目的 总结在三维标测系统Carto 3指导下射频消融治疗特发性室速患者的护理方法。 方法 对2010年11月－2011年10月收治的62例特发性室速患者，采用Carto 3系统进行心室标测和消融治疗，并予以周全细致的护理。 结果 本组61例患者顺利完成射频消融术，1例因诱发室颤后停止手术。术后随访6个月，3例出现既往相同形态室速，其余58例症状较前均有不同程度的缓解，未发生明显心动过速，手术成功率为93.55%。 结论 Carto 3系统指导下的特发性室速射频治疗安全、高效，可减少射线透视量，恰当细致的护理配合是手术获得成功的基础与保障。
【Abstract】ObjectiveTo investigate the effect of high intensity focused ultrasound (HIFU) on the immunity of patients with advanced primary liver cancer (PLC). MethodsForty cases of PLC admitted to our institution from Mar. 2003 to Dec. 2003 were included in this study. Patients were divided into 2 groups and received either HIFU or radiofrequency ablation (RFA) treatment randomly. CD3, CD4, CD8, CD4/CD8, NK, IL-2, TNF were chosen to assess the immune status before and after treatment. The results were compared statistically. ResultsThe survival rate after HIFU was 80.0%, 61.1%, 42.9%, 33.3% at 3 months, 6 months, 9 months and 1 year respectively, which was similar to that after RFA treatment. The changes of immunity parameters of CD3, CD4, CD8, CD4/CD8, NK, IL-2 and TNF were not significant after HIFU treatment. In addition, the differences of those parameters between HIFU group and RFA group were insignificant. ConclusionThere are no detrimental effects on immunity in the early period after HIFU treatment.
Objective To investigate the clinical applicationand curative effect of isoionic microtrauma arthroscope on treatment of knee arthropathy. Methods From May 2003 to November 2004, 52 cases of knee joint injury were cured by using isoionic microtrauma arthroscope, including 30 cases ofknee osteoarthritis, 10 cases of meniscus injury, 5 cases of kneecap dislocation, 5 cases of laxity of anterior cruciate ligation and 2 cases of rheumatoid arthritis. In accordance with Lysholm criterion for knee joint function, the scores were 35.5±4.9 before operation. Results All of these patients were followed up for 2-17 months. The scores of knee joint function was 86.4±5.3 after operation, and there was significant difference (Plt;0.001). Conclusion Isoionic microtrauma arthroscope is characterized by low-temperature hemoagglutination, crimpling,boiling, cutting and hemostasia, which makes kneejoint arthroscope operation easier-to-do, miner histological scathe and lighter side effect; so it is favourable for functional recovery and its curative effect is satisfactory.
Objective To investigate the risk factors of infection after radiofrequency ablation in patients with liver metastases after choledochojejunostomy. Methods The clinical data of patients with liver metastases treated by radiofrequency ablation in our hospital from January 2010 to April 2022 were collected retrospectively and analyzed by univariate and multivariate logistic regression analysis. Results A total of 57 patients were included in the study, and the total number of postoperative infections was 19 (33.33%). Univariate logistic regression analysis showed that the tumor location, maximum tumor diameter, number of tumors, ablation times, and ablation duration were related to the occurrence of infection after radiofrequency ablation (P<0.01). The results of multivariate logistic regression analysis showed that the tumor location [OR=6.45, 95%CI (1.11, 37.35), P=0.037] and ablation duration [OR=1.49, 95%CI (1.16, 1.91), P=0.002] were independent risk factors for infection after radiofrequency ablation in patients with choledocho-jejunostomy. Conclusions For patients with metastatic liver cancer with a history of choledochojejunostomy, the tumor location and the duration of ablation are closely related to postoperative infection. We should strengthen the indivi-dualized management of such patients during and after operation should be strengthened to promote disease recovery.
