1例射频消融术后并发肺栓塞的抢救配合及护理

总结1例射频消融术后并发肺栓塞的抢救配合及护理体会，认为肺栓塞患者一旦发生晕厥，应立即行心肺复苏，以确保有效的循环和呼吸，尽早溶栓，改善临床症状。积极的抢救、熟练的配合、良好的护理是此患者康复的关键，同时术后早期生命体征的监测、并发症的预防、合理饮食、适当活动及休息对预防肺栓塞的发生也是很重要的。     

Long-term results in the treatment of menorrhagia and hypermenorrhea with a thermal balloon endometrial ablation technique.

BACKGROUND AND OBJECTIVES: Evaluation of long-term results using a thermal balloon endometrial ablation technique to treat menorrhagia and hypermenorrhea, considered dysfunctional uterine bleedings. METHODS: A single-arm, prospective study with long-term follow-up of 48 months at the department of obstetrics and gynecology, University of Kiel, Germany. Following hysteroscopic evaluation of the uterine cavity and fractionated curettage, the Cavaterm endometrial thermal ablation technique was performed on 70 patients over the age of 40 with menorrhagia and hypermenorrhea in whom medical treatment had previously failed. The study included a group of 10 patients with adenomyosis and uterine fibroids. RESULTS: In 65 patients, a complete 48-month follow-up evaluation was possible: 58% of patients reported amenorrhea and 33% hypomenorrhea. Nine percent of patients remained eumenorrheic. Fifty percent of the small group with failed indications for the procedure had to undergo a hysterectomy. CONCLUSIONS: The Cavaterm thermal coagulation system in the earlier mode of application (15 minutes at a temperature of 70 degrees C and a pressure of 200 mm Hg) is a safe and highly effective method of endometrial ablation resulting in a minimal amount of posttreatment menstrual bleeding.     

微波导入与达克宁栓治疗念珠菌阴道炎临床分析

目的:分析微波导入联合达克宁栓治疗严重念珠菌阴道炎的效果。方法:对182例严重念珠菌阴道炎患者随机分为两组:研究组采用微波导入联合达克宁栓进行治疗;对照组则单用达克宁栓治疗。比较两组疗效。结果:治疗后5d～7d及1个月随访结果均显示,研究组的疗效明显高于对照组,差异有显著性意义(P<0.01),治疗后1个月研究组复发率明显低于对照组(P<0.05)。结论:微波导入联合达克宁栓治疗严重念珠菌阴道炎效果好,值得临床推广。     

CT导向下经皮射频消融术治疗肾上腺恶性肿瘤

目的对29例肾上腺肿瘤患者行射频消融（RFA）治疗，研究其近期局部治疗效果、不良反应和副作用。方法肾上腺肿瘤患者共29例，病灶总数31个，其中直径≤2．0cm的病灶共5个，2．1-4．0cm者18个，4．1-6．0cm者5个，≥6．1cm者3个，经RFA治疗1个月后行螺旋CT双期增强扫描评价肿瘤治疗效果。结果上述病灶经消融治疗后达到完全坏死者分别为5个、18个、3个、2个。患者无严重并发症出现。结论RFA治疗安全可靠，副作用小，是治疗肾上腺恶性肿瘤的有效方法之一。     

Visualisation of intra-cardiac structures and radiofrequency lesions using intracardiac echocardiography.

