经桡动脉和股动脉途径PCI治疗高龄冠心病患者的临床效果分析

目的:评价经桡动脉和股动脉途径PCI治疗高龄冠心病患者近期和远期临床效果。方法:选取2007年1月至2012年2月在我院行PCI治疗且年龄≥80岁的冠心病患者237例,按照患者入院PCI治疗途径分为经桡动脉途径组(Ⅰ组,n=114)和经股动脉途径组(Ⅱ组,n=123)。记录和比较两组患者的手术效果、术后卧床时间和住院时间、术后并发症和主要不良心血管事件的发生情况。结果:两组患者置入支架数、支架直径、支架长度、手术时间、对比剂用量、对比剂肾病和手术成功率比较差异均无统计学意义(P>0.05)。Ⅰ组11.4%患者PCI过程中需更改介入路径,发生率显著高于Ⅱ组(P<0.05);Ⅰ组患者术后卧床时间和住院时间分别为(4.8±1.4)h和(1.7±1.1)d,均显著短于Ⅱ组患者(P<0.05);Ⅰ组患者血管并发症、围术期TIMI小出血和围术期TIMI大出血的发生率均明显低于Ⅱ组患者(P<0.05);随访12个月和24个月时,两组患者主要不良心血管事件的发生率比较差异均无统计学意义(P>0.05)。结论:经桡动脉途径行PCI治疗高龄(≥80岁)冠心病患者具有时间短、出血等并发症少的优势,近期效果优于股动脉径路,但远期临床效果与股动脉径路相当。     

经桡动脉和经股动脉途径PCI治疗冠状动脉慢性闭塞性病变的可行性和安全性比较

目的:比较经股动脉和经桡动脉途径介入治疗冠状动脉慢性闭塞性病变的可行性和安全性。方法:选择2011年1月至2012年8月南京市第一医院收治的325例因为冠状动脉慢性闭塞性病变行经皮冠状动脉介入治疗的患者为研究对象,根据手术途径分为经桡动脉治疗(n=211)和经股动脉(n=114)组,回顾性分析和比较患者的基线特征、病变特征、手术经过和手术相关并发症。结果:经桡动脉和经股动脉组手术成功率分别为79.62%和80.70%(P0.05)。两组患者的性别、年龄、危险因素(高血压、糖尿病及高脂血症)以往PCI及CABG手术史及冠心病临床表现比较均无统计学差别(均P0.05);两组患者的慢性闭塞性病变病变数量、术中主动脉内球囊反搏(intra-aortic balloon pump,IABP)使用率、术后TIMI血流、手术时间、冠状动脉穿孔并发症的发生率比较无统计学差别(均P0.05),但经股动脉手术组较经桡动脉组术中血管内超声(intravascular ultrasound,IVUS)的使用率更高(57.01%vs45.02%,P=0.039)。结论:经桡动脉PCI治疗冠状动脉慢性闭塞性病变更安全、有效,其IVUS的使用率低于经股动脉PCI治疗,但对于复杂慢性闭塞性病变病变术者可能更倾向于采用经股动脉途径。     

股动脉及股静脉血气在烧伤脓毒症患者早期诊断价值

目的:探索股动脉及股静脉血气对烧伤脓毒症患者早期诊断价值。方法:选择自2009年7月至2014年12月我院收治的特重烧伤患者80例,根据是否患有脓毒症,将35例脓毒症患者作为观察组,45例非脓毒症患者作为对照组。在所有患者左侧股动脉、股静脉置管,并抽血,进行血气分析。结果:动脉血气分析中观察组患者股动脉血中HCO3-水平明显低于对照组,且差异具有统计学意义(P0.05);静脉血气分析中观察组患者股静脉血中Pv CO2显著高于对照组,Pv O2、Sv O2、HCO3-水平明显低于对照组,且差异均具有统计学意义(P0.05)。观察组患者的△PO2、△PCO2、△SO2、△HCO3-、△p H水平均显著高于对照组,且差异均具有统计学差异(P0.05)。结论:股动脉和股静脉血气分析可反映出机体组织的血流灌注情况及氧的供需状态,对烧伤脓毒症患者早期诊断具有重要价值。     

食指固定定位法在桡动脉采血中的应用

目的 探讨食指固定定位法在桡动脉采血中的应用效果.方法 将250例患者随机分为观察组130例和对照组120例,对照组使用传统的食指和中指固定定位法采集桡动脉血,观察组使用食指固定定位法采集桡动脉血,比较两组采血一次穿刺成功率.结果 两组桡动脉采血一次穿刺成功率比较,差异有统计学意义(P＜0.05).结论 采用食指固定定位法采集桡动脉血可以提高一次穿刺成功率.     

