Background and Objectives: Establishing a stable pathway is the basis for interventional surgery, and hyper-selected intubation has become the basic requirement for vascular intervention therapy. Super-selection intub...Background and Objectives: Establishing a stable pathway is the basis for interventional surgery, and hyper-selected intubation has become the basic requirement for vascular intervention therapy. Super-selection intubation can not only significantly improve the efficacy of peripheral intervention treatment, but also greatly reduce surgical complications. However, during the treatment of peripheral vascular intervention (such as liver tumor arterial chemotherapy embolism, hemoptysis bronchial arterial embolism, gastrointestinal hemorrhagic gastrointestinal arterial embolism, etc.), vascular mutation is often large, and there are many branches, and the direction of blood flow is into the direction of blood flow, the horns are even reverse, and even the use of straight-headed microstructures will have difficulty interpolation difficulties or even failure, which increases the risk of surgery and affects safety treatment. To overcome this, pre-plasticized microcatheters have emerged, among which the InstantPass Swan-Neck Microstructure is a catheter with a head-end morphology similar to Cobra. Our research aims to explore the feasibility, safety, and technical advantages of the use of swan-neck microcatheter in peripheral vascular hyperboloid intubation. Materials and Methods: From January 2023 to March 2024, 31 patients with swan-neck microstructure were used in the peripheral vascular intervention therapy outside the hospital. Among them, there were 23 men and 8 women, aged 32 - 81 years old, an average (55 ± 13) years, and the average irradiation time was 35.1 ± 24.7 minutes. 10 cases of iodide oil arterial chemotherapy embolism, 7 cases of microspheres of hepatic arteries, 3 cases of gastric duodenal artery selective embolism, 3 cases of vein embolism with esophageal stomach, and 2 cases of sperm varicose vein embolism, 2 cases of selective embolism of the intestinal membrane, 2 cases of uterine arteries embolism, and 2 cases of renal arterial embolism. 11 of these patients switched to the swan-neck microstructure after using the straight-headed microstructure super-selective intubation. To analyze whether the swan-neck microcatheter is successfully transported to the target location, whether it can provide a satisfactory path for subsequent intravascular treatment, evaluate the surgery instant image results and complications related to the microstructure during the surgery period, analyze the angle of the target blood vessels and the main blood vessels, the target blood vessels, the target blood vessels, the relationship between the degree of pedestrian and the success rate of ultra-selective intubation, and summarize the indication of the application of the swan-neck microstructure in peripheral intervention therapy. Results: In this study, 31 patients used 31 swan-neck microcatheters, of which 22 (70.9%) target vascular and main blood vessels were ≤90˚;17 patients (54.8%) patients were curved and angulated;11 cases (35.5%) were after the failure of the superselective intubation of the straight-headed microstructure, the swan-neck microcatheter was successful after the failure;1 case (3.2%) patients with microstructure-related mezzanine occurred during surgery, and the complication rate of the perioperative ductation was 3.2%. All target lesions are finally successfully completed, and the success rate of surgical technology is 100%. Conclusion: Swan-neck microcatheters have a high success rate in superselective cannulation of peripheral blood vessels and perform well in vascular tortuosity and angulated lesions.展开更多
