Previous studies have comprehensively evaluated predictive models related to peripherally inserted central catheter-related venous thrombosis (PICC-RVT) , but have not further elaborated on its application and effect in the tumor patient population. This article reviews the PICC-RVT evaluation tools that are clinically mature and applicable to cancer patients, analyzes the presentation forms, statistical methods, and limitations of different models, in order to provide suggestions and references for model selection by clinical healthcare professionals and the construction of future PICC-RVT prediction models for cancer patients.

目的 研究生理盐水冲管对连续肾脏替代治疗无抗凝方式体外循环寿命影响.方法 病例样本为2019年3月～2020年3月时间段我院收治的84例无抗凝肾脏替代治疗高危出血风险患者,分组方式为随机数字表法,平均划分为2组,即研究组和对照组,两组样本量保持一致,n=42,对照组患者治疗期间未采用生理盐水冲管,研究组患者治疗期间间隔60min采用生理盐水100 mL冲洗滤器与体外循环管路,研究比较组间各项临床指标.结果 评估组间上机后2 h、3h、4h、5h、下机前舒张压、收缩压、心率数值,无显著差异(P>0.05),评估组间不同时间段脉压数值,研究组高于对照组(P<0.05).结论 高危出血风险患者行无抗凝连续肾脏替代治疗上机时间5 h内不得进行生理盐水冲管,5 h后可进行生理盐水冲管,以此来延长体外循环寿命.

目的 探讨不同氧流量驱动肝素雾化吸入用于老年慢性阻塞性肺疾病(COPD)并呼吸衰竭患者治疗的价值,分析患者血浆和肽素(Copeptin)水平所受影响.方法 根据随机数字表法将120例COPD并呼吸衰竭患者分为A组、B组、C组,各40例.全部患者接受肝素雾化吸入治疗,A组氧流量为5 L/min,B组为7 L/min,C组为9 L/min,在肝素雾化吸入7 d后评价其治疗效果.分别于治疗前1 d、治疗3 d时、治疗7 d时,检测并对比三组血浆Copeptin水平、痰液黏稠度、呼吸力学指标、血气分析指标等变化情况,同时治疗期间记录患者不良反应发生情况.结果 治疗3 d时、治疗7 d时,三组血浆Copeptin水平均较治疗前1 d呈下降趋势,肉眼观察痰液黏稠度呈下降趋势,B组下降速度快于其他两组,三组组间、时点、组间·时点比较,差异有统计学意义(P<0.05),A、C两组比较,差异无统计学意义(P>0.05);较治疗前1 d,三组呼吸力学指标均有变化,B组较其他两组气道峰值(Ppeak)、平台压(Pplat)、呼吸阻力(Raw)呈下降趋势,Cd呈上升趋势,三组组间、时点、组间·时点比较,差异均有统计学意义(P<0.05),但A、C两组比较,差异无统计学意义(P>0.05);三组治疗3 d时、治疗7 d时的动脉血氧分压(PaO2)、氧合指数(PaO2/FiO2)水平均较治疗前1 d呈上升趋势,动脉血二氧化碳分压(PaCO2)水平呈下降趋势,B组上升或下降速度高于其他两组,三组组间、时点、组间·时点比较,差异有统计学意义(P<0.05);A、C两组比较,差异无统计学意义(P>0.05);A、B两组治疗期间均未发生血小板减少等情况,C组2例出现轻度血小板减少,在及时处理后恢复正常.结论 采用7 L/min氧流量驱动肝素雾化吸入治疗老年COPD并呼吸衰竭效果优于5 L/min与9 L/min的氧流量,利于降低患者血浆Copeptin水平,降低其痰液黏稠度,改善呼吸力学参数,增加胸肺动态顺应性,获得最佳雾化效果,且不良反应少.