经桡动脉心导管术诊断和治疗冠状动脉疾病的临床研究

目的:观察经桡动脉介入诊治冠心病的安全性和有效性。方法:对1503例患者进行了经桡动脉途径介入诊治,其中包括心绞痛患者1218例,心梗患者268例,二尖瓣和/或动脉瓣手术前对冠状动脉进行解剖学评估17例,观察患者手术安全性、成功率以及与经桡动脉手术相关的并发症发病率。结果:介入治疗成功率为93.1%(1400/1503),手术失败的主要原因为桡动脉穿刺失败(39例),严重桡动脉痉挛(42例),右锁骨下动脉不同程度的弯曲(18例),近端严重狭窄(14例)。术后有14例患者出现严重并发症(瞬时缺血性病变),60例出现有症状的窦性心动过缓,43例出现静脉血栓,77例出现血肿,88例出现桡动脉梗阻。结论:经桡动脉途径是一种安全、有效、患者更容易接受的冠心病介入诊治方法。     

经桡动脉脑血管造影及术后血管封堵术对患者疗效及安全性观察

目的:探讨经桡动脉脑血管造影(transradial angiography,TRA)及术后血管封堵术对患者疗效及安全性。方法:选取我院2019年1月-2019年10月收治的193例行脑血管造影及术后血管封堵术的患者作为研究对象,将其随机分为TRA组(n=97例)和经股动脉途径(Transfemoral approach,TFA)组(n=96例)。观察两组穿刺成功率、术后3 d主要终点事件发生率、穿刺时间、术后住院时间、手术时间、受线时间、材料费、穿刺点局部并发症等。结果:TRA组穿刺成功率为98.97%,TFA组穿刺成功率为97.91%,两组对比无统计学意义(P>0.05);TRA组的穿刺时间长于TFA组、术后住院时间少于TFA组,差异有统计学意义(P<0.05);TRA组的受线时间、手术时间及材料费显著低于TFA组,有统计学意义(P<0.05);两组术后3 d主要终点事件发生率比较无统计学意义(P>0.05);TRA组穿刺点血肿及穿刺点并发症发生率较TFA组明显降低,差异有统计学意义(P<0.05),且无其他并发症情况发生。结论:经桡动脉脑血管造影(TRA)及术后血管封堵术具有局部穿刺点并发症发生率低、术后住院时间短、费用低、可以提高患者的舒适度等特点,更为安全有效,具有一定的临床优势。     

五指山小型猪两种股动脉穿刺方法的比较

目的比较五指山小型猪在急性心肌梗死造模前行股动脉穿刺所使用的两种方法的成功率和并发症发生率以及所花费时间,为动物实验时行股动脉穿刺提供依据。方法拟行股动脉穿刺的五指山小型猪16头随机分为两组即切开直视穿刺组（n：8）和超声引导穿刺组（n=8）,比较两组穿刺的成功率、并发症发生率以及穿刺所花费时间。结果切开直视穿刺组的成功率及感染发生率均无差异,但出血发生率前者显著低于后者（P〈0．05）,且花费时间也明显少于后者（P〈0．05）。结论切开直视股动脉穿刺术是一种成功率高,安全性好,花费时间相对较少的方法。     

腹部手术前后血气分析及肠道菌群变化

目的:探讨围手术期腹部外科病人血气和酸碱平衡、肠道菌群变化及临床意义.方法:随机检测100例腹部外科择期手术患者术前和术后血气分析.同时对术后发生腹泻的13例患者行粪便菌群分析.结果:手术后低血氧27例,而胃癌根治、直肠癌根治、肝叶切除等大手术者均有不同程度酸碱失衡,且发生酸碱失衡者中9例合并菌群失调.结论:具有高危因素的腹部手术患者,术前及术后检测血气,监测肺功能及酸碱平衡,并积极诊治肠道菌群失调.     

强化护理质量控制对提高血气分析结果准确性的研究

目的探讨护理质量控制对血气分析结果准确性的影响。方法选择我院EICU病房需行动脉血气分析的患者100例分为对照组和实验组各50例,对照组实施常规方法采集送检,实验组在采集过程中对分析前负性因素加强护理质量控制,评估两组患者血气分析结果的准确率并分析。结果对照组50例,直接穿刺动脉采集标本356次,其中28次标本因为各种原因重新采集,准确率为92.1%;观察组50例,直接穿刺动脉采集标本368次,其中13次标本因为各种原因重新采集,准确率为96.5%,差异有统计学意义(P0.05)。结论血气结果的准确率与采血时患者状态、采血部位及采血的具体操作密切相关,加强对这些因素的护理质量控制,可明显提高血气分析结果的准确性,为临床诊治提供依据。     

