急性肺栓塞误诊为急性冠状动脉综合征51例分析

徐翠荣  李国宏  陈泳  汤卫红 《工业加热》2012,(12):1046-1048

两种输液方式在急性心肌梗死急诊介入治疗术中补液效果

【摘要】 目的 观察单位时间内不同补液量在急性下壁/后壁/右室心肌梗死患者行经皮冠状动脉介入治疗（PCI） 时的应用效果。方法 选择2016年12月至2018年9月急性下壁/后壁/右室心肌梗死行PCI手术的患者82例,入介入手术室后随机分成观察组（41例）,对照组（41例）,观察组60 min内补充0.9%NaCl溶液1 500 mL。对照组60 min内补充0.9%NaCl溶液500 mL。比较两组血压、心率、血氧饱和度、球囊开通后心源性休克及急性肺水肿等并发症发生率、血管活性药物使用和追加补液情况。结果 两组患者补液前血压、心率、血氧饱和度比较差异无统计学意义（P＞0．05）,球囊开通后10 min,观察组血压、心率均高于对照组,差异有统计学意义（P＜0．05）,球囊开通后30 min,观察组血压高于对照组,差异有统计学意义（P＜0．05）。并发症发生率、血管活性药物使用率、追加补液率对照组均显著高于观察组,差异有统计学意义（P＜0．05）。结论 急性下壁/后壁/右室心肌梗死PPCI患者在血压、心率、血氧饱和度综合指标监测下,60 min内输注0.9%NaCl溶液1 500 mL是安全的,效果优于60 min内输注 0.9%NaCl溶液500 mL,有助于及时防治此类PPCI患者血管开通后的低血压状态,利于血管活性药物的合理使用,且减少相关并发症发生。

     

急性心肌梗死介入治疗术中恶心呕吐的护理

【摘要】 目的 探讨急性心肌梗死（ＡＭＩ）行经皮冠状动脉内介入（ＰＣＩ）术中恶心呕吐及时有效的护理在ＡＭＩ患者治疗中的辅助价值。方法 收集中国医科大学附属第四医院２０１０年１月－ ２０１１年２月共１０９例ＡＭＩ行ＰＣＩ术中恶心呕吐患者,其中２１例患者出现恶心症状,８３例患者出现１　～　３次呕吐,５例严重患者出现４　～　５次并伴喷射性呕吐。予恶心呕吐患者护理评估, 并对恶心呕吐患者实施心理护理,恶心护理,放松疗法,呕吐姿势指导,呕吐护理,遵医嘱平衡补液等护理方法,确保手术顺利进行。结果 ２１例出现恶心症状的患者采用此护理方案未发生呕吐,８３例发生恶心伴呕吐患者通过采用此护理方案给予处理,确保了手术未间断持续进行,５例严重患者再次给予心理护理,呕吐姿势指导,最终顺利的完成了手术。结论 ＡＭＩ患者在ＰＣＩ术中用恰当的方法处理好恶心呕吐在ＡＭＩ行ＰＣＩ术中可起到重要的辅助作用。
     

伴多支血管病变超高龄急性冠状动脉综合征患者不同介入策略疗效观察

【摘要】 目的 评价经皮冠状动脉介入治疗（PCI）中完全血运重建对伴发多支血管病变超高龄（＞80岁）急性冠状动脉综合征患者的安全性和有效性。方法 2012年9月至2014年9月82例经冠状动脉造影证实为多支血管病变并入院接受PCI术治疗的80岁以上急性冠状动脉综合征患者入选本研究,其中45例仅作罪犯血管血运重建,37例作完全血运重建。观察记录两组患者临床特征、住院期间和1年随访期间主要心血管不良事件（MACE）如全因死亡、心绞痛复发和心肌缺血再次血运重建等,以及对比剂肾病发生率。结果 两组患者年龄、性别、吸烟史、伴高血压病、伴糖尿病、伴高脂血症、脑卒中史和既往PCI史无明显差异。完全血运重建组和罪犯血管血运重建组患者对比剂肾病发生率分别为8.1%（3/37）、13.3%（6/45）,差异无统计学意义（P=0.457）;MACE发生率分别为8.1%（3/37）、40.0%（18/45）,差异有统计学意义（P=0.022）,其中心绞痛复发率分别为2.7%（1/37）、20.0%（9/45） （P=0.041）。结论 伴发多支血管病变超高龄（＞80岁）急性冠状动脉综合征患者接受PCI术完全重建血运治疗是安全、有效的。