AIMS: Fluoroscopy does not allow identification specific anatomical landmarks during electrophysiological studies. Intra-cardiac echocardiography permits visualization of these structures with excellent accuracy, but the optimal method has not been fully described. The aim of this study was to assess the capability of intra-cardiac echocardiography for the visualization of such structures using two different approaches. We also assessed its capability for the evaluation of radio frequency lesions 20 min after catheter ablation of the cavo-tricuspid isthmus. METHODS: Intra-cardiac echocardiography was performed using a 9 MHz rotating transducer in eight consecutive patients (age range: 37-76 years) after radio frequency ablation of the cavo-tricuspid isthmus. The ultrasound catheter was inserted through the femoral vein into the superior vena cava and was pulled back to the inferior vena cava. The echo catheter was then reinserted through the subclavian vein and advanced into the right ventricular apex and was pulled back from the right ventricular to the superior vena cava. Qualitative evaluation and intra-cardiac measurements were performed off-line. RESULTS: The fossa ovalis, the tricuspid valve, and the terminal crest were visible in all patients regardless of the method of introduction of the echo catheter. Left-sided structures were less accurately seen by intra-cardiac echocardiography. The horizontal diameter of the fossa ovalis was 8.9+/-1.8mm. The cavo-tricuspid isthmus was visible using the femoral approach in three patients. The isthmus could be visualized in all patients, and in three patients together with the ostium of the coronary sinus, using the subclavian approach. radio frequency lesions were not visible 20 min after ablation. Additionally, both the left and right ventricles could be seen using the subclavian approach. CONCLUSIONS: The subclavian approach is feasible, safe and superior to visualize the isthmus. Twenty minutes after radio frequency ablation of the cavo-tricuspid isthmus radio frequency lesions are not visible using intra-cardiac echocardiography.     

Remote-controlled catheter ablation of accessory pathways: results from the magnetic laboratory.

AIMS: This study evaluates feasibility, safety, and efficacy of magnetic remote-controlled accessory pathway (AP) ablation. METHODS AND RESULTS: The novel magnetic navigation system (MNS) (Niobe, Stereotaxis) creates a steerable magnetic field (0.08 T) controlling the distal magnetic tip of an ablation catheter. In conjunction with a catheter advancer system (Cardiodrive, Stereotaxis) remote catheter ablation is enabled. Conventional electrophysiology study identified AP conduction in 59 patients (37 males, 36+/-14 years, 60 APs). First generation 1-magnet tip (1-M) (group I, n=18), second generation bipolar 3-magnet tip (3-M) (group II, n=27), and third generation quadripolar 3-magnet tip catheters (3-M quad.) (group III, n=14) were used for magnetic remote-controlled ablation. Successful AP ablation was achieved in 67% (group I), 85% (group II), and 92% (group III). A significant decrease of median [IQR: Q1-Q3] fluoroscopy time and dosage was observed: 21.2 [12.1-33.8] min, 1110 [395-3234] microGym2 (group I); 6.5 [4.4-15.4] min, 290 [129-489] microGym2 (group II), and 4.9 [3.4-8.0] min, 129 [74-270] microGym2 (group III). Mean procedure time (217+/-67 min; 182+/-68 min, and 172+/-90 min) significantly decreased in group III. Median number [Q1-Q3] of radiofrequency current applications in groups I, II, and III was 4 [2-9], 4 [2-6], and 2 [2-4], respectively. No complications occurred. CONCLUSION: Remote AP ablation is safe and feasible using the novel MNS. Introduction of the 3-magnet quadripolar ablation catheter significantly improved the efficacy of the procedure.     

射频消融术后尿潴留患者的护理

分析86例射频消融术后患者出现尿潴留的不同原因，包括不习惯床上排尿、精神因素、疼痛等。护理对策包括：减少卧床时间，心理护理，变换体位，物理诱导，术后多饮水等，结果81例患者排尿成功，只有5例(5．8％)男性前列腺肥大患者需要导尿。     

TUVP手术时间对血红蛋白及电解质的影响

目的 了解经尿道前列腺汽化电切手术时间对血红蛋白及血清电解质的影响。方法 对64例经尿道前列腺汽化电切术患按手术时间分组，观察手术前后血红蛋白及血清电解质的变化。结果 手术时间对血清电解质的降低有的影响，对血红蛋白降低的影响不显。结论 减少TUR综合征的关键是要操作熟练，缩短手术时间及手术中注意止血。