Objective To further definite the distribution of caudal arteries and veins of rat by anatomical dissection and to deepen the understanding of their physiological functions, and provide a basis for standardization of animal experimental techniques and design of animal models. Methods Eighteen SPF adult SD rats were used in this study. Several techniques were used in combination to study the anatomy and histology of the rat tail blood vessels:paraformaldehyde perfusion through the abdominal aorta was performed for rapid and thorough fixation, blue and red paints were injected to visualize the tail veins and arteries, respectively, arterial microangiography was performed to illustrate the distribution of tail arteries, and the microscopic structure of arteries and veins was verified by histological examination. Results Three longitudinal superficial arterial and venous systems of rat tail were confirmed and a dorsal arterial and venous chain structure was defined, which deeped our knowledge about the distribution of the deep blood vessels. In addition, the caliber of arteries was not corresponding with that of veins, providing a basis of their physiological functions. A bilayer cage connecting structure of the rat tail vasculature was for the first time defined. Conclusions The rich vascular structure of rat tail is described in details in this study. The existence of basal vascular system of rat tail is clarified. A concept of bilayer framework of the rat tail vasculature is proposed, which lays a good foundation for related researches of their physiological functions, and provides a good basis for avoiding major injuries and compensatory responses of hindlimb ischemia during animal experiments.

目的评估不同麻醉与多模式镇痛在开腹胰十二指肠切除术加速康复外科（enhanced recovery after surgery,ERAS）策略中的安全性与有效性。方法采用回顾性队列研究,收集2016年3月至2018年4月北京协和医院39例开腹胰十二指肠切除术患者的临床资料,其中19例采用ERAS治疗方案（ERAS组）,20例采用常规治疗方案（对照组）,比较两组患者术中血流动力学相关指标、外周组织灌注情况及麻醉相关术后早期恢复指标、住院时间、ICU停留时间、住院费用的差异。结果 ERAS组患者术中阿片药用量、出室前血乳酸浓度显著低于对照组（P均＜0. 05）,术后第一天外周血白细胞数量及中性粒细胞数量、血糖、术后早期阿片药用量、疼痛及恶心评分、镇痛满意度、拔除导尿管和胃管时间、术后首次下床活动时间、首次排气时间、住院费用各项指标均显著优于对照组（P均＜0. 05）;两组患者手术时间、术中血流动力学相关指标、出血量无显著差异（P均＞0. 05）。结论应用不同ERAS麻醉与多模式镇痛策略可有效减轻开腹胰十二指肠切除术患者的手术应激、减少阿片药用量、促进术后早期恢复、缩短住院时间、降低住院费用。

外伤是引起肌腱损伤的主要原因,肌腱损伤将导致肢体活动障碍,影响了日常工作劳动,导致生活质量下降.因此,肌腱修复质量直接关系到手功能恢复情况及日常生活质量.自2013年2月至2014年11月,我科收治因外伤引起的肌腱损伤患者45例,进行积极的康复护理,效果满意.现将护理体会总结如下: 1 临床资料 本组病例45例,男39例,女9例,年龄15～50岁,平均29岁.患者均为外伤情况下致使肌腱损伤,其中闭合性损伤19例(车祸伤3例、挤压伤6例、机器牵拉伤10例),开放性损伤26例(切割伤18例、刀刺撕脱伤6例、爆炸伤2例).

超声心动图对心血管疾病的诊断与治疗发挥着重大作用,本文就其中几项颇有潜力、令人期待的技术进行讨论,以期引起学者和仪器开发者的关注:①开展经鼻咽食管超声心动图的研发工作;②如何应用速度向量成像法探测异位起搏点和心肌梗死部位;③积极发展更加清晰的立体超声成像;④创建监测心内腔压力的新方法.