     

Budd-Chiari综合征伴下腔静脉混合型血栓机械性抽吸联合溶栓疗效分析

【摘要】目的比较机械性血栓抽吸联合导管溶栓与单纯导管溶栓治疗Budd-Chiari综合征(BCS)伴下腔静脉(IVC)混合型血栓的效果。 方法回顾性分析43例BCS伴IVC混合型血栓患者临床资料。根据治疗方法分为研究组(n=22,机械性血栓抽吸后辅以尿激酶溶栓和血管成形术)和对照组(n=21,单纯尿激酶溶栓后辅以血管成形术)。 结果研究组IVC-右心房压力差由术前(25.2±4.1) cmH2O改善至术后(9.1±1.6) cmH2O,对照组IVC-右心房压力差由术前(23.3±5.1) cmH2O改善至术后(8.9±1.9) cmH2O,两组间术前术后差异均有统计学意义(P＜0.05);术后血栓完全溶解率分别为68.2%(15/22)和57.1%(12/21),差异无统计学意义(P＞0.05)。研究组溶栓天数、尿激酶用量、并发症发生率分别为(6.4±3.4) d、(25.4±13.9)×105 U、0%,低于对照组(10.3±4.1) d、(40.8±15.7)×105 U、19.1%,差异均有统计学意义(P＜0.05)。术后平均随访(24.5±12.7)个月,研究组和对照组再狭窄率分别为9.1%(2/22)和4.8%(1/21),差异无统计学意义(P＞0.05)。 结论机械性血栓抽吸联合导管溶栓治疗BCS伴IVC混合型血栓效果与单纯导管溶栓相当,但溶栓天数较少、尿激酶用量较少,并发症发生率更低。


     

64排螺旋CT检测冠状动脉罪犯病变积分 对急性冠脉综合征的诊断价值

【摘要】 目的 应用64排螺旋CT（64?蛳SCT）检测冠状动脉罪犯病变指标,包括斑块类型、斑块衰减（PA）、重构指数（RI）,并计算钙化积分（CS）及罪犯病变积分（CLS）,探讨其对急性冠脉综合征（ACS）的诊断价值。方法 2009年1月至2010年12月对110例临床明确诊断冠心病（CAD）患者行64?蛳SCT检查,其中ACS 43例,稳定型心绞痛（SAP）67例。测量患者冠状动脉罪犯病变指标,包括斑块类型、PA、RI,并计算CS及CLS。比较ACS和SAP两组患者上述指标的差别。结果 ACS组比SAP组拥有更多的点状钙化（92.30% 比 9.1% , P < 0.05）、更低的PA（41.32 ± 21.08比90.37 ± 48.19, P < 0.01）、更高的RI（1.29 ± 0.42比0.89 ± 0.45, P < 0.01）、更低的CS（71.43 ± 6.74比154.41 ± 19.02, P < 0.05）及更高的CLS（1.15 ± 1.12比1.06 ± 0.63; P < 0.01）。CLS > 2.0 可以区分ACS和SAP,其灵敏度和特异度分别为97.7%和67.3%。结论 CLS可用于区分ACS和SAP,对ACS的早期诊断具有一定价值。
     