This paper proposes a Van der Pol (VDP) oscillator screening for peripheral arterial disease (PAD) in patients with diabetes mellitus. The long-term elevated blood sugar levels produce a high risk of peripheral neurop...This paper proposes a Van der Pol (VDP) oscillator screening for peripheral arterial disease (PAD) in patients with diabetes mellitus. The long-term elevated blood sugar levels produce a high risk of peripheral neuropathy and peripheral vascular disease, especially in the foot of a diabetic. Early detection is important, in order to prevent foot problems for diabetic patients with PAD. Photoplethysmography (PPG) is a non-invasive method for the detection of blood volume changes in peripheral arteries. Because of changes in the resistance-compliance, the rise time and transit time for the PPG signals increase and change in their shape are highly correlated with PAD severity. In this study, the Burg autoregressive (AR) method is used to determine the characteristic frequencies of the right-and left-side PPG signals. For bilateral frequency spectra, the VDP oscillator uses asynchronous signals. This produces damped sinusoidal responses and the oscillation overshoot (OS) is an approximating function only of the damped factor. This index is used to estimate the degree of PAD, including normal the condition and diabetic patients with PAD. The results show that the proposed method is efficient and more accurate in the estimation of PAD.展开更多
Objective: To replace the peripheral venous puncture for blood sampling with taking blood samples extracorporally from arterial line before predilution during RCA-CRRT performed. Methods: A new type of double-lumen fe...Objective: To replace the peripheral venous puncture for blood sampling with taking blood samples extracorporally from arterial line before predilution during RCA-CRRT performed. Methods: A new type of double-lumen femoral catheter was used instead of the current tubes. The new type of double-lumen tube had a greater distance from the inner venous ports to the inner arterial ports than current tubes. The minimum distance from the venous port to the arterial port was greatly lengthened. Replacement solution contained citrate, zero Ca<sup>2+</sup>, zero bicarbonate, low Na<sup>+</sup>. Blood samples were synchronously collected from the arterial line before the infusion of citrate replacement fluid and from the peripheral vein. The iCa concentration data of two groups were analyzed to observe the difference between iCa concentration levels in the arterial line and in peripheral vein;the anticoagulant effect of RCA and possible complications were observed, such as bleeding, clottings and hypocalcaemia. Results: 28 times of RCA-CRRT were performed on17 AKI and CRF patients with active bleeding or at the high risk of bleeding;336 blood samples were collected. Statistics showed that the difference of iCa concentration between arterial line group and the peripheral vein group was not significant (P = 0.9), there is a high degree of similarity between the iCa concentration of arterial line blood and the peripheral venous blood. None of the patients developed citrate toxicity or metabolic alkalosis. None induced bleeding, or bleeding aggravated. No obvious clotting occurred. Systemic calcium concentration was achieved in the ideal range. Conclusion: In clinical practice, the data of iCa concentration from arterial line can be used to replace that from peripheral vein when the new type of double-lumen femoral catheter is placed in femoral vein. RCA-CRRT therapy is safe and effective.展开更多
