目的 探讨如何避免COVID-19在介入手术室交叉感染.方法 2020年2月7至28日对国内16个省、市、自治区68所三级医院介入手术室净化空调系统空气压力设计情况进行调查,结合介入手术实际及COVID-19防控现状进行分析.结果 68所医院介入手术室净化空调系统均无空气负压设计,不具备呼吸道传染病专业防护条件.结论 疫情期间增强防控风险意识、加强医疗环境管理、强化感染防护措施、筹划改造、扩建及新建负压介入手术室,有助于降低COVID-19在介入手术室交叉感染风险.

Objective: To Explore Cardiovascular Interventions affect the surgeon in the diagnosis and treatment of radiation protection and safety and put forward relevant proposals made by the radiological protection of operators.Methods: The use of multi-dose,the TLD dose tablets and head thoracoabdominal intends people die body respectively determination intraoperative surgery by the standing of important regional changes in the size of the chopper,check the bed to the image intensifier of the distance,the image intensifier irradiated wild changes in patients whothe dose of radiation received value,and for comparative analysis.Results: Successfully measured surgeon related factors change the radiation dose values,and plotted involved in the diagnosis and treatment of patients who stand region dose distribution diagram measured and given the size of the chopper,the examination bed to the distance of the image intensifier,the image intensifier radiation field changesintraoperative radiation dose values.Conclusions: The surgeon standing area,shading,distance,image intensifier,radiation field size,etc.affect the radiation Protection and Safety,the surgeon should be used in a variety of radiological protection measures for its protection.

目的对介入诊疗中工作人员辐射防护与安全的主要影响因素进行测定与研究,对相关影像因素的特点加以探讨.方法分别测定影像增强器照射野的大小、管球角度改变、冠脉造影中不同手术体位对受检者和第一术者体表入射剂量的影响,对介入诊疗中重要站立区域的辐射剂量进行测定与评价,测定和研究介入诊疗区域内辐射场的分布情况.结果成功测量各主要影响因素的相关数值.结论影像增强器照射野越大,受检者所受剂量越小,影像增强器照射野的改变对第一术者所受剂量的影响无明显规律.对第一术者而言足位辐射剂量最大,头位次之,其他体位辐射剂量相对较小.冠脉造影中正足位的面积剂量乘积值最大,其次为右足位.对第一术者的剂量贡献绝大部分是距地面高60-80cm处剂量高区散射束所致.一般的,被检者左上辐射场的强度最高.被检者右侧一般为手术人员站立处,必须加以防护.在介入手术过程中一定不要忽视防护装置的作用.

Objective To measure and evaluate the distribution feature of radiation dose at the conventional puncture plane in invasive diagnosis and treatment area, and depict the corresponding isodose curve. Methods A platform was built at the conventinal puncture plane in invasive diagnosis and treatment area.By taking the center of X_ray source as the measurement center coosing the conventinal antero_posterior and lateral basic postures and choosing one measurement site for every 0.1 m in 8 directions,measurements were carried out for three times at every measurement point and the arithmetic means,were calculated,corrected and converted to mGy/h. Results We successfully measured doses of X_ray radiation in invasive diagnosis and treatment area,and depicted the distribution curve. Conclusion Generally, the left_superior radiation field of the patient is the strongest,where the physician interns always stands to install a pacemaker.Therefore,the latter should be alerted.The practising physicians and interns often stand there to watch the performance.They should avoid standing there.Nurses always stand in the left_inferior field of the patient doing fluid infusion and adding drugs into the fluid.They should be aware of the danger.Electrophysiology technicians often stand on the left_foot side of the patient,although the radiation dose in not large,they should take care too.Operators always stand on the right side of the patient.They should be protected.;

Objective To determine the dose distribution and maximum skin dose to the patient for four interventional procedures: coronary angiography (CA), hepatic angiography(HA),radiofrequency ablation (RF) and cerebral angiography(CAG) ,and to estimate the definitive effect of radiation on skin. Methods Skin dose was measured using LiF: Mg,Cu,P TLD chips. A total of 9 measuring points were chosen on the back of the patient with two TLDs placed at each point, for CA,HA and RF interventional procedures ,whereas two TLDs were placed on one point each at the postero-anterior(PA) and lateral side (LAT) respectively, during the CAG procedure. Results The results revealed that the maximum skin dose to the patient was 1683.91 mGy for the HA procedure with a mean value of 607.29 mGy. The maximum skin dose at the PA point was 959.3 mGy for the CAG with a mean value of 418.79 mGy; While the maximum and the mean dises at the LAT point were 704 mGy and 191.52 mGy, respectively. For the RF procedure the maximum dose was 853.82 mGy and the mean was 219.67 mGy. For the CA procedure the maximum dose was 456.1 mGy and the mean was 227.63 mGy. Conclusion All the measured dose values in this study are estimated ones which could not provide the accurate maximum value because it is difficult to measure using a great deal of TLDs. On the other hand , the small area of skin exposed to high dose could be missed as the distribution of the dose is successive.;