1976年Frazin首先推出由口腔插入单晶体的M型经食管超声探头，1982年德国Schlüter等使用经口腔相控阵食管探头进行检查，这是经食管超声心动图研究工作中的一大进步，其后经不断改进，已由二维超声发展为三维超声成像，并结合彩色多普勒等先进技术，使此项检查得到迅速发展。目前经食管超声心动图技术日益成熟，对临床诊断和治疗发挥着巨大作用，其应用也越来越广泛。但此项技术虽有其优点，也有不足之处，本文作者希望能加以改进，研制专用的经鼻咽食管超声心动图探头，并进一步在临床上试用，其目的是为提高此项检查技术在心脏疾病检查中的作用和价值。

目的 探讨0～18岁正常儿童左心室心肌局部收缩期径向峰值应变率(SrR)参考值,及其与年龄、心率的相关性.方法 获取164名0～18岁正常儿童胸骨旁左心室短轴二维动态图像,采用GE Echo PAC软件分析并得到左心室SrR,比较各节段SrR值,对SrR与年龄、心率进行相关分析.结果 二尖瓣水平前间隔基底段与下壁基底段SrR差异有统计学意义(P=0.002);乳头肌水平前间隔中间段与侧壁中间段SrR差异有统计学意义(P=0.033);心尖水平各节段差异均无统计学意义(P均＞0.05).除前间隔心尖段、前壁心尖段以外,其余节段SrR与年龄均相关(R2 =0.014～0.206,P＜0.05);左心室壁各节段SrR与心率均相关(R2 =0.048～0.237,P＜0.05).二尖瓣水平各节段SrR与心率相关(R2=0.066～0.123,P＜0.05);乳头肌水平各节段SrR与年龄和心率相关(R2=0.088～0.268,P＜0.05);心尖水平各节段SrR与心率相关(R2=0.048～0.127,P＜0.05).观察者内、观察者间的变异系数分别为4.2％、8.6％.结论 运用斑点追踪技术评价正常儿童左心室局部心肌SrR时需考虑年龄、心率因素.

目的 总结多发性大动脉炎(Takayasu's arteritis,TA)颈动脉受累的声像图特点并评价超声在TA诊断及活动性评估中的作用.方法 对58例TA患者的颈动脉进行常规超声检查,测量受累颈总动脉管壁厚度.将TA患者分为活动期和非活动期两组,以58名正常人作为对照,比较各组间颈动脉管壁厚度的差异,并使用受试者工作特征曲线分析管壁厚度对TA活动性的评估效果.结果 58例TA患者共106条颈动脉受累,其中76条(71.7％)管壁超声表现为弥漫性、均匀性增厚,增厚管壁呈中等或中低回声.35条(33.0％)管壁呈通心粉征,67条(63.2％)呈靶环征.TA活动期组管壁厚度大于非活动期组,且均大于对照组(P均＜0.05).以管壁厚度来判断TA活动状态,最佳诊断阈值为2.25 mm,敏感性为71.4％,特异性66.0％.按照有无管腔狭窄进一步分组,分别确立诊断阈值后,非狭窄组中特异性提高为81.5％,狭窄组中敏感性提高为90.0％.结论 靶环征是TA受累颈动脉除通心粉征外的另一超声新征象,有助于TA的超声诊断.管壁厚度对于评估TA活动性有一定帮助.

压疮是指因患者的皮肤长期受压，阻碍局部血液的供应，形成缺血、缺氧的情形，最后使得组织缺乏营养而损坏、溃疡和死亡。断指再植患者由于疾病的性质和治疗的需要，活动受到限制和固定，不能随意翻身，且绝对卧床时间在10～14天左右，受压部位易于发生压疮。预防压疮尤为重要，它可以在根本上减轻患者的痛苦，并减轻了医护人员的工作。但是一般气垫床对于患者是一种经济负担，且使用时间不长：减压贴一旦被污染就不能再次使用。通过近年科室工作的护理人员的经验找到一种经济、适用的方法-水波垫。对此也被断肢再植患者与医务人员所接受。

目的 总结近10年北京协和医院手术切除嗜铬细胞瘤麻醉手术经验.方法 北京协和医院1992-09-01-2012-08-31期间手术切除嗜铬细胞瘤461例,按照病历尾号随机采样307例进行回顾性分析.2002-09-01-2012-08-31手术治疗234例作为试验组;1992-09-01-2002-08-31手术治疗73例作为对照组.重点关注术前准备时间、麻醉管理、术中脏器损伤、术后ICU停留时间和术后住院时间等与围术期预后相关的指标近10年的变化.结果 近10年,腹腔镜手术切除嗜铬细胞瘤成为主要手术方式(84.1％),术前准备时间缩短8.9d,引流管拔除时间缩短3.4d,ICU停留时间缩短3d,术后平均住院日缩短8.4 d(P＜0.01).结论 围术期优化治疗策略,可以明显改善嗜铬细胞瘤切除术围术期预后.

