气道内支架在良性气道狭窄中的应用进展

【摘要】 气道内支架置入术可有效缓解良性气道狭窄,但其在安全性及远期疗效等方面仍见解不一。临床应用的支架主要包括硅酮支架、暂时性覆膜金属支架以及生物可降解支架等。由于可能引起肉芽组织增生、支架断裂、支架移位以及气道感染等并发症,对于良性气道狭窄患者,只有在不宜手术或对其他腔内介入治疗未取得明显疗效,或疗效难以维持时,才考虑气道内支架置入。支架置入是一种临时性治疗手段或最后的解决方案。合理掌握支架置入的时机,正确处理并发症,可以取得较好的临床疗效。

     

气道倒 Y 型一体化自膨胀式金属内支架的递送技术研究和初步临床应用

目的探讨气道倒Y型自膨胀式金属内支架治疗气管、隆突和双主支气管复合狭窄的可行性和疗效。方法根据气道复合狭窄的特殊解剖结构与病变特点，设计气道倒Y型一体化自膨胀式金属内支架。X线监视下，对７例重度呼吸困难的气道复合狭窄患者置入７枚气道倒Y型一体化内支架。结果内支架均一次性置入成功，所有患者置入内支架后呼吸困难即刻缓解，生活质量提高。结论气道倒Y型一体化自膨胀式金属内支架能有效解除气道复合性狭窄，技术可行，操作简单、安全、近期疗效可靠，值得进一步推广应用。     

食管癌性重度狭窄并食管-气道瘘的内支架置入治疗

目的探讨食管癌性重度狭窄合并食管-气道瘘的内支架置入效果.方法透视下,27例食管重度癌性狭窄合并食管-气道瘘患者置入食管覆膜内支架.结果支架全部一次性置入成功,瘘口完全封堵,患者恢复正常进食,肺部感染得以控制.结论内支架置入治疗食管癌性狭窄并食管-气道瘘损伤小、操作简单安全、并发症少、成功率高,控制呛咳具有立竿见影的效果.     

DSA导向气道内支架置入治疗气道狭窄的手术配合与护理

目的 研究ＤＳＡ导向气道内支架置入治疗气道狭窄的护理要点。方法 对采用气道内支架置入治疗的１１８例气管狭窄患者,在治疗中实施相应护理。结果 １１８例气道狭窄患者置入支架后,呼吸困难明显改善。结论 通过术前加强心理护理和手术体位训练,术后密切观察生命体征变化,预防并发症,做好康复护理及出院指导,有助于患者的康复。     

大气道良性严重狭窄的内支架暂时性置入治疗

【摘要】 目的 探讨内支架暂时性置入治疗大气道良性严重狭窄的疗效。方法 根据胸部CT测量狭窄段的位置、长度和程度,选择支架的类型和大小。气管狭窄选择管状部分覆膜支架;支气管狭窄选择气管-支气管分支型部分覆膜内支架。透视监视下,对12例大气道良性狭窄患者置入内支架,并在术后25 ～ 30 d取出。结果 支架一次性置入成功,患者胸闷、呼吸困难、喘鸣等症状在支架置入后即刻明显改善。术后顺利取出支架,无严重并发症。随访2个月 ～ 2年,11例患者呼吸道通畅,1例再狭窄。结论 内支架暂时性置入治疗大气道良性狭窄既能达到解剖学治愈,又能防止支架长期置入内膜过度增生、再狭窄等并发症,该技术值得大力推广应用。     

支架植入治疗恶性气道狭窄的研究进展

【摘要】 恶性气道狭窄严重影响患者晚期的生活质量。气管支架植入是缓解恶性气道狭窄安全、快速而有效的方法，广泛应用于临床，但无法直接延长患者生命。并发症发生率因狭窄部位、类型和支架的不同差异较大。本文就气管支架治疗恶性气道狭窄的临床应用现状及研究进展作一综述。

     

倒Y型气道支架置入治疗复合气道病变

目的　　　探讨倒Ｙ型一体化气道金属支架置入在气管下段、气管隆突和双主支气管复合病变（狭窄和瘘）中的应用。方法　　　根据气道复合病变的特殊解剖结构,设计倒Ｙ型一体化自膨胀式金属内支架。在Ｘ线监视下,１２例气道复合病变患者置入倒Ｙ型一体化自膨胀式金属内支架１２枚。结果　　　所有患者置入倒Ｙ型金属气道支架均一次成功,１２例患者置入内支架后呼吸困难即刻明显缓解,进食呛咳消失。一般状况明显改善,生活质量提高。结论　　　气道倒Ｙ型一体化金属内支架置入治疗气道复合病变疗效可靠。     