Objective To raise a concept on important standing areas during invasive diagnosis and treatment,measure doses of Xray radiation,and evaluate distributing characteristics within these areas in order to give suggestions on radiation protection for operators,especially for the principal operator. Methods We measured doses of Xray radiation from 10 cm to 180 cm above the round within important standing areas during coronary angiography,by choosing a measurement site in every 10 cm away from the radiation field's center.We measured doses of Xray radiation 3 times at every measurement site under 3 different conditions:no shields were used,using upper and lower radiation protection shields,and using these shields in combination with shielding clothes. Results We successfully measured doses of Xray radiation in important standing areas during invasive diagnosis and treatment under 3 different conditions,and depicted the distributing sketch maps of doses of Xray radiatin. Conclusion Radiation protection within important standing areas during invasive diagnosis and treatment plays a vital role in building the invasive radiation system,so we should attach improtance to radiation protection within these areas.Furthermore,we had better use more protection mothods simultaneously,especially the upper and lower protection shields.;

目的比较骨髓间充质干细胞移植和骨髓动员对急性心肌梗死再通模型中心功能改善作用,并比较两者的心肌及血管再生作用.方法将模型分为3组,对照组(7头),骨髓动员组(5头),细胞移植组(8头).心梗再通模型制作后,骨髓动员组予G-CSF静脉注射1天,皮下注射连续6天,细胞移植组予骨髓间充质干细胞4～8×106经梗死相关冠脉注入.3周后观察以下指标:1超声心动图检测心功能及局部室壁运动.2免疫组织化学染色,行不同区域血管计数,并观察增殖期内皮细胞数和新生心肌细胞数.结果(1)骨髓动员组和细胞移植组心功能及局部室壁运动均见明显改善.(2)细胞移植组在心梗周围区可见分散分布的BrdU标记移植细胞,骨髓动员组中未观察到处于增殖期的心肌细胞;细胞移植组和骨髓动员组均可见大量新生血管,但二者分布区域不同.结论骨髓动员及骨髓间充质干细胞移植均可明显改善心肌梗死后心功能,而骨髓间充质干细胞可通过补充可收缩细胞而使心功能改善更加明显,二者对不同区域的血管再生作用不同.

目的对采用主动脉内球囊反搏(IABP)治疗的心源性休克和心脏破裂病人的住院死亡情况进行回顾性分析.方法对心源性休克和心脏破裂的28例病人,均安装IABP,其中20例进行了冠状动脉造影,13例接受了冠状动脉成形术(PTCA)、冠脉旁路移植术(CABG)或心脏外科手术.结果 1例因急诊血管成形失败而行急诊CABG成功,11例急诊血管成形(直接PTCA)开通了梗死相关动脉(IRA),12例(42.9%)存活,16例死亡(57.1%):11例因休克死亡;4例心脏破裂因没有手术干预的时机死亡;1例游离壁破裂因心肌坏死面积过大死于手术台上;还有1例病人在出院7 d后死于室颤.在所有无心脏破裂的心源性休克病人中,与接受PTCA和CABG的病人相比,未接受PTCA和CABG的病人的死亡率较高(81.8% vs 16.7%).所有心脏破裂的病人无一存活,死亡率100%.结论使用IABP对于急性心肌梗死(AMI)所致的心源性休克有显著的效果,但仅使用IABP结合常规治疗而不开通IRA并不能提高这些病人的生存率,心脏破裂的病人若不能及时修补缺损,使用IABP仅能延长病人的存活时间,不能改善病人的生存率.

胸椎与胸髓的MRI由于受到扫描线圈大小及扫描野的限制，常常难以准确定位。传统的定位方法是利用MRI上相应的体表影像来定位，如胸骨柄大概相当于第2胸椎水平、胸骨角大概相当于第4、5胸椎水平等。这种方法受到影像清晰度、个体差异、扫描体位等诸多因素的影响，无法准确定位。而对于胸椎肿瘤、胸椎结核及胸椎骨折等患者往往需要比较准确地指出其发生病变的椎体。因此，胸椎与胸髓的MRI需要一种相对比较准确、行之有效的定位方法。 一、材料与方法 笔者借鉴天津医科大学总医院MR室利用浓缩维生素AD胶丸的方法，并加以改进，总结出C7定位法及L1定位法，2种方法都能很好地解决胸椎的MR影像的定位问题。 1.定位标记的制作：使用浓缩维生素AD胶丸7～8粒（主要成分为维生素D2），用医用胶布横向粘贴成“一字形”。注意AD胶丸应缠牢。胶丸定位标记可以重复使用。 2.L1定位法:将胶丸定位标记横向粘贴于扫描者背部L1处。在常规胸椎MR扫描前加扫腰椎矢状定位像，扫描野不小于42 cm×42 cm，其余扫描参数与常规相同。扫描像上应包括腰、骶椎及定位标记。然后胶丸定位标记位置不动，行常规胸椎MR扫描。胸椎定位像上应包括胶丸定位标记，MR照片上应注意加摄腰椎定位像和胸椎定位像。 3.C7定位法: 将胶丸定位标记横向粘贴于扫描者背部C7处，即隆椎下。常规胸椎MR扫描前加扫颈椎矢状定位像，扫描野一般不小于33 cm×33 cm，其余扫描参数与常规相同。扫描像上应包括寰、枢椎及定位标记。胶丸定位标记位置固定不动，行常规胸椎MR扫描检查。同样，胸椎定位像上应包括胶丸定位标记，照片上应加摄颈椎定位像和胸椎定位像。