布-加综合征亚型分型的专家共识

【摘要】 徐州医科大学附属医院介入科于2012年至2015年间承担了江苏省科技支撑计划临床专项项目《布-加综合征介入诊疗规范化研究》课题（编号BL2012021）,经过3年临床研究,结合20余年2 150余例患者总结,2016年1月14日在徐州市召开了布-加综合征介入诊疗规范化研究论证会,来自中国医师协会腔内血管学专业委员会腔静脉阻塞专家委员会及国内从事布-加综合征研究的介入放射学、血管外科学、病理学和影像诊断学专家就布-加综合征分型与亚型划分进行了充分和深入的讨论,与会专家一致达成亚型界定的共识:肝静脉阻塞亚型为肝静脉/副肝静脉膜性阻塞、肝静脉节段性阻塞、肝静脉广泛性阻塞、肝静脉阻塞伴血栓形成,下腔静脉阻塞亚型为下腔静脉膜性带孔阻塞、下腔静脉膜性阻塞、下腔静脉节段性阻塞、下腔静脉阻塞伴血栓形成,混合型亚型为肝静脉和下腔静脉阻塞、肝静脉和下腔静脉阻塞伴血栓形成,共10个亚型。

     

Harmonic analysis of climatic data

The utility of using the fast Fourier transform as a means of consolidating climatic data is presented and discussed in this paper. It is shown that a 20-year data set consisting of 175,320 hourly values of a climatic variable can be represented by only 75 Fourier coefficients with no significant loss of information content. Complete consolidated climatic data sets are presented for Albuquerque, New Mexico; Madison, Wisconsin and Miami, Florida. In addition, some other applications of the Fourier transform to the field of Solar Engineering are discussed.     

Economic analysis of hydrogen-powered data center

The data center needs more and more electricity due to the explosive growth of IT servers and it could cause electricity power shortage and huge carbon emission. It is an attractive and promising solution to power the data center with hydrogen energy source. The present work aims to conduct an economic analysis on the hydrogen-powered data center. Configurations of hydrogen-powered and traditional data centers are compared and the differences focus on backup power system, converter/inverter, fuel cell subsystem, carbon emission, hydrogen and electricity consumptions. Economic analysis is conducted to evaluate the feasibility to power the data center with hydrogen energy source. Results show that electricity price increasing rate and hydrogen cost are the main factors to influence economic feasibility of hydrogen-powered data center. When the electricity price keeps constant in the coming two decades, the critical hydrogen price is about 2.8 U.S. dollar per kilogram. If the electricity price could increase 5% annually due to explosive growth of electric vehicles and economy, critical hydrogen price will become 6.4 U.S. dollar per kilogram. Hydrogen sources and transportation determine the hydrogen price together. Hydrogen production cost varies greatly with hydrogen sources and production technologies. Hydrogen transport cost is greatly influenced by distances and H₂ consumptions to consumers. It could be summarized that the hydrogen-powered data center is economic if hydrogen could be produced from natural gas or H₂-rich industrial waste streams in chemical plant and data center could not be built too far away from hydrogen sources. In addition, large-scale hydrogen-powered data center is more likely to be economic. Solar hydrogen powered data center has entered into a critical stage in the economic feasibility. Solar hydrogen production cost has restrained the H₂ utilization in data center power systems now, since it could be competitive only when more strict carbon emission regulation is employed, hydrogen production cost reduces greatly and electricity price is increasing greatly in the future. However, it could be expected solar hydrogen-powered system will be adopted as the power source of data centers in the next few years.     

Extended analysis of VVER-1000 surveillance data

Up to now 20 surveillance specimen sets of 14 VVER-1000 Reactor Pressure Vessel (RPV) have been evaluated in Russia, Ukraine and Bulgaria by different testing organisations:

• •Kurchatov Institute, Russia (10 RPVs);
• •Institute for Nuclear Research, Ukraine (two RPVs);
• •Institute of Metal Science, Bulgaria (two RPVs).

The extended analysis presented here is based on the results of 17 surveillance sets testing results of surveillance programmes. The materials involved contain very low and homogeneous levels of phosphorus and copper and a significant variation of nickel and other elements like manganese, etc.The observed temperature transition shifts are showing consistent behaviour:

• •The steels with low nickel content are embrittling at a much lower rate than the one predicted by the Guide (chemistry factor=20).
• •The Guide looks to be conservative also for the higher nickel steels if the content of manganese is lower than 0.8 wt%.
• •The steels embrittling at much higher rates are those with high nickel and high manganese contents at the same time.