全麻下单导丝引导Y型气道支架置入术治疗复杂气管疾病6例

【摘要】 目的 探讨在全身麻醉下采用单导丝引导Y型气道支架置入的方法和临床应用。方法 接受气道Y型支架治疗复杂气管疾病患者6例,其中气管胸膜瘘1例,食管-气管瘘2例,气道复合型狭窄3例。全身麻醉后在DSA监视下对6例患者置入气道Y型支架。结果 6例患者共置入Y型气道支架6枚,均为单导丝引导置入,其中1例支架右侧分支误入右肺上叶支气管内,余5例支架置入均一次获得成功。结论 全麻下Y型气道支架置入术能有效封堵支气管残端胸膜瘘、左主支气管食管瘘,能快速有效解除气管隆突区复合性气道狭窄,近期疗效显著,手术安全、可靠,单导丝引导置入技术操作相对于双导丝引导置入技术操作简单、快速有效、值得推广应用。     

球囊扩张及内支架成形术治疗气管良恶性狭窄的临床应用

目的评价X线监视下内支架成形术和球囊扩张术治疗良恶性气管狭窄的临床意义。方法回顾分析４５例气道狭窄患者,其中恶性气管狭窄３７例,包括纵隔淋巴结转移１４例、食管癌１３例、肺癌４例、支气管腺癌３例、淋巴瘤２例、喉癌１例;良性气管狭窄８例,包括支气管内膜结核６例、胸骨后甲状腺腺瘤１例、气管插管后１例。对其中３８例患者行气道内支架成形术,７例患者行球囊扩张术。所有操作均在X线透视下完成。结果３８例患者共放置５３枚支架,除１例死于痰液窒息外,其他患者术后临床症状均即刻缓解,随访无支架移位;４例患者发生再狭窄,分别行再次内支架成形术和球囊扩张术。７例患者共行１９次球囊扩张术,术后症状明显缓解,无复发。平均随访２４．５个月（０～１２４个月）,３１例因疾病死亡,无与支架或球囊扩张相关死亡病例。结论X线透视下行内支架成形术和球囊扩张术是治疗良恶性气管狭窄的安全、快速、有效方法     

气管-主支气管覆膜分支状内支架的设计及初步应用

目的设计治疗胸腔胃-主支气管瘘和主支气管狭窄的气管-主支气管覆膜分支状内支架.方法根据胸腔胃-主支气管瘘和主支气管狭窄的特殊解剖结构和病变特点,设计气管内主支架部分性覆膜、主支气管内分支支架全覆膜的分支状内支架.X线监视下,1例胸腔胃-隆突瘘、1例胸腔胃-左主支气管瘘、1例胸腔胃-右主支气管瘘、1例左主支气管结核性瘢痕狭窄共置入5枚支架.结果内支架一次性置入成功,3例胸腔胃-气道瘘完全封闭,即刻消除了呛咳症状,有效控制肺部感染,改善了呼吸状况.1例左主支气管狭窄支架植入24 d后取出,狭窄段恢复正常.结论     

火电厂节能工作浅析

本文探讨了火电厂节能基本程序和工作方法,分析节能工作要从基础工作、技术创新、设备整治、燃烧管理等方面入手的论述.     

浅析磨合期汽车的使用

如何合理使用磨合期的汽车，使其摩擦机件的磨损量能够平稳、均匀地磨合而不至于过度磨损，对汽车实际使用寿命有着重要的意义。从机器磨合期的特点和磨损机理出发，对汽车磨合期如何正确使用进行了有实际意义的探讨。     

Geothermal energy in agriculture in Yugoslavia

SFR Yugoslavia has natural hot water springs practically all over its territory, indicating the presence of geothermal reservoirs underground. There is no final estimate of how much energy can be expected from this new resource, except for figures based on the results of studies and investigations.The first use of geothermal energy in Yugoslavia in numerous spas dates back to the 19th century. Some remarkable examples of central heating are known, but the most widespread use is in agriculture (in greenhouse heating, farm heating and drying of agricultural products).     

Energy conservation measures in an institutional building in sub-tropical climate in Australia

In this study, various energy conservation measures (ECMs) on heating, ventilating and air conditioning (HVAC) and lighting systems for a four-storied institutional building in sub-tropical (hot and humid climate) Queensland, Australia are evaluated using the simulation software called DesignBuilder (DB). Base case scenario of energy consumption profiles of existing systems are analysed and simulated first then, the simulated results are verified by on-site measured data. Three categories of ECMs, namely major investment ECMs (variable air volume (VAV) systems against constant air volume (CAV); and low coefficient of performance (COP) chillers against high COP chillers); minor investment ECMs (photo electric dimming control system against general lighting, and double glazed low emittance windows against single-glazed windows) and zero investment ECMs (reset heating and cooling set point temperatures) are evaluated. It is found that the building considered in this study can save up to 41.87% energy without compromising occupancies thermal comfort by implementing the above mentioned ECMs into the existing system.     

