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心脏瓣膜置换同期应用双极射频消融术治疗心房纤颤患者的术后护理

摘要:目的:总结54例心脏瓣膜置换同期应用双极射频消融术治疗心房纤颤患者的术后护理经验。方法：除做好瓣膜置换术后常规护理外,重视心律和心率的监测、电解质平衡的维持、应用胺碘酮的观察及护理、起搏器的观察、抗凝监测和健康指导与心理护理。结果：通过严密的监测和精心的护理,本组病例术后恢复良好,术后7~10 d出院。结论：做好心脏瓣膜置换同期应用双极射频消融术治疗心房纤颤患者的术后护理,认真观察患者瓣膜置换、消融术后心房纤颤治疗效果,为此类患者的生命质量提高提供了保证。

Influence of Radiofrequency Ablation on Hepatic Function and Nursing Measures

摘要:目的： 探讨肝癌患者行射频消融术围手术期的肝功能变化情况,以及相应的护理措施。方法:对2006～2009年6月在我院接受射频消融术治疗的91例肝癌患者,监测其围手术期的肝功能指标,如丙氨酸氨基转移酶及总胆红素等变化情况,分析射频消融术对肝功能的影响,总结相应的护理措施。 结果:全组无死亡病例。射频消融术后早期丙氨酸氨基转移酶及总胆红素与术前有显著差异（P＜005）。结论: 肝癌患者行射频消融术后早期肝功能减退,应加强护理措施,促进患者恢复。 Abstract: Objective: To explore the influence of radiofrequency ablation (RFA) on hepatic function of patients suffering hepatocelluler carcinoma and to summarize corresponding nursing measures.Methods: Ninetyone patients suffering hepatocelluler carcinoma received RFA were studied with their hepatic function preoperation and postoperation. Alanine aminotransferase (ALT) and total bilirubin (TB) were selected as the liver functional parameters,and perioperative changes of the two parameters were measured. Influence of RFA on hepatic function was analyzed and corresponding nursing measures were summarized. Results: Significant changes of ALT and TB were observed early after RFA,and there were statistical difference between preoperation and postoperation (P＜005). Conclusion: Proper nursing measures should be applied to improve hypohepatia and promote recovery of patients.

Application of Low-temperature Bipolar Radiofrequency Ablation on Patients withMultilevel Obstructive Sleep Apnea-hypopnea Syndrome

摘要：目的：探讨低温双极射频消融技术治疗多平面阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea-hypopnea syndrome，OSAHS）的价值。方法：对67例多平面OSAHS患者采用低温双极射频消融治疗，根据术前、术后症状改善情况及多导睡眠监测（polysomnography，PSG）结果的比较判定疗效。结果：67例患者中治愈21例，显效22例，有效15例，无效9例，总有效率86.57%。术前与术后1年AHI和SaO2结果经t检验，差异有显著性(P＜0.01)。所有病例均无并发症发生。结论：低温双极射频消融术治疗阻塞性睡眠呼吸暂停低通气综合征（OSAHS）疗效肯定，特别是同期治疗多平面阻塞安全可靠，具有独特的优势。

Thera Peutic Observation on 32 Cases of Gastritis Verrucosa Treated by Radiofrequency under the Guidance of Endoscopy Combined with Drugs

目的：探讨射频配合药物治疗疣状胃炎的疗效。方法:将胃镜诊断为疣状胃炎患者68例随机分为两组，射频配合药物治疗组用射频波25～40W对病灶行一次性“ 烧灼”，术后口服奥美拉唑胶囊4周；药物治疗组使用奥美拉唑治疗4周组作为对照组。两组若幽门螺杆菌(HP)阳性者均给予根除HP治疗。结果：射频配合药物治疗组症状缓解/消失率及疣状病灶消退率明显优于药物治疗组（P＜0.01）。结论：射频配合药物治疗疣状胃炎是一种较理想的、值得推广的有效方法，具有治疗彻底，操作技术简单,使用安全,病灶愈合快,治愈时间短,价格便宜,病人痛苦小等优点。

Progression of Radiofrequency Ablation in Treatment of Hepatocellular Carcinoma

Effect on Microvessel Density and Vascular Endothelial Growth Factor Expression of Radiofrequency Ablation with Arsenious Acid on Liver VX2 Tumors