背景近年来中国极早产儿救治数量显著增加,中心血管导管已成为国内NICU的常用技术,极早产儿救治中可能存在中心血管导管的不合理使用,但目前尚缺乏其使用现况数据。目的通过回顾采集和分析中国新生儿协作网(CHNN)数据库正式运行第1年极...背景近年来中国极早产儿救治数量显著增加,中心血管导管已成为国内NICU的常用技术,极早产儿救治中可能存在中心血管导管的不合理使用,但目前尚缺乏其使用现况数据。目的通过回顾采集和分析中国新生儿协作网(CHNN)数据库正式运行第1年极早产儿中心血管置管现况,并对各医院进行问卷调查,以期发现当前极早产儿中心血管导管使用中存在的问题,为后续质量改进提供基线数据。设计横断面调查。方法基于2019年CHNN成员医院登记的极早产儿中心血管导管数据,描述不同出生胎龄早产儿中心血管导管使用状况(置管率、留置时间),问卷调查CHNN成员医院中心血管导管病房规范及管理、置管指征、拔除指征、维护实践和并发症情况。纳入CHNN数据库中入院日期在2019年1月1日至2019年12月31日、生后24 h内收入NICU、出生胎龄24^(+0)~31^(+6)周的极早产儿连续病例;排除存在严重先天性畸形者,治疗未结束时转至非CHNN医院者,未达到医生建议的出院标准家长主动选择终止维持生命支持的治疗并出院者;剔除病例纳入不完整或数据质量不合格的成员医院的数据。根据胎龄分为24~28周和~31周亚组。根据医院类型分为儿童专科医院、妇幼保健院和综合医院。自行设计问卷,调查病房规范及管理、留置及拔除指征、中心血管导管维护、中心血管导管相关并发症现况,由NICU主任或经主任授权的高年资新生儿专科医生填写问卷。主要结局指标中心血管导管置管类型、置管率和留置时间。结果(1)CHNN成员57家三级医院NICU 6532例极早产儿进入本文分析,留置中心血管导管4563例(69.9%),其中脐动脉导管(UAC)368例(5.6%)、脐静脉导管(UVC)2532例(38.8%)、经外周穿刺中心静脉置管(PICC)3895例(59.6%)和外科中心静脉置管(SCVC)55例(0.8%)。相对于未留置中心血管导管患儿,留置中心血管导管患儿的胎龄小、出生体重低、小于胎龄儿比例高、多胎比例高、本院出生比例低及5 min Apgar评分<7分比例高(P均<0.01),同时其母亲妊娠高血压、产前激素使用以及剖宫产比例均较高(P均<0.01)。留置与未留置中心血管导管极早产儿相比,病死率差异无统计学意义,但各项并发症更多,住院时间更长,差异有统计学意义。(2)任意中心血管导管置管率总体呈现随胎龄增加而下降的趋势,胎龄24~28周亚组和~31周亚组中心血管导管置管率分别为87.8%和63.1%。UAC和UVC置管率随胎龄增加而下降。PICC置管率随胎龄呈哑铃状,胎龄25~28周置管率最高(75.2%~85.5%),但仍有52.8%的胎龄~31周亚组患儿留置。留置≥2类中心静脉置管(UVC以及PICC或SCVC)占29.0%,随胎龄增加而下降,胎龄~31周亚组占21.8%。(3)UAC、UVC和PICC中位留置时间分别为6(4~8)d、7(4~9)d和22(15~31)d。不同类型医院CHNN成员医院中心血管导管置管率及留置时间差别显著。(4)共发放问卷57份,回收52份(91.2%),50%CHNN成员医院对中心血管导管管理有病房规范文件。在各类导管的留置指征、拔除指征、最长留置天数上存在单位间差异。62%和23%的CHNN成员医院在近1年内发生过中心血管导管相关的渗漏和血栓并发症。结论国内NICU中极早产儿中心血管导管留置较为普及,存在过度置管和置管不足共存、PICC置管时间过长、CHNN成员医院差异大等主要问题。亟需建立统一指南和规范,并通过质量控制和质量改进,促进更加合理、规范的中心血管导管使用。展开更多
文摘Background and Objectives: Establishing a stable pathway is the basis for interventional surgery, and hyper-selected intubation has become the basic requirement for vascular intervention therapy. Super-selection intubation can not only significantly improve the efficacy of peripheral intervention treatment, but also greatly reduce surgical complications. However, during the treatment of peripheral vascular intervention (such as liver tumor arterial chemotherapy embolism, hemoptysis bronchial arterial embolism, gastrointestinal hemorrhagic gastrointestinal arterial embolism, etc.), vascular mutation is often large, and there are many branches, and the direction of blood flow is into the direction of blood flow, the horns are even reverse, and even the use of straight-headed microstructures will have difficulty interpolation difficulties or even failure, which increases the risk of surgery and affects safety treatment. To overcome this, pre-plasticized microcatheters have emerged, among which the InstantPass Swan-Neck Microstructure is a catheter with a head-end morphology similar to Cobra. Our research aims to explore the feasibility, safety, and technical advantages of the use of swan-neck microcatheter in peripheral vascular hyperboloid intubation. Materials and Methods: From January 2023 to March 2024, 31 patients with swan-neck microstructure were used in the peripheral vascular intervention therapy outside the hospital. Among them, there were 23 men and 8 women, aged 32 - 81 years old, an average (55 ± 13) years, and the average irradiation time was 35.1 ± 24.7 minutes. 10 cases of iodide oil arterial chemotherapy embolism, 7 cases of microspheres of hepatic arteries, 3 cases of gastric duodenal artery selective embolism, 3 cases of vein embolism with esophageal stomach, and 2 cases of sperm varicose vein embolism, 2 cases of selective embolism of the intestinal membrane, 2 cases of uterine arteries embolism, and 2 cases of renal arterial embolism. 11 of these patients switched to the swan-neck microstructure after using the straight-headed microstructure super-selective intubation. To analyze whether the swan-neck microcatheter is successfully transported to the target location, whether it can provide a satisfactory path for subsequent intravascular treatment, evaluate the surgery instant image results and complications related to the microstructure during the surgery period, analyze the angle of the target blood vessels and the main blood vessels, the target blood vessels, the target blood vessels, the relationship between the degree of pedestrian and the success rate of ultra-selective intubation, and summarize the indication of the application of the swan-neck microstructure in peripheral intervention therapy. Results: In this study, 31 