肝动脉化疗栓塞后肝脓肿形成的原因及治疗

目的　探讨肝动脉化疗栓塞(HACE)后正常肝实质并发脓肿的原因及治疗。方法　6例肝癌患者经HACE术后，正常肝实质内形成脓肿。明确诊断后，在B超引导下行经皮穿刺脓肿引流和对脓腔进行抗菌素灌洗。结果　4例患者脓肿愈合，2例患者脓腔明显缩小。结论　分析肝内脓肿形成的主要原因为:(1) 胆道损伤；(2) 门静脉内癌栓形成；(3) 胆囊动脉及胆道周围动脉丛的栓塞。在B超引导下经皮穿刺脓肿引流及选用敏感抗菌素每天对脓腔进行灌洗是治疗HACE术后并发肝脓肿的有效手段。     

预防性应用抗生素的不同方法对介入治疗并发肝脓肿的影响

【摘要】 目的 探讨预防性应用抗生素的不同方法对肝动脉化疗栓塞术（TACE）后并发肝脓肿的影响。方法 回顾性分析2010年1月至2012年8月所有行TACE治疗的患者560例，共行TACE治疗869例次。以2012年1月1日为界点，之前543例次TACE为A组，术前、术后都预防性使用抗生素，而后的326例次TACE为B组，抗生素均在TACE前使用。统计两组TACE后肝脓肿发生的例数并卡方检验肝脓肿发生率的差异。结果 A组肝脓肿发生率0.73%（4/543），B组1.84%（6/326），两组比较差异无统计学意义（P = 0.250 7）。发生10例肝脓肿患者中9例有肝脏外科手术、PTCD及射频治疗史。结论 临床预防应用抗生素的方法改变对TACE术后肝脓肿的发生率的影响无统计学差异，TACE后并发肝脓肿的原因复杂，对TACE后有发生肝脓肿的高危患者积极应用抗生素预防感染，值得进一步探讨。

     

肝动脉化疗栓塞术后并发肝脓肿５例治疗分析

目的 探讨肝动脉化疗栓塞术（ＴＡＣＥ）后并发肝脓肿的原因及治疗。方法 总结我院２００８年３月至２０１０年９月治疗的原发性肝癌患者３５３例,肝转移癌 １０２例;其中有外科手术史患者９８例;共并发肝脓肿５例,３例并发于原发性肝癌,２例并发于肝转移癌。采用在Ｘ线透视引导下行经皮穿刺脓肿引流术,术后给予抗生素冲洗。结果 所有患者经治疗后临床症状明显缓解,脓腔于术后１２ ～ ２５ ｄ愈合或明显缩小。结论 ＴＡＣＥ术后肝脓肿由多种原因导致,采用经皮穿刺脓肿引流是治疗ＴＡＣＥ术后并发肝脓肿的有效手段。     

细菌性肝脓肿的经皮穿刺引流治疗

【摘要】 目的 探讨经皮穿刺引流技术对细菌性肝脓肿治疗的临床价值。方法 对30例细菌性肝脓肿患者在超声导引下进行穿刺与抽吸,在DSA导引下对脓肿进行置管引流,术后辅以适当的引流管冲洗。结果 2例直径 < 4 cm脓肿单纯抽吸与冲洗,28例直径 > 4 cm者进行置管引流,无严重并发症发生;26例无恶性肿瘤患者均治愈,4例肿瘤患者中1例治愈,3例死亡。结论 超声与DSA引导下经皮穿刺抽吸引流技术治疗细菌性肝脓肿操作简单,创伤小,安全性高、恢复快。

     

