胶乳气囊导尿管堵塞的研究

使用充液漏斗向天然胶乳气囊导尿管(以下简称导尿管)的气囊中注入额定容量的空气或无菌水时,会遇到难注入或注不入的问题;在气囊正常膨胀条件下,使用充液漏斗抽出气囊中的空气或无菌水时,会遇到难抽出或抽不出(简称堵塞)的问题。针对前述2类问题进行了研究。结果表明,采用黑胶丝代替尼龙丝作形成导尿管毛细管腔的模具材料,规范夹孔操作工艺杜绝小胶屑掉落到生产环境中,控制用作隔离剂的硅橡胶溶液浓度不超过2%,规范隔离剂涂覆工艺避免出现隔离剂涂层脱落,在浓缩天然胶乳中掺入20份天甲胶乳(MG49)用作基础管身胶料或在基础管身硫化胶乳中加入30份碳酸钙分散体提高管身硬度等,是减少导尿管毛细管腔发生堵塞的有效途径。     

医用导尿管的表面抗菌改性研究

将纳米SiO2作为抗菌剂载体，制备出一种新型栽银锌纳米SiO2抗菌剂，再对其用硅烷偶联剂KH-550处理。采用紫外光辐射法对医用导尿管进行表面活化，制备得表面接枝载银锌纳米SiO2抗菌剂的抗菌导尿管。IR、抑菌环实验结果表明，抗菌剂以化学价键的形式接枝到导尿管表面，制得的抗茵导尿管对大肠杆菌有明显的抑菌作用．     

Determinants of C-reactive protein in chronic hemodialysis patients: relevance of dialysis catheter utilization

Biomarkers of inflammation, especially C-reactive protein (CRP), have been consistently shown to predict poor outcomes in chronic hemodialysis (CHD) patients. However, the determinants of CRP and the value of its monitoring in CHD patients have not been well defined. We conducted a retrospective cohort study to evaluate possible determinants of the inflammatory response in CHD patients with a focus on dialysis catheter utilization. Monthly CRP were measured in 128 prevalent CHD patients (mean age 56.6 years [range 19-90], 68% African Americans, 39% diabetics [DM]) over a mean follow-up of 12 months (range 2-26 months). There were a total of 2405 CRP measurements (median 5.7 mg/L; interquartile range [IQR] 2.4-16.6 mg/L). The presence of a dialysis catheter (p<0.002), cardiovascular disease (p=0.01), male gender (p=0.005), higher white blood cell count (p<0.0001), elevated phosphorus (p=0.03), and lower cholesterol (p=0.02) and albumin (p<0.0001) concentrations were independent predictors of elevated CRP in the multivariate analysis. Additionally, CRP levels were significantly associated with the presence of a catheter, when comparing the levels before and after catheter insertion (p=0.002) as well as before and after catheter removal (p=0.009). Our results indicate that the presence of a hemodialysis catheter is an independent determinant of an exaggerated inflammatory response in CHD patients representing a potentially modifiable risk factor.     

Accidental extravascular insertion of a subclavian hemodialysis catheter is signaled by nonvisualization of catheter tip

Subclavian hemodialysis (HD) catheter placement under fluoroscopy with perforation of the superior vena cava (SVC) is a rare complication that needs to be recognized and treated appropriately. We report the case of a 47-year-old black woman under treatment for end-stage renal disease secondary to HIV-associated nephropathy who sustained an extravascular insertion of fluoroscopy-guided subclavian catheterization for HD. Subsequent successful removal of the extravascularly placed catheter along with repair of the lacerated SVC were effected by open thoracic surgery.     

导管机器人系统的主从介入

传统的血管微创介入手术过程中医生在手术现场,其不可避免地遭受大量的X射线照射;并且导管的操作难度较大,对医生插管技术要求过高.针对此问题,研制了一种新型的集成有双电磁传感器的可定位导管机器人,并采用D-H法对其进行了运动学分析,同时设计了一套介入装置来代替医生进行导管操作,并通过对主从控制方法的研究实现了该系统的主从介入.在介入过程中,医生通过主手控制介入装置动作来实现导管的推/拉、旋转和弯曲操作,并可在引导图像的辅助下完成插管手术操作.实验表明,开发的可控导管具有较好的操作性能,介入装置实现了3种基本的介入操作,提高了导管的定位精度,同时主从介入方式也保证了医生在手术过程的安全性.     

Successful Long-Term Central Venous Access

Daily home hemodialysis (DHHD) requires simple, vascular access to minimize patients' discomfort but also to guarantee tolerance and long-term efficiency. The arteriovenous fistula is not ideal for DHHD because of the double puncture required every day; in addition, the rate of dysfunction is probably greater because of the more frequent use. Central venous catheters may be a good alternative to the arteriovenous fistula as long-term vascular access for DHHD. In this study we report our experience with the internal jugular vein two-catheter access for long-term dialysis and evaluate its possible use for DHHD. Since 1988, Tesio's twin catheters have been positioned in 908 patients with exhausted peripheral vascular bed. In all patients hemodialysis could be performed a few minutes after the surgical procedure. The survival rate of catheters, in a selected group of 46 patients, at 1, 2, and 5 years was, respectively, 92%, 87%, and 82%. The mean blood flow was 282±29 mL/min at 1 month, 286±36 mL/min at 1 year, and 274±37 mL/min at 5 years. Venous pressure in the inlet side was 102±31 mm Hg at 1 month, 126±36 mm Hg at 1 year, and 132±58 mm Hg at 5 years. Catheter clotting was treated either with thrombolytic agents or with catheter (one or both) replacement. Sepsis was treated with systemic antibiotic therapy or catheter removal. Data support the potential role of the internal jugular vein two-catheter system for DHHD.