Uncertainties in decarbonising heat in the UK

Heating is arguably one of the most difficult sectors to decarbonise in the UK's energy system. Meeting the 80% greenhouse gas emission reduction target by 2050 is likely to require that heat related emissions of CO₂ from buildings are near zero by 2050, and there is a 70% reduction in emissions from industry (from 1990 levels). Though it is clear that the use of the natural gas network will reduce over time, recent modelling suggests a limited residual role for gas by 2050 to help meet peaks in heat demand. High levels of uncertainty about the way in which heat will be decarbonised present a number of challenges to policy makers. This paper will explore the risks and uncertainties associated with the transition to a low carbon heat system in the UK as outlined by the 4th carbon budget review. The potential impact of key uncertainties on the levelised costs of heat technologies and the development of energy networks are explored using a sensitivity analysis approach. Policy changes required to decarbonise the heat sector are also examined.     

Solar drying in sludge management in Turkey

Two main wastewater treatment plants in Bursa city in Turkey will start to operate and produce at least 27,000 tons of dry solids per year by the end of 2006. The purpose of this study was to investigate an economical solution to the sludge management problem that Bursa city would encounter. The general trend in Turkey is mechanical dewatering to obtain a dry solid (DS) content of 20%, and liming the mechanically dewatered sludge to reach the legal landfilling requirement, 35% DS content. This study recommends limited liming & solar drying as an alternative to only-liming the mechanically dewatered sludge. Open and covered solar sludge drying plants were constructed in pilot scale for experimental purposes. Dry solids and climatic conditions were constantly measured. Faecal coliform reduction was also monitored. The specially designed covered solar drying plant proved to be more efficient than the open plant in terms of drying and faecal coliform reduction. It was found that, if the limited liming & solar drying method was applied after mechanical dewatering instead of only-liming method, the total amount of the sludge to be disposed would be reduced by approximately 40%. This would lead to a reduction in the transportation, handling, and landfilling costs. The covered drying system would amortize itself in 4 years.     

Viscous heating in liquid flows in micro-channels

Many experimental works on forced convection through micro-channels evidenced that when the hydraulic diameter is less than 1 mm, conventional theory can no longer be considered as suitable to predict the pressure drop and convective heat transfer coefficients. This conclusion seemed valid for both gas and liquid flows. Sometimes the authors justified this claim by invoking “new” micro-effects. On the contrary, in this paper the explanation of the experimental results obtained for micro-channels in terms of friction factors will be researched inside the conventional theory (Navier-Stokes equations). In particular, this paper will focus on the role of viscous heating in fluids flowing through micro-channels. A criterion will be presented to draw the limit of significance for viscous dissipation effects in micro-channel flows. The role of the cross-sectional geometry on viscous dissipation will be highlighted and the minimum Reynolds number for which viscous dissipation effects can no longer be neglected will be calculated as a function of the hydraulic diameter and of the micro-channel geometry for different fluids. It will be demonstrated how viscous effects can explain some experimental results on the Poiseuille numbers in micro-channels, which recently appeared in the open literature.     

Energy consumption in rural transportation in India

Energy consumption in rural transportation has been computed, taking into account the energy embodied in vehicles or bullocks, as well as the fuels or feeds and food (of operators). Bullock cart transport consumes over four times more energy than vehicles. However, animal transport will continue to be preferred because of its availability.     

Leading-edge Technologies in Hydropower Development in China

After the implementation of the Reform and Opening-up Policy for a period of 40 years, the exploitation of China’s hydropower resources developed significantly. Through vast amounts of scientific and technological research and construction practices, China has accumulated abundant engineering experience with respect to the construction technologies required for 300-meter-high concrete arch dams, 200-meter-high roller-compacted concrete gravity dams, 200-meter-high concrete face rockfill dams, and 250-meter-high earth core rockfill dams, large-flow discharge and energy dissipation, huge underground cavern group constructions, complicated foundation treatments for high earth and rockfill dams and high and steep slope reinforcements. These series of technologies have now reached an international leading level. In the near future, these technical improvements will likely have broader application prospects and make greater contributions toward hydropower development both in China and across the world.