patients used 31 swan-neck microcatheters, of which 22 (70.9%) target vascular and main blood vessels were ≤90˚;17 patients (54.8%) patients were curved and angulated;11 cases (35.5%) were after the failure of the superselective intubation of the straight-headed microstructure, the swan-neck microcatheter was successful after the failure;1 case (3.2%) patients with microstructure-related mezzanine occurred during surgery, and the complication rate of the perioperative ductation was 3.2%. All target lesions are finally successfully completed, and the success rate of surgical technology is 100%. Conclusion: Swan-neck microcatheters have a high success rate in superselective cannulation of peripheral blood vessels and perform well in vascular tortuosity and angulated lesions.
文摘This paper proposes a Van der Pol (VDP) oscillator screening for peripheral arterial disease (PAD) in patients with diabetes mellitus. The long-term elevated blood sugar levels produce a high risk of peripheral neuropathy and peripheral vascular disease, especially in the foot of a diabetic. Early detection is important, in order to prevent foot problems for diabetic patients with PAD. Photoplethysmography (PPG) is a non-invasive method for the detection of blood volume changes in peripheral arteries. Because of changes in the resistance-compliance, the rise time and transit time for the PPG signals increase and change in their shape are highly correlated with PAD severity. In this study, the Burg autoregressive (AR) method is used to determine the characteristic frequencies of the right-and left-side PPG signals. For bilateral frequency spectra, the VDP oscillator uses asynchronous signals. This produces damped sinusoidal responses and the oscillation overshoot (OS) is an approximating function only of the damped factor. This index is used to estimate the degree of PAD, including normal the condition and diabetic patients with PAD. The results show that the proposed method is efficient and more accurate in the estimation of PAD.
文摘Objective: To replace the peripheral venous puncture for blood sampling with taking blood samples extracorporally from arterial line before predilution during RCA-CRRT performed. Methods: A new type of double-lumen femoral catheter was used instead of the current tubes. The new type of double-lumen tube had a greater distance from the inner venous ports to the inner arterial ports than current tubes. The minimum distance from the venous port to the arterial port was greatly lengthened. Replacement solution contained citrate, zero Ca<sup>2+</sup>, zero bicarbonate, low Na<sup>+</sup>. Blood samples were synchronously collected from the arterial line before the infusion of citrate replacement fluid and from the peripheral vein. The iCa concentration data of two groups were analyzed to observe the difference between iCa concentration levels in the arterial line and in peripheral vein;the anticoagulant effect of RCA and possible complications were observed, such as bleeding, clottings and hypocalcaemia. Results: 28 times of RCA-CRRT were performed on17 AKI and CRF patients with active bleeding or at the high risk of bleeding;336 blood samples were collected. Statistics showed that the difference of iCa concentration between arterial line group and the peripheral vein group was not significant (P = 0.9), there is a high degree of similarity between the iCa concentration of arterial line blood and the peripheral venous blood. None of the patients developed citrate toxicity or metabolic alkalosis. None induced bleeding, or bleeding aggravated. No obvious clotting occurred. Systemic calcium concentration was achieved in the ideal range. Conclusion: In clinical practice, the data of iCa concentration from arterial line can be used to replace that from peripheral vein when the new type of double-lumen femoral catheter is placed in femoral vein. RCA-CRRT therapy is safe and effective.