转移性肝肿瘤TACE治疗后肝脓肿形成的临床特征及治疗分析

【摘要】 目的 探讨转移性肝肿瘤在TACE后肝脓肿形成的临床特征、相关危险因素、临床治疗措施的有效性及安全性。方法 采用回顾性研究方法,在1 812例转移性肝肿瘤TACE治疗后发生肝脓肿患者23例中,分析其临床特征及脓肿形成的危险因素,并对经皮穿刺引流（PCD）或结合经皮穿肝胆管引流（PTCD）治疗方法进行疗效和安全性分析。结果 收集转移性肝肿瘤在TACE后肝脓肿的发病率为1.3%（23/1812）,术后高热、寒战、白细胞升高及中性粒细胞比例升高为脓肿主要表现,肝脓肿确诊时间平均为介入术后（11.3±3.7） d。消化道来源的恶性肿瘤患者占73.9%。有胃肠道手术史患者18例（78.3%）;有糖尿病史者12例（52.2%）;患者肝内转移灶数目大于3个者19例（82.6%）;在脓肿发生后均有肝功能变差（P=0.024）;19例（78.3%）患者动脉造影显示肿瘤为乏血供。患者血培养及脓液培养显示大肠埃希菌是肝脓肿主要的病原菌。肝脓肿液化前使用抗感染药物的平均天数为（10.4±3.3） d,脓肿液化的时间平均为（15.9±3.7） d。最大脓肿直径的平均为（9.2±2.0） cm。所有患者均行肝脓肿穿刺引流术（PCD）,平均PCD的次数为（3.7±1.7）次。有7例患者存在胆汁瘤合并梗阻性黄疸行PCD后再行PTCD。平均肝脓肿引流时间为（3.1±1.7）个月。PCD和PTCD后均未出现感染性腹膜炎及肿瘤破裂,未发现有脓肿穿刺点肿瘤种植等并发症。所有患者肝脓肿后的中位生存期（8.0±0.7）个月。单纯行PCD的患者肝脓肿后的中位生存期为（9.0±1.0）个月,而 PCD+PTCD组患者平均生存期为（5.0±0.7）个月,两者的中位生存期存在明显统计学差异（P=0.041）。结论 转移性肝肿瘤TACE后发生肝脓肿的危险因素与原发肿瘤的部位、消化道手术有关,糖尿病可能是危险因素之一。其临床特征为病灶多发,易发于乏血供伴中央坏死病灶,主要感染细菌为消化道来源,易发胆汁瘤。积极有效的抗生素治疗,脓腔穿刺引流或结合PTCD是此类肝脓肿的有效治疗方法。
     

CT引导下肝脓肿穿刺置管引流术的探讨

目的探讨CT引导下肝脓肿穿刺引流术的方法和疗效。方法本组２０例肝脓肿患者,均经临床、生化和影像学（CT）检查确诊为肝脓肿,行CT引导下定位穿刺抽吸并置管引流。脓肿位于肝左叶６例,肝右叶９例,肝２叶５例。结果１４例为单个脓肿,６例为多发脓肿,单个脓肿经１次抽吸后脓肿完全消失９例,l例经２次抽吸基本消失,多发或多房脓肿穿刺先抽较大脓肿,后抽较小脓肿,或分次抽吸,２０例均放置引流管并冲洗,平均引流置管时间为１９．２d,所有患者至随访截止日未见复发。结论CT引导下穿刺抽吸引流是治疗肝脓肿的非常有效的方法。     

经皮穿刺引流术在细菌性肝脓肿治疗中的作用

【摘要】 细菌性肝脓肿是一种罕见又会危及生命的疾病,近年来发病率有所升高。就治疗而言,经皮穿刺引流术联合抗生素已成为细菌性肝脓肿的一线治疗手段,外科手术多用于介入引流无效或肝脓肿合并有外科适应证的腹部疾病。作为常用的两种介入引流术,经皮穿刺导管引流术和经皮穿刺细针抽吸术广泛应用于细菌性肝脓肿的治疗,并以前者居多。尽管细菌性肝脓肿的预后已明显改善,但其仍有一定的致死率,治疗指南仍未达成共识,经皮穿刺引流术的适应证仍存在争议。本文复习国内外文献,就经皮穿刺引流术在细菌性肝脓肿治疗中的发展历程、疗效、预后、抗生素的使用原则、与外科对比及治疗适应证探讨进行综述,以指导临床实践。
     

双介入治疗肝肿瘤的临床应用

目的探讨采用穿刺引流抽吸肝肿瘤中心坏死物（DTND）和经动脉化疗栓塞（TACE）治疗肝肿瘤的疗效。方法明显液化坏死的原发性巨块型肝癌４例，消化道间叶细胞来源肝转移瘤１例。患者先行肝TACE术，随后行DTND。４例行坏死物持续负压引流，１例反复多次抽吸。在引流或抽吸同时向瘤腔内注入无水乙醇。结果４例持续引流者肿瘤缩小明显，抽吸者肿瘤略缩小。５例均未出现并发症。结论PTND结合肝TACE术是治疗液化坏死肝肿瘤安全、可行的方法。     

肝脓肿经皮穿刺引流术的疗效及影响因素分析

【摘要】 目的 观察经皮穿刺引流对肝脓肿的治疗效果,分析影响疗效的因素,探讨降低病死率、并发症率,缩短住院时间的方法。方法 收集2011年1月至2016年1月收治的121例肝脓肿患者临床资料。对确诊肝脓肿患者,充分抗感染治疗的同时,CT评估病灶液化情况,在CT引导下行经皮肝穿刺引流,分析治疗后的病死率、并发症率、住院时间及其影响因素。结果 共有121例肝脓肿患者纳入研究。2例患者穿刺引流后死亡,病死率为1.6%,影响患者死亡率的因素为高龄、基础疾病,脓肿直径及实性成分; 2例患者穿刺引流后出现肝周脓肿、腹壁脓肿,并发症率为1.6%,对并发症积极处理后达到临床治愈,影响并发症率的因素主要为手术操作欠妥;119例患者均达到临床治愈,治愈率为98.3%,平均住院时间为（15.1±6.0） d。影响住院时间的危险因素为:脓肿个数X6（r=0.232,P=0.021）,脓肿大小X7（r=0.26,P=0.005）,白细胞计数X8（r=0.238,P=0.009）。进一步分析显示影响因素与住院时间相关性的多元线性回归方程有统计学意义（P<0.05）,多元回归方程为:Y=-3.438+3.055X6+0.527X7+0.297X8,F=5.819,R2=0.416。性别、年龄、糖尿病、致病原菌种类、脓肿位置对住院时间的影响无统计学差异（P>0.05）。结论 经皮穿刺肝脓肿引流术是治疗肝脓肿的有效方法,具有病死率低,并发症率低、住院时间短的特点。