不同途径行PCI治疗高龄冠心病患者的临床疗效和安全性比较

目的:比较不同动脉途径行经皮冠状动脉介入(PCI)治疗高龄冠心病患者的临床疗效和安全性。方法:选取214例高龄冠心病患者,按动脉途径不同分为对照组(107例)与研究组(107例),对照组行经股动脉PCI(TFI),研究组行经桡动脉PCI(TRI),比较两组的手术情况、手术前后心功能相关指标的变化及不良反应的发生情况。结果:两组手术成功率、支架置入数量、造影剂用量比较无显著差异(P0.05);研究组动脉穿刺时间、导管插入时间、X线曝光时间均显著长于对照组(P0.05),术后卧床时间、住院时间均显著少于对照组(P0.05)。手术后1 d,两组左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD)、左心射血分数(LVEF)较手术前均明显改善,但两组比较无显著性差异(P0.05)。研究组治疗期间外周血管并发症的发生率显著低于对照组(P0.05),但治疗期间及术后6个月心血管不良事件的发生率与对照组间无显著差异(P0.05)。结论:经桡动脉途径与股动脉PCI用于治疗高龄冠心病患者对患者心功能的改善作用相当,但经桡动脉行PCI术后卧床时间及住院时间较短,外周血管并发症的发生率较低,安全性更高。     

Microbiologic analysis of results from blood cultures

The aim of our investigations was the microbiological analysis together with the evaluation of sensitivity of bacteria frequently isolated from blood cultures. Blood samples were taken from patients with symptoms suggesting bacteremia in Rydygier's Hospital in Cracow. A total of 11,170 blood samples taken from 1997 to 2000 were tested. Automatic VITAL system (bioMerieux) was applied to culture and detect microorganisms. Bacteria were identified by ATB system (bioMerieux). Susceptibility was detected by ATB and disc diffusion method. Percentage of positive results relating to detection of microorganisms of clinical significance was 16.9% (1891 cultures). Staphylococcus spp. (Staph. epidermidis in range 22.8% to 21.9%), Enterococcus spp. and Streptococcus spp. were most frequently isolated species among aerobic Gram-positive bacteria. In 2000, compared to 1997 the number of isolates of MRSA increased considerably (from 1.8% to 6.8%). In blood infections the increase of frequency of E. coli bacteria was also noted: 6.1% and 11.4% in 1997 and 2000, respectively. Among non-fermentant bacilli the percentage of occurrence of P. aeruginosa in the period of 4 years was comparable in the range 7.3% in 1997 to 7.2% in 2000. The increase in the frequency of blood infections of A. baumanii was also noticed (respectively from 4.8% to 9.9%). Susceptibility of P. aeruginosa strains to selected beta-lactame antibiotics and aminoglycosydes increased in 2000 in comparison to 1999. A. baumanii strains were 100% sensitive only to imipenem.     

大鼠连续定时采血新方法——股动脉插管法

本文对股动脉插管的制备及大鼠股动脉插管方法进行了详细描述,此种方法适宜于大鼠股动脉连续定时采血。     

Instaneous changes in the radial artery blood flow under different physiological conditions

Using a Doppler pulse flowmeter we measured the blood flow in the radial artery at rest and during physical exercise and various other stimuli (arithmetical calculations, electrical stimulation, deep inspiration). The mean resting flow in the radial artery was 0.66 ml/s. Every stimulus was instantaneously followed by a drop in the blood flow to a minimum value; there was no significant differences between these values. The results demonstrate that the new, non-invasive apparatus can be used to study quick changes in the blood flow not detected by routine non-invasive methods.     

Intrapericardial denervation: radial artery blood flow and heart rate responses to LBNP

Eight rhesus monkeys were used to study responses of radial artery blood flow velocity (RABFV) and heart rate (HR) to low (0 to -20 mmHg) and high (0 to -60 mmHg) ramp exposures during supine lower body negative pressure (LBNP). These levels were chosen to separate peripheral vascular responses associated with stimulation of low- and high-pressure baroreceptors. Four monkeys had efferent and afferent cardiac denervation by use of the Randall procedure with pharmacological (phenylephrine and atropine) verification. Animals were studied 3 wk after surgery to avoid reinnervation. Findings were compared with those of four identically treated intact animals. Denervated animals showed no change in RABFV or HR during low-level LBNP; however, HR increased significantly (P less than 0.05) when LBNP reached -50 mmHg and blood flow velocity also fell (P less than 0.05) starting at -30 mmHg pressure. In contrast, intact animals showed steady decreases in RABFV during both high- and low-pressure protocols, with HR showing a 6-beat/min increase (P less than 0.05) starting at -20 mmHg pressure. As with denervated animals, intact animals showed a more pronounced increase in HR after reaching a level of -60 mmHg suction. Cardiac output (electromagnetic flowmeter, ascending aorta) fell significantly in both groups starting at -30 mmHg pressure. Left ventricular pressure (Konigsberg pressure cell) in three intact animals showed a progressive fall in systolic pressure starting at -10 mmHg suction, which became significant at -55 mmHg pressure. These results demonstrate that cardiac denervation by use of the Randall technique significantly affects RABFV and HR responses to LBNP in rhesus monkeys. The lack of RABFV change during LBNP in denervated animals suggests that these changes coupled with HR response can be used as an effective method to verify the completeness of denervation of low-pressure baroreceptors in animals that have undergone intrapericardial denervation.