ObjectiveTo investigate the efficacy of bipolar radiofrequency ablation for left ventricular aneurysm-related ventricular arrhythmia associated with mural thrombus. MethodsFifteen patients with left ventricular aneurysm-related frequent premature ventricular contractions associated with mural thrombus were enrolled in Beijing Anzhen Hospital between June 2013 and June 2015. There were 11 male and 4 female patients with their age of 63.5±4.8 years. All patients had a history of myocardial infarction, but no cerebral infarction. All patients received bipolar radiofrequency ablation combined with coronary artery bypass grafting, ventricular aneurysm plasty and thrombectomy. Holter monitoring and echocardiography were measured before discharge and 3 months following the operation. ResultsThere was no death during the operation. Cardiopulmonary bypass time was 92.7±38.3 min. The aortic clamping time was 52.4±17.8 min.The number of bypass grafts was 3.9±0.4. All the patients were discharged 7-10 days postoperatively. None of the patients had low cardiac output syndrome, malignant arrhythmias, perioperative myocardial infarction, or cerebral infarction in this study. Echocardiography conducted before discharge showed that left ventricular end diastolic diameter was decreased (54.87±5.21 cm vs. 60.73±6.24 cm, P=0.013). While there was no significant improvement in ejection fraction (45.20%±3.78% vs. 44.47%±6.12%, P=1.00) compared with those before the surgery. The number of premature ventricular contractions[4 021.00 (2 462.00, 5 496.00)beats vs. 11 097.00 (9 327.00, 13 478.00)beats, P < 0.001] and the percentage of premature ventricular contractions[2.94% (2.12%, 4.87%) vs. 8.11% (7.51%, 10.30%), P < 0.001] in 24 hours revealed by Holter monitoring were all significantly decreased than those before the surgery. At the end of 3-month follow-up, all the patients were angina and dizziness free. Echocardiography documented that there was no statistical difference in left ventricular end diastolic diameter (55.00±4.41 mm vs. 54.87±5.21 mm, P=1.00). But there were significant improvements in ejection fraction (49.93%±4.42% vs. 45.20%±3.78%, P=0.04) in contrast to those before discharge. Holter monitoring revealed that the frequency of premature ventricular contractions[2 043.00 (983.00, 3 297.00)beats vs. 4 021.00 (2 462.00, 5 496.00)beats, P=0.03] were further lessened than those before discharge, and the percentage of premature ventricular contractions[2.62% (1.44%, 3.49%)vs. 8.11% (7.51%, 10.30%), P < 0.001] was significantly decreased than those before the surgery, but no significant difference in contrast to those before discharge. ConclusionThe recoveries of cardiac function benefit from integrated improvements in myocardial ischemia, ventricular geometry, pump function, and myocardial electrophysiology. Bipolar radiofrequency ablation can correct the electrophysiological abnormality, significantly decrease the frequency of premature ventricular contractions, and further improve the heart function.
Objective To compare the effect of monopolar and bipolar radiofrequency ablation in patients with atrial fibrillation and concomitant rheumatic heart disease. Methods The clinical data of 261 patients who underwent valve replacement and radiofrequency Maze Ⅲ procedure in Shanghai First People's Hospital from 2010 to 2015 were retrospectively analyzed. According to the radiofrequency ablation system, patients were assigned to a monopolar radiofrequency ablation group (n=209, 129 males, 80 females, aged 59.6±9.7 years) and a bipolar radiofrequency ablation group (n=52, 36 males, 16 females, aged 58.6±11.2 years). After procedures, clinical factors such as patients' basic information, perioperative complication and mortality, the elimination rate of atrial fibrillation were measured. Results There was no statistic difference in perioperative morbidity and mortality between two groups. The ablation time of the monopolar radiofrequency ablation group was longer than that of the bipolar group (29.7±3.3 minvs. 22.3±7.8 min,P=0.035). Postoperative diameter of left atrium was reduced in both groups. Compared with the monopolar radiofrequency ablation group, bipolar group had a better elimination rate of atrial fibrillation at three months and one year follow-up (82.0%vs. 66.3%,P=0.037; 80.0%vs. 59.6%,P=0.008). Conclusion Valve replacement combined with radiofrequency Maze Ⅲ procedure is safe and efficient. Compared with monopolar radiofrequency ablation, bipolar radiofrequency ablation has advantage on elimination rate of atrial fibrillation, ablation time and cardiopulmonary bypass time.
ObjectiveTo review the progress of percutaneous radiofrequency catheter-based renal sympathetic denervation for resistant hypertension as well as the inadequacy, and to reevaluate the clinical significance of the technology. MethodsDomestic and foreign literatures were collected to summary the progress of percutaneous radiofrequency catheter-based renal sympathetic denervation in treatment of resistant hypertension. ResultsThe percutaneous radiofrequency catheter-based renal sympathetic denervation in the treatment of resistant hypertension had obtained some positive results recently, but the long-term outcomes and safety of the technology were still subjected to further evaluation. ConclusionThe effect of percutaneous radiofrequency catheter-based renal sympathetic denervation for resistant hypertension remains to be controversial, and both the equipment and technology of radiofrequency catheter-based ablation need to be improved.