波动引导的右颈内静脉穿刺法

传统的右颈内静脉穿刺置管方法基于对其解剖位置及体表投影的统计学资料,无论前、中、后入路均属盲探性操作,故可能损伤动脉、神经或气管、食管、纵隔、肺等毗邻脏器,形成的颈部血肿压迫气管、血胸、气胸、甚或纵隔血肿、心包填塞等穿刺即刻并发症无论在理论上还是实践中都难于被消除,特别是当颈内静脉位置变异而仍以解剖标志引导时尤然。为此,有学者提出穿刺置管应在超声引导下进行,以提高穿刺的安全性和成功率,但此法需昂贵的设备和对超声技术的熟练掌握,一时难以在临床普及。本文介绍一种便捷、实用而又安全有效的新方法。

Passive ranging algorithm in terms of polar coordinates

For the missile with passive seeker,the improvement of passive ranger's precision is one of the key issues in development of the defense penetrate strategy. On the offensive warheads,the infrared imaging device was used to measure the line-of-sight angle information of the blocker,and then using the algorithm of Kalman Filter under polar coordinates,the distance from the blocker to the warheads was obtained. The simulation result under polar coordinates was compared with that of Cartesian coordinate. The validity of the method was analyzed,and the schemes of improvement were brought out.

建立颈内静脉临时血透通道的方法和体会

目的总结经右颈内静脉穿剌置管建立临时血透通道的经验,以提高穿剌成功率,减少并发症。方法回顾分析一年来22例建立右颈内静脉临时血透通道的方法,对比解剖定位与生理定位法穿剌置管的一次成功率和及时/延时肝素化后的颈部血肿发生率。结果9例解剖定位法中5例一次成功,2例误穿动脉形成颈部血肿;13例波动引导的生理定位法11例一次成功,无误穿动脉。14例及时肝素化的患者中有6例出现程度不等的血肿;8例延时肝素化者仅1例出现血肿。结论提倡用波动引导的生理定位法穿剌置管,成功后应延时肝素化。