目的 评价超声引导组织活检(core-needle biopsy,CNB)对甲状腺病变的诊断价值.方法 选取2004年11月至2011年6月在北京协和医院就诊的117例进行CNB、有完整手术病理或随访资料的甲状腺病变患者,回顾性分析其甲状腺病灶的CNB及病理结果.结果 CNB结果显示,117例甲状腺病变中良性85例,恶性28例,可疑恶性2例,取材不满意2例,取材成功率98.3％;弥漫性病变37例,甲状腺结节80例.29例手术患者术后病理显示恶性24例(22例乳头状癌,2例淋巴瘤),其中5例CNB为良性(假阴性);良性5例.80例甲状腺结节中小于1 cm者2例,1～2 cm者21例,大于2 cm者57例.结论 超声引导CNB取材成功率高,安全可靠,可作为超声引导细针抽吸活检(fine needle aspiration,FNA)的有效补充手段,并可用于特殊甲状腺病理类型,如淋巴瘤的首选诊断方式.

Objective To compare the values of ultrasound and magnetic resonance imaging( MRI) in the diagnosis of hand and wrist joint involvement in rheumatoid arthritis( RA) patients and summarize the distribution pattern of these lesions.Methods A total of 11 RA cases were included.The detection rates of synovitis,bone erosion,and tenosynovitis of different joints were calculated based on ultrasound and MRI findings.The diagnostic efficiency of ultrasound was evaluated by using the MRI as golden standard.Results Totally 103 joints and 112 tendon areas were evaluated.The detection rates of synovitis,bone erosion,and tenosynovitis of wrist and hand joints were 59.2%,11.7%,and 18.8% by ultrasound and 62.1%,14.6%,and 32.1% by MRI.The detection rate of wrist joint was higher than metacarpophalangeal( MCP) or proximal interphalangeal( PIP) joints.The detection rate of extensor lesions was higher than that of flexor lesions at the wrist level; at the MCP level,however,the detection rate of flexor lesions was higher than that of extensor lesions.Compared with MRI,for the diagnosis of synovitis,bone erosion,and tenosynovitis,the ultrasound had a sensitivity of 92.2%,73.3%,and 59.5%,a specificity of 94.9%,97.7%,and 98.6%,a positive predictive value of 96.7%,84.6%,and 96.2%,and a negative predictive value of 88.1%,95.6%,and 80.2%.Conclusions Wrist joint involvement is more common than MCP and PIP joints involvement in RA patients.The tendon involvement is more common in extensor at the wrist level,while in flexor at the MCP level.Compared with MRI,the diagnostic efficiency of ultrasound is higher for wrist lesions than for hand joints lesions.However,ultrasound is less sensitive in the diagnosis of extensor lesions at the MCP level.

<正>心电图对观察心脏激动程序变异和心律失常具有重要价值,而超声心动图M型曲线、多普勒血流频谱与组织多普勒成像对显示心脏结构活动状态及血流动力学变化非常敏感。若将心电图和超声检查结果互相参照,对应观察心电激动程序、传递过程、心肌收缩、瓣膜开闭及血流动态等诸多指标,将会在解析心脏活动异常的类型、图像特征和临床诊断等方面发挥重要作用。

In this study,we examined patients with simple aortic regurgitation(in accordance with the degree of regurgitation,patients were divided into mild,moderate and severe group)which diagnosis by two-dimensional echocardiography,using conventional twodimensional color Doppler echocardiography.We received two-dimensional gray scale images of parasternal left ventricular short axis view of mitral valve and left ventricular short axis view of apex,all the images were stored in a disc.Echo PAC workstation with STI imaging analysis software was used.Two-dimensional strain,the movement of change in rotation and twist in left ventricular were compared between aortic regurgitation group and normal control group.