     

经皮穿刺引流治疗肝脓肿12年临床经验

【摘要】 目的 总结分析细菌性肝脓肿的临床及CT特征，评价经皮穿刺引流术的疗效。方法 回顾性分析近12年来住院治疗的肝脓肿患者的临床资料及CT特征。分析的CT特征包括:病灶数量、是否多房、囊实性、腔内是否含气等。分析影响疗效的因素，并探讨影响住院时间及引流时间的因素。采用统计学方法包括单样本T检验、卡方检验和Fisher精确切验。统计学软件采用SPSS16.0。结果 计有578例患者纳入本研究。主要临床症状为发热，和右上腹疼痛。52例（9.0%）患者存在感染性休克，80例（13.8%）患者并发血流感染。实验室检查异常主要为白细胞及中性粒细胞百分比升高，白蛋白降低，肝酶升高，总胆红素升高， C反应蛋白（CRP）升高。416例（71.9%）血细菌培养或脓汁细菌培养阳性。致病菌占首位的为肺炎克雷伯菌（69.7%）。经皮穿刺引流术治疗肝脓肿的技术成功率99.7%，临床成功率97.4%，病死率0.9%。并发症5例（0.9%），平均住院时间（13.1 ± 7.4）d。平均带管引流时间（29.2 ± 9.3）d。住院时间的影响因素为:脓肿含气、合并感染性休克、合并其他部位感染、合并肝胆胰恶性肿瘤；带管引流时间的影响因素为:脓肿多房、实性，合并肝胆胰恶性肿瘤。合并肝胆胰恶性肿瘤是影响治疗成功率的唯一因素。结论 对于化脓性肝脓肿，只要不合并肝胆胰恶性肿瘤，经皮穿刺引流都应该成为治疗的首选。脓肿多房、实性、含气、合并感染甚至感染性休克等因素没有影响介入治疗的临床成功率，只是延长了住院时间或带管引流时间。

     

牵引电动机主动齿轮热套的改进建议

1 问题的提出 牵引电动机主动齿轮系内燃机车走行部传递动力的关键部件之一,它与电机轴的装配形式采用的是圆锥轴过盈配合,在机车满负荷运行时,其承担着列车大约410kW(C型车为480kW)的牵引力。如果机车在运用当中出现主动齿轮松脱或崩裂,特别是机车在低速重载牵引工况下,将导致电机绕组烧损放炮,造成正线机破,严重影响着机车的行车安全。我厂自试修机车以来,主动齿轮厂外松脱、崩裂现象时有发生,尤其是近期连续发生2381号、3541号、3591号、1094号机车因主动齿轮松脱、崩裂造成干线机破事故。这不仅给工厂造成较大的经济损失,而且严重影响着工厂的质量信誉,给用户也带来诸多不便。     

Strategy for selection of elements for heat transfer enhancement

The present paper points out that the selection of elements for heat transfer enhancement in heat exchangers requires a methodology to make a direct comparison of the performances of heat exchanger surfaces with different elements. Methods of comparison used in the past are, in many respects, approximate and hence fail to predict accurately the relative performance of conventional heat exchanger surfaces operated with different heat exchanger elements. Owing to the direct use of the Colburn factor for performance assessment, these methods over-predict the relative performance of heat exchangers. In the present paper, a more consistent comparison method is presented and is demonstrated to work by comparison of the performance of an experimentally investigated pin fin heat exchanger with that of a smooth pipe heat exchanger. The method yields results that belong to the volume goodness factors group. It represents a practical approach, as it is applicable to all kinds of heat exchanger surfaces and does not require the conversion of the experimental data in terms of Nusselt number and friction factor for comparison purposes. The present work demonstrates that the suggested method can also be used for performance comparison of existing heat exchanger surfaces with available heat transfer and pressure loss data.     

