患者获得良好的效果,减少并发症。     

用LM算法改进的BP网络在表面肌电信号识别中的应用研究

提出用Levenberg-Marquardt算法改进BP神经网络识别表面肌电信号的方法.采用多尺度小波变换对肌电信号进行分析,提取各尺度下小波系数幅值的最大和最小值构造特征矢量,输入BP神经网络可进行模式识别,经过训练能够成功地从表面肌电信号中识别展拳、握拳、前臂内旋、前臂外旋四种运动模式.实验表明,LM算法在响应时间和识别精度上都比标准的BP算法有了很大提高.     

Cost analysis of peritrochanteric fractures according to types of surgical treatment and progressive care from the viewpoint of financial providers

AIM: The aim of this study to calculate the health insurance cost of treatment of patients with pertrochanter fracture of femur from the first hospital admission for 18 months follow up period according to different surgical methods and progressivity levels. DATA AND METHODS: Recruitment criteria were: 1) all patients with a hip fracture in 2000 defined by the International Classification of Disease (ICD) as "S7210"; 2) working age between 18-60 and 3) first admission to surgical unit, and had an operation. The cost analyses include the cost of acute and chronic in-patient care, outpatient care and sick pay. RESULTS: The total costs were the highest in case of those types of operations with lower cost of prothesis device and lower load stability (Ender 588.000 Ft, fix angled plate 534.000 Ft) because of the higher sick-pay costs. The total costs were the lowest in case of those types of operations with higher cost of prothesis device and higher load stability (Gamma 512.000 Ft, DHS 465.000 Ft) because of the lower sick-pay costs. The gain in recovery time with the 3-4 months shorter disability period can be seen in case of operations with higher load stability. The average length of stay decreases from 15-17 days to 9-11 along progressivity levels. CONCLUSION: With the application of load stable prothesis device the total health insurance costs were the lowest at the universities and national institute while these costs proved to be higher.     

长柄人工股骨头置换治疗老年股骨粗隆间骨折的临床研究

目的探讨长柄人工股骨头置换治疗老年股骨粗隆间粉碎性骨折的临床疗效。方法治疗70岁以上股骨粗隆间粉碎性骨折15例,对住院时间、术后负重行走时间及并发症进行观察、随访。结果平均住院时间16d,平均术后负重时间14d,术后并发髋关节疼痛2例。结论长柄人工股骨头置换治疗老年粗隆间粉碎性骨折功能恢复好,能早期下地负重,减少发症,临床上值得推广。     

下肢动脉旁路移植术后人工血管闭塞的再手术治疗

目的 总结下肢动脉旁路移植术后人工血管闭塞的再手术治疗经验.方法 回顾性分析21例下肢动脉旁路移植术后人工血管闭塞患者再手术的治疗效果.结果 21例患者术后均获随访,随访时间6～36(12±3)个月.肢体存活率71.4%(15/21),截肢率28.6%(6/21),9例最后通过股深动脉供血的患者肢体全部存活.结论 下肢动脉旁路移植术后人工血管闭塞的主要原因是内膜增生或流人道及流出道的狭窄闭塞,再手术前应仔细分析闭塞原因以选择合适的手术方式.股深动脉重建对于人工血管闭塞的再手术治疗非常重要.

Abstract：

Objective To review reoperation on blood vessel prosthesis occlusion after arterial bypass graft in lower limbs. Method The treatment effect of 21 patients with reoperation on blood vessel prothesis occlusion after arterial bypass graft in lower limbs was analyzed retrospectively. Results All the cases were followed up 6-36 (12 ±3) months. The limb salvage rate was 71.4%(15/21) ,the amputation rate was 28.6% (6/21). All 9 limbs that underwent revascularization from deep femoral artery reserved. Conclusions Endomembrane hyperplasy, occlusion of the inflow and outflow tracts are the major reasons for the occlusion of blood vessel prosthesis after arterial bypass graft in lower limbs. Appropriate procedures should be based on careful consideration of the occlusion reasons. Profundaplasty is an effective therapy for those who are treated by reoperation on blood vessel prosthesis occlusion in lower limbs.     

Thromboembolic accident after mitral valve replacement

Between January 1981 and December 2000, we report 112 cases of mitral valvular replacement with bileaflet prothesis. Saint Jude prosthesis was implanted in 71% of cases. With a mean follow-up of 110 months we report a thromboembolic accident in 7 cases (6.2%). The linear rate of thromboembolic accident is 0.69% A/P. This complication was concerned 5 women and 5 men. The mean age is 54 years (43-65 years). An embolic accident without prosthesis thrombosis is noted in 6 cases. We report only one case of prosthesis occlusive thrombosis with urgent chirurgical intervention. Par rapport au RVM, l'ATE est survenue dans uns délai moyen de 129 months (86-168 months). Left atrium size, embolic antecedent, and bad anticoagulation are the predicted factors of thromboembolic accidents in our study. Patient age and sex, atrial fibrillation, type of bileaflet prosthesis don't influence the occurrence of thromboembolic accident.     

应用万古霉素骨水泥占位器植入术对人工全髋关节置换术后感染的护理

目的探讨人工全髋关节置换术后感染应用万古霉素骨水泥占位器植入术围手术期护理观察要点。方法对28例人工全髋关节置换术后感染行感染假体取出,病灶清除后万古霉素骨水泥占位器植入术患者术前、术后体温、血沉(ESR)、C反应蛋白(CRP)结果进行比较,观察应用万古霉素药物不良反应。结果应用万古霉素骨水泥占位器植入术后患者ESR、CRP均较术前降低,差异有统计学意义,其中2例在静脉滴注万古霉素过程中出现寒颤、发热,4例出现"红人综合征",经处理后症状均缓解。结论 ESR、CRP、体温的变化趋势是应用万古霉素骨水泥占位器植入术围手术期护理观察重点,实施有针对性的护理措施可有效帮助患者顺利通过治疗阶段。     

The impact of technology in Pathological Anatomy and the contribution of this speciality to technological development

It is obvious that technology has contributed throughout history to the development of the different sciences. In this article, we define the concept of Pathology as a medical speciality, and we explain its influence in a hospital, considering very different fields such as education, research, quality control, hospital information, and patient care. This speciality has undergone a considerable evolution, to which technological innovation has undoubtedly contributed. As a basic discipline, it is of great importance in pre and post-graduate training, in the medical education at the hospital or outside it, and in the fields previously mentioned. Its relation with other disciplines such us Chemistry, (fixation and dyeing), Physics (mechanical devices), Mathematics (algorithms, morphometry, statistics...) and Telecommunications (telepathology, image analysis...) is examined and their contribution to Pathology is evaluated. We are also aware of contributions made by Pathology to technological innovation in the evaluation of different diagnostic methods or in the recent therapeutic technologies based on Radiotherapy, Hyperthermia, laser, prothesis, etc.; where histological examination provides accurate information about the therapeutic capacity or side-effects, or the rejection reactions caused, aiding the research to obtain adequate results.