The threshold for nickel is evaluated to be at Ni>1.5 wt% and for manganese at Mn>0.8 wt%.Manganese, together with nickel, seems to play a key role in low Cu and P steels embrittlement [1], [2].Correlation analysis which considers Ni and Mn and fluence dependence to 1/3 power are showing predictive capabilities within 20 °C scatter band in most cases.Other elements, like, for example, carbon and sulphur could also explain the residual scatter in the data [3].     

Correlation analysis of geothermal data in North America

Correlation studies of the geothermal parameters have been carried out for Michigan Basin and the results are interpreted with the help of observed relations between heat flow, geological age and crustal thickness for North America. Heat flow and geothermal gradient are found to decrease with thermal conductivity, while they are positively correlated with each other, supporting the earlier findings of Negi et al. (1974). It is noted that, to some extent, these associations can be explained with the help of variations in crustal thickness.     

探究机车轴温数据的分析方法

介绍一种适合各型机车轴温数据分析的思路,并结合现场实际举例说明其特点。将其思路引入北京唐智科技发展有限公司JK00430地面分析软件中,从而提高数据分析准确度及效率。     

Weather data for building energy cost-benefit analysis

This paper deals with European TRY weather data processing for climatic indexes generation, useful for HVAC energy and cost simplified evaluation. For nine Italian locations are presented: 99 and 2·5% dry bulb temperatures, 2·5% wet bulb temperatures, heating and cooling degree days, latent enthalpy days, unitary sensible and latent loads. TRY psychrometric data were processed according to a bin method that preserves the correlation between dry bulb temperature and moisture content, and then reduced by an averaging technique. An example is worked out in order to present an engineering shorthand for energy and cost evaluation of HVAC system. © 1998 John Wiley & Sons, Ltd.     

磁共振静脉造影诊断Cockett综合征的价值

【摘要】 目的 评价磁共振静脉造影（MRV）非增强髂静脉成像诊断Cockett综合征的价值。方法 采用Ingenia 3.0T超导型 MRI系统,选择腹部表面线圈,扫描序列为M2DIPEAR（TR/TE=45/5.8 ms,翻转角60°）、THRIVE（TR/TE=6.8/3.5 ms,翻转角10°）、BTFE- SPAIR（TR/TE=3.4/1.7 ms,翻转角80°）和FLAIR（TR/TE=9 000/120 ms,翻转角90°）,层厚均为3 mm,平均采集次数3次。结果 Cockett综合征MRV表现为受压骼静脉前后径变窄,横径增宽,血管前缘可见弧形压迹,侧支血管形成等;轻、中、重患者左侧髂静脉平均直径分别为7.52、4.83、2.76 mm,平均受压率分别为37%、69%、83%。结论 非增强MRV是可行的髂静脉狭窄诊断方法,尤其适用于特定人群检查需要。

     

大数据驱动的我国新能源汽车需求分析

文章基于网络搜索大数据,以新能源汽车为例,结合统计学和计量经济学理论与方法,利用斯皮尔曼相关系数、协整检验和格兰杰因果关系,检验分析了搜索指数与新能源汽车实际需求之间的关系。以新能源汽车历史销量作为单一变量建立自回归滑动平均模型(ARMA),并与加入了搜索指数的向量自回归模型(VAR)进行比较。结果表明,加入搜索指数的预测模型相较传统的预测模型,在样本期内和样本期外的预测精度分别提高了11.69%和14.95%。该模型只需利用前4个月的新能源汽车销售数据和网络搜索大数据,就能够准确地预测下一个月的需求,在提高预测时效性的同时,也为个人、企业和政府决策提供可靠的依据。     

车轮踏面擦伤检测装置及数据分析

阐述了一种基于振动加速度原理的在线式踏面擦伤检测装置的工作原理及实施方案。通过对其所采集到的信号进行有效的分析,去除干扰,可使擦伤信号易于判定。