Strategies for selection of thermo-chemical processes for the valorisation of biomass

Research on biomass conversion has been gaining a lot of interest as biomass is renewable and sustainable in nature. Products from biomass can be obtained by different methods amongst which thermo-chemical route has a very high potential. Biomass is generally available in a localised manner in varying quantities and qualities throughout the year and hence, region specific technologies have to be developed considering the end user requirement. Pyrolysis is a very versatile technique with the above considerations. The process parameters can be tweaked to necessity to produce more bio-oil or bio-char. Thermogravimetric analysis is essential for understanding the decomposition behaviour of the feedstock before the lab scale pyrolysis is carried out. Pyrolysis using several regional feedstocks has been carried out under nitrogen and hydrogen atmosphere and different biomass feedstocks were also liquefied using sub/supercritical solvents. This review aims to provide a comparison of the results obtained using various processes. This helps in the decentralised processing of biomass (dry biomass using pyrolysis and wet biomass by hydrothermal liquefaction) to produce bio-crude which can be upgraded to produce fuels/chemicals/petrochemical feedstocks in an environmental friendly manner.     

Quantitative evaluation for effective removal of phosphorus for SoG-Si

Production of solar cells has increased rapidly in recent years, and metallurgical production of solar grade silicon (SoG-Si), has increased compared with more expensive processes such as Siemens process and Cz processes. It is important to understand the thermodynamic behavior of phosphorus in slag for optimized refinement of SoG-Si. In this study, the thermodynamic behavior of phosphorus in the CaO-SiO₂-CaF₂ slag system was investigated at 1773 K for various oxygen potential and slag composition. In addition, evaporation of phosphorus in the reduction process was observed during slag refining by addition of H₂ gas.Experimental results showed that the stability of phosphorus in slag depends on both the O²⁻(basicity) content of the slag and the solubility of Ca in silicon, and the dissolution mechanism of phosphorus into slag was derived. Results confirmed that phosphorus and calcium in molten silicon were also removed by acid leaching. The effective removal of phosphorus for SoG-Si using several refining processes was evaluated quantitatively.     

锅炉锅筒吊杆销轴强度校核计算程序

锅炉锅筒吊杆销轴强度校核一直是一个比较烦琐的计算过程，重复性大，通过用计算程序，可减轻劳动强度，节省劳动时间，满足生产需要。     

Application of scanning mid-IR-laser microscopy for characterization of semiconductor materials for photovoltaics

Scanning mid-IR-laser microscopy was previously demonstrated as an effective tool for the characterization of different semiconductor crystals. Now the technique has been successfully applied for the investigation of CZ Si_xGe_1−x – a promising material for photovoltaics – and multicrystalline silicon for solar cells. In addition, this technique was shown to be appropriate for the imaging of polishing-induced defects as well as huge defects such as “pin holes”. Besides, previously unexplained “anomalous” (cubic power) dependence of signal of the scanning mid-IR-laser microscope in the optical-beam-induced light scattering mode on the photoexcitation power obtained for mechanically polished samples has now been attributed to the excess carrier scattering on charged linear defects, likely dislocation lines. The conclusion is made in the article that scanning mid-IR-laser microscopy may serve as a very effective tool for defect investigations in materials for modern photovoltaics.     

铁路货车回转阻力矩计算方法初探

回转阻力矩作为货车转向架的一项重要技术参数,在铁路货车的设计中具有举足轻重的地位,其取值的大小直接影响转向架的动力学性能。分析了货车转向架回转阻力矩的典型形式和计算的基本原理,推导了平面心盘、球面心盘的摩擦阻力距计算公式。并以转K6型转向架和Y25型转向架为例,对旁承摩擦阻力矩、平面心盘和球面心盘摩擦阻力矩进行了详细的计算。     

锅炉机械不完全燃烧损失q4解析评估模型研究

针对传统计算机械不完全燃烧损失不利于在线耗差寻找的问题 ,通过理论推导和试验分析研究 ,推导出基于煤质特性与运行特性的锅炉机械不完全燃烧损失解析评估模型 ,实现了造成 q4 变化之因素的定量寻找。并分别以煤质特性参数可燃基挥发分Vdaf和运行特性参数炉膛出口过量空气系数αl 为例 ,验证了模型的精确性 ,为节能降耗提供依据     

Guidelines for assessment of investment cost for offshore wind generation

Offshore wind generation represents a key element for development of renewable energy, thanks to higher availability of energy source and lower presence of constraints. However, the feasibility of offshore wind farms has to be carefully evaluated, due to remarkable economical efforts required. In this paper, economic issues concerning costs in pre-investment and investment stages for offshore wind farms exploiting alternating-current transmission system are analysed. Single cost centres are detailed, taking into account technical features and current equipment exploitation. The aim is to formulate a general model to evaluate the total investment depending on wind farm layout. The model is employed to determine the most suitable connection solution for a 150-MW test wind farm, accounting for different connection schemes and the presence of an offshore or onshore substation. Further tests are run to evaluate cost variation for larger wind farms with different nominal voltage levels.