应用H_2O_2肝动脉声学造影观察肝癌所致动－门静脉分流

应用Ｈ＿２Ｏ＿２肝动脉声学造影观察肝癌所致动－门静脉分流湖北省恩施土家族苗族自治州医院杨兵，李丽亚，金华才，谢宝璇，谭壮勇我们在１９９１年报道了Ｈ２Ｏ２肝动脉声学造影观察肝内占位性病变声像图改变的文章（１）。在进一步的研究中。发现Ｈ２Ｏ２肝动脉声学造...     

亲体小肠移植1例的手术配合及体会

小肠移植是挽救短肠综合征及其他肠功能不全患者生命的有效手段，但其是所有大器官移植中最困难的一种。小肠属于高免疫源性器官，由于肠腔内聚集有大量的病原菌及其他微生物，移植后发生的排斥反应及感染较难控制。因此，小肠移植发展十分缓慢，成为临床上器官移植难以成功的典型代表。由于亲体小肠移植具有组织相容性好及冷缺血时间短的优点，越来越受到医学界的重视。2005年1月21日我院成功实施亲体小肠移植1例，手术顺利，供受者均健康存活，现将手术配合及体会报告如下。     

手术室护士安全用药的管理

科学地分析、确定手术室护士在用药过程中现存和潜在的安全隐患因素并提出相应的管理措施,主要包括:影响手术室护士安全用药的因素有用药过程中未严格执行查对制度,药物商品名多变造成药品类别记忆混淆,不熟悉围手术期用药的正确方法,不熟悉药物不良反应的处理,药品存放不规范和用药后记录不规范不完整,应该在管理工作中坚持以人为本的原则,强化慎独精神,坚持零缺陷的管理理念,严格执行查对制度,及时、准确、无误地执行医嘱,不断更新护士的用药知识,掌握用药的正确方法,认真处理带入手术室的各种药物,注意观察及处理用药后的不良反应,并认真、规范和完整地书写护理记录。认为提高护士安全用药意识和能力,防止用药差错的发生,保证患者在手术室期间安全有效的用药是护理管理的重点。     

重建钢板内固定治疗肩胛颈骨折14例

作者自2001年2月至2004年7月采用重建钢板内固定治疗14例有明显移位的肩胛颈骨折患者，疗效满意，现报告如下。     

手术治疗胆囊癌71例临床分析

胆囊癌临床不少见,其恶性程度高,预后差且发病率有逐渐增高的趋势.作者回顾性分析我院 1991～ 2002年 4月间所行 71例各类胆囊癌手术,并结合文献对不同分期的胆囊癌的诊断及合理手术方式、对预后的影响、手术中的问题等加以讨论.     

静脉麻醉下行无痛结肠镜检查病人的护理

[目的]探索无痛结肠镜检查中的配合与护理。[方法]在226例病人进行无痛结肠镜检查中,护理人员加强心理护理、肠道准备、术中观察、密切配合医生插镜。[结果]在226例病人检查中,镜检成功率99.56%,无一例穿孔、出血、麻醉意外等并发症发生。[结论]无痛苦肠镜检查是安全可靠的,它能增加病人的依从性,在有严格监护条件下值得临床推广应用。     

三维电解剖标测指导疑难右侧游离壁旁路的导管消融

Objective To demonstrate the electroanatomic substrates of right-sided free wall (RFW)accessory pathways (APs) which were refractory to conventional catheter ablation utilizing three-dimensional (3D) mapping. Methods Seventeen patients with RFW APs that failed initial conventional catheter ablation(s)by a mean of 1～3(1.8±0.6) attempts were enrolled in the study. Electroanatomic mapping of the right atrium was performed during right ventricular pacing in 14 patients and orthodromic reciprocating tachycardia in 3patients. Radiofrequency energy was delivered via irrigation catheter to the earliest atrial activation site. Results The earliest atrial activation site, which represented the atrial insertion of the APs, was separated from the tricuspid annulus by an average of 9 ～ 20 ( 13.6 ± 3.4 ) mm, and the local activation time was 18 ～ 80(31.5±16.3) ms earlier than that of the corresponding annular point. The target electrogram demonstrated AP potential in fourteen patients and ventriculoatrial fusion in the rest three. Accessory pathway was blocked in one case during moving the catheter and RF ablation delivery on the areas. One patient exhibited an AP with wide branching on the atrial side during mapping. RF ablation with an irrigated catheter successfully interrupted AP conduction in remaining 16 patients without complications. After a mean follow-up of 3 ～ 41 (18.6±12.7) months, there were no recurrences of ventricular preexcitation or episodes of tachycardia. Conclusion RFW APs refractory to conventional catheter ablation might be due to unique anatomic AP features such as more epicardial course at the annulus level with atrial insertion distance from the tricuspid annulus. Electroanatomic mapping is helpful to accurately localize the atrial insertion sites of these APs and facilitates catheter ablation.     