文摘背景近年来中国极早产儿救治数量显著增加,中心血管导管已成为国内NICU的常用技术,极早产儿救治中可能存在中心血管导管的不合理使用,但目前尚缺乏其使用现况数据。目的通过回顾采集和分析中国新生儿协作网(CHNN)数据库正式运行第1年极早产儿中心血管置管现况,并对各医院进行问卷调查,以期发现当前极早产儿中心血管导管使用中存在的问题,为后续质量改进提供基线数据。设计横断面调查。方法基于2019年CHNN成员医院登记的极早产儿中心血管导管数据,描述不同出生胎龄早产儿中心血管导管使用状况(置管率、留置时间),问卷调查CHNN成员医院中心血管导管病房规范及管理、置管指征、拔除指征、维护实践和并发症情况。纳入CHNN数据库中入院日期在2019年1月1日至2019年12月31日、生后24 h内收入NICU、出生胎龄24^(+0)~31^(+6)周的极早产儿连续病例;排除存在严重先天性畸形者,治疗未结束时转至非CHNN医院者,未达到医生建议的出院标准家长主动选择终止维持生命支持的治疗并出院者;剔除病例纳入不完整或数据质量不合格的成员医院的数据。根据胎龄分为24~28周和~31周亚组。根据医院类型分为儿童专科医院、妇幼保健院和综合医院。自行设计问卷,调查病房规范及管理、留置及拔除指征、中心血管导管维护、中心血管导管相关并发症现况,由NICU主任或经主任授权的高年资新生儿专科医生填写问卷。主要结局指标中心血管导管置管类型、置管率和留置时间。结果(1)CHNN成员57家三级医院NICU 6532例极早产儿进入本文分析,留置中心血管导管4563例(69.9%),其中脐动脉导管(UAC)368例(5.6%)、脐静脉导管(UVC)2532例(38.8%)、经外周穿刺中心静脉置管(PICC)3895例(59.6%)和外科中心静脉置管(SCVC)55例(0.8%)。相对于未留置中心血管导管患儿,留置中心血管导管患儿的胎龄小、出生体重低、小于胎龄儿比例高、多胎比例高、本院出生比例低及5 min Apgar评分<7分比例高(P均<0.01),同时其母亲妊娠高血压、产前激素使用以及剖宫产比例均较高(P均<0.01)。留置与未留置中心血管导管极早产儿相比,病死率差异无统计学意义,但各项并发症更多,住院时间更长,差异有统计学意义。(2)任意中心血管导管置管率总体呈现随胎龄增加而下降的趋势,胎龄24~28周亚组和~31周亚组中心血管导管置管率分别为87.8%和63.1%。UAC和UVC置管率随胎龄增加而下降。PICC置管率随胎龄呈哑铃状,胎龄25~28周置管率最高(75.2%~85.5%),但仍有52.8%的胎龄~31周亚组患儿留置。留置≥2类中心静脉置管(UVC以及PICC或SCVC)占29.0%,随胎龄增加而下降,胎龄~31周亚组占21.8%。(3)UAC、UVC和PICC中位留置时间分别为6(4~8)d、7(4~9)d和22(15~31)d。不同类型医院CHNN成员医院中心血管导管置管率及留置时间差别显著。(4)共发放问卷57份,回收52份(91.2%),50%CHNN成员医院对中心血管导管管理有病房规范文件。在各类导管的留置指征、拔除指征、最长留置天数上存在单位间差异。62%和23%的CHNN成员医院在近1年内发生过中心血管导管相关的渗漏和血栓并发症。结论国内NICU中极早产儿中心血管导管留置较为普及,存在过度置管和置管不足共存、PICC置管时间过长、CHNN成员医院差异大等主要问题。亟需建立统一指南和规范,并通过质量控制和质量改进,促进更加合理、规范的中心血管导管使用。