目的 应用实时三维超声心动图(RT-3DE)评价冠心病患者左室局部与整体收缩和舒张功能.方法 根据冠状动脉造影将病变组分为左旋支或/和右冠支病变组(LCX/RCA组)24例、单纯左前降支病变组(LAD组)21例、包含LAD的双支或多支病变组(多支组)27例;以及正常对照组22例,采集各研究对象左室全容积图像,在分析软件上获得局部峰值充盈率/射血率(rPFR/rPER)、整体峰值充盈率/射血率(gPFR/gPER)和左室射血分数(LVEF).结果 绝大多数狭窄冠状动脉供血节段的rPFR、rPER较之相应正常冠状动脉供血节段显著减低(P＜0.05或P＜0.01);正常对照组、LCX/RCA组、LAD组、多支组间gPFR、gPER、LVEF依次递减(P＜0.05或P＜0.01).相关性分析表明各组各节段内rPFR与rPER(r=0.89～0.99,P＜0.01),各组内gPFR与gPER(r=0.975～0.985,P＜0.01)、以及gPER与LVEF(r=0.878～0.980,P＜0.01)均呈良好的相关性.结论 RT-3DE测量rPFR、rPER、gPFR、gPER、LVEF能全面反映冠心病患者左室局部与整体的舒张和收缩功能,为临床提供更完整的信息.

Objective To evaluate the effect of coronary artery bypass grafting(CABG) with global peak filling rate(gPFR),global peak ejection rate(gPER) and left ventricular ejection fraction(LVEF) with real-time three-dimensional echocardiography(RT-3DE).Methods RT-3DE full volumetric dataset in 30 patients of CABG(CABG group,including pre-CABG,1 week after CABG,1 month after CABG subgroups) and 22 normal subjects(control group) were acquired.The gPFR,gPER and LVEF in all subjects were offline obtained.The differences of gPER,gPFR,LVEF between control group and CABG group,among CABG subgroups,and the correlations among gPER,gPFR,LVEF in control group and CABG group were analyzed.Results The gPER,gPFR,LVEF of CABG group were significantly lower than those of the control group(P0.01),gPER,gPFR,LVEF of 1 month after CABG subgroup were significantly greater than those of pre-CABG subgroup and 1 week after CABG subgroup(P0.01).No significant differences of gPER,gPFR,LVEF were found between 1 week after CABG subgroup and pre-CABG subgroup(P0.05).Correlation analysis indicated that good positive correlation existed between gPER and LVEF(r=0.98,0.90,0.96,0.86,all P0.01),gPER and gPFR(r=0.98,0.98,0.98,0.97,all P0.01) in control group and CABG subgroups.Conclusion RT-3DE can assess left ventricular functional changes in patients with pre-and post-CABG by measuring gPER,gPFR and LVEF,which is a new approach for clinical evaluation of CABG' effect.

胶原Ⅲ肾病(collagen type Ⅲ glomerulonephro pathy)又名胶原纤维性肾小球疾病(collagenofibrotic glomerulopathy)是近年来认识到的一种罕见的特殊的肾小球疾病 .主要表现为肾小球内出现大量异常Ⅲ型胶原沉积,它由超微结构发现胶原纤维,经免疫荧光染色判定为Ⅲ型胶原而命名.

Objective To accurately investigate the characteristic and effective of occlusive devices in ventricular septal of defect (VSD) by using stereo 3D echocardiography. Methods Six patients with VSD were included who were undergone the defect closing operation with Amplatzer occluder device. Stereo 3D echocardiography was performed to show 3DE imaging appearance after the operative procedure. Results Stereo 3D echocardiography were performed after the procedure of implanting occluder device. It was clear to show the location of the occluder and the space relationship of each parts. Conclusions The appearance,location and space relationship of occluder could be seen clearly by stereo 3D echocardiography after implanting occluder device. Compare with 2D, real-time 3D echocardiography, stereo 3D echocardiography could provide more veracious information about heart structures and the therapeutic devices for clinical use.