碎裂QRS波在致心律失常性右心室心肌病诊断中的价值

Objective To evaluate diagnostic value of fragmented QRS complex (fQRS)in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). Methods Forty-three patients [33 men, aged (40. 4 ± 13.9)years]meet the ISFC/ESC diagnostic criteria for ARVC were enrolled in this study. A standard twelve-lead electrocardiogram was obtained during the resting status. Characteristics of fQRS were detailedly studied by three doctors independently. A comparison of the prevalence among fQRS, epsilon wave and T wave inversion( TWI )in the right precordial leads exceeding V3 was done. Results Most fQRS could be found in the inferior leads (44. 3% ) and the right precordial leads (24. 2% ). Within the QRS complex, the prevalence of fQRS in the R wave was significantly higher than it in the S wave(58. 4% vs 32. 9% ,Z =4. 30,P ＜0. 01 ).fQRS could be found in a total of 31 of 43 cases( mean 4. 6 ± 1.7 ( range 2 to 9) per patient). The prevalence of fQRS was significantly higher than that of epsilon wave ( 73.8% vs 30. 2%, Z = 3.67, P ＜ 0. 01 ) and TWI (73.8% vs41.9% ,Z =2. 61 ,P＜0. 01 ). Conclusion fQRS was a common electrocardiographic abnormality,and most was found in the inferior and right precardial leads in patients with ARVC. It may be used as an important noninvasive preliminary screening electrocardiographic criteria.     

磁导航遥控射频导管消融治疗房室结折返性心动过速的初步体会

Objective To evaluate the safety and feasibility of remote radiofrequency catheter ablation of atrioventricular nodal reciprocating tachycardia (AVNRT) using the magnetic navigation system (MNS). Methods A total of 37 patients[female 29, mean age (44 ± 15 )years]with documented AVNRT were enrolled in this study from March 2007 to June 2009. A 4 mm tip magnetic mapping and ablation catheter ( Helios Ⅱ ,Stereotaxis, USA),which was remotely controlled by the MNS (Niobe Ⅱ , Stereotaxis, USA), was used for both mapping and ablation. Conventional slow pathway modification with focal ablation at the fight posterior septum was first performed in all patients. If it was failed, linear lesions at the base of Koch' s triangle was then done. Results After ablation, AVNRT was non-inducible in all 37 patients without any complication except one case experienced transient first degree AV block. Focal ablation was performed in 34 patients, and linear ablation strategy was used in the remaining three cases to achieve the end point. Among all the 37 patients, slow pathway ablation was achieved in 14, whereas slow pathway modification was reached in the remaining 23 cases.The mean procedural time, the RF deliveries, the duration of RF application were ( 120 ± 32) min, (2. 9 ± 1.6)times, ( 130 ± 33 )s,respectively. The total fluoroscopy time and the physician X-ray exposure time were(5.3 ±2. 7)min and(2.9 ± 1.1 ) min,respectively. There was no significant change of the AH interval,the HV interval,and the atrioventricular nodal conduction refractory period after ablation. Compared with the first 18 patients, the mean procedural time, the total fluoroscopy time and the X-ray fluoroscopy time during magnetic navigation were significantly decreased in the later 19 patients (P ＜0. 001 ). It indicated that the learning curve of remote catheter ablation using the MNS is short. Conclusion Remote catheter ablation using the MNS to cure AVNRT is safe and effective with short learning curve and decreasing X-ray exposure time for interventional physicians.     

起源于左侧希氏-浦肯野系统的特发性加速性室性自主心律

目的 介绍起源于左侧希氏-浦肯野系统的特发性加速性室性自主心律,揭示其临床特征并探讨可能的电生理机制.方法 回顾分析4例特发性加速性室性自主心律患者的心电图形态特征、临床表现、治疗方法及预后.结果 4例患者,男性2例,平均年龄48(40～54)岁,均无器质性心脏病.室性自主心律均呈右束支阻滞型,其QRS时限0.11～0.13 s,符合左侧希氏-浦肯野系统起源,其中3例电轴右偏,1例电轴左偏.自主心律RR间期不规则,平均频率为87(55～110)次/min,与窦性心律交替出现.所有患者临床均表现为发作性心悸.1例患者室性自主心律在短期服用普罗帕酮后消失,另1例短期服用维拉帕米后消失,余2例未予以特殊处理后自然消退.平均随访4.5(2～8)年,临床无心律失常发作,亦无其他心血管事件发生.结论 起源于左侧希氏-浦肯野系统的加速性室性自主心律是左侧希氏-浦肯野系统特发性室性心律失常的一种表现形式,多数为自限性,临床呈良性经过.