Objective　To evaluate the effect on microvessel density (MVD) and vascular endothelial growth factor (VEGF) expression of combining radiofrequency ablation (RFA) with arsenious acid (AA) locally treating liver VX2 tumor in rabbits. Methods　Twenty-eight New Zealand White rabbits with implanted liver VX2 tumors were randomly divided into four groups, control group (n=7), AA group (n=7), RFA group (n=7) and combination (RFA+AA) group (n=7). All rabbits were killed 14 days after treatment. MVD and VEGF expression were examined by immunohistochemistry. Results　The MVD degraded one by one in control group,AA group,RFA group and RAF+AA group, which were (38.50±0.44), (23.07±0.47), (18.65±0.39) and (11.36±0.36)/HP respectively, compared while each two groups, P＜0.05. The VEGF expression also degraded one by one, the ratio of positive cases were 7/7, 5/7, 4/7 and 2/7 respectively, compared while each two groups, P＜0.05. There was positive correlation between VEGF expression and MVD (Person conefficient of product-moment correlation r=0.47, P＜0.01). Conclusion　Combining RAF with AA therapy can greatly decrease MVD and VEGF expression of tumor tissue.

Large Hepatocarcinoma: Treatment with RadioFrequency Ablation

Objective To explore efficacy and safety of radiofrequency ablation (RFA) in the treatment of large hepatocarcinoma. MethodsFortythree cases of large hepatocarcinoma underwent RFA with the expandable cluster electrode,eight of all cases had undergone transcatheter artery chemoembolization (TAE) for 1-2 sessions within 2 months before RFA; the tumors were 5-10 cm in diameter, mean 7.5 cm. Hepatic function examination, alphafetoprotein, enhanced CT scans,color ultrasonography and needle biopsy were performed,pre and posttreatment. Complete necrosis was evaluated by dynamic enhanced CT scans and biopsy. Therapeutic time and sessions of RFA,length of stay in hospital and complications of RFA were observed; and thirtynine of 43 cases after RFA were followed up for 12-18 months.ResultsFortythree cases of large hepatocarcinoma received RFA for 67 sessions， 1-3 sessions per case，mean 1.6 sessions; therapeutic time 55-150 min,mean 75 min; length of stay in hospital 3-15 day， mean 8.7 day; major complications of RFA included local skin burn of electrode board in 2 cases （4.6%） and moderatetolarge right pleural effusion in 3 cases （7.0%），overall complications rate was 11.6%; complete necrosis was achieved in 41.0% of cases which were evaluated by dynamic enhanced CT scans at least 6 months followed RFA; of thirtyone cases of positive AFP, AFP level became negative in 3,decreased obviously in 5 within 6-12 months after RFA; in 12-18 months followup,oneyear survival rate was 69.2%.Conclusion RFA appears to be safe, effective and minor invasive for the treatment of large hepatocarcinoma.

Influence of Preoperative Left Atrial Dimension on the Effectiveness of Surgical Radiofrequency Ablation for Treatment　 of Atrial　Fibrillation

Abstract：　Objective　To analyze the influence of preoperative left atrial dimension （LAD） on the effectiveness of surgical radiofrequency ablation for the treatment of atrial fibrillation （AF） through a 5-year postoperative follow-up of AF patients after surgical radiofrequency ablation. Methods　Clinical data of 433 patients with persistent or permanent AF who received bipolar radiofrequency ablation procedures during concomitant cardiac surgery in Beijing Anzhen Hospital from 2006 to 2009 were retrospectively analyzed. All the patients were divided into 4 groups according to their preoperative LAD：Group A， 75 patients with their LAD＜50 mm， including 22 males and 53 females with their average age of 56.50±10.05 years；Group B， 89 patients with their LAD ranging from 50 to 60 mm， including 32 males and 57 females with their average age of 55.63±10.28 years；Group C， 117 patients with their LAD ranging from 60 to 70 mm， including 41 males and 76 females with their average age of 55.13±10.96 years；and Group D， 152 patients with their LAD＞70 mm， including 68 males and 84 females with their average age of 53.22±11.49 years. Postoperative ECG records right after surgery， before discharge， at 6 months and 1，2，3，4 and 5 years during follow-up were collected. The relationship between preoperative LAD and postoperative sinus rhythm restoration rate was analyzed. Results There was statistical difference in sinus rhythm restoration rate right after surgery（P=0. 011）， before discharge（P=0. 002）， at 6 months（P＜ 0. 001） and 1 year （P＜0. 001）， 2 years（P＜0. 001）， 3 years（P＜0. 001）， 4 years（P＜0. 001） and 5 years（P= 0. 006） during follow-up among the 4 groups. Postoperative sinus rhythm restoration rates right at 6 months and 1，2，3， 4 and 5 years during follow-up was 90.4%， 89.9%， 90.3%， 91.3%， 89.1%， and 90.9% in Group A， 80.2%，79.0%，78.1%， 76.1%，72.5%，70.0% in Group B，74.7%，74.0%，71.2%，72.4%，70.0%， and 64.7% in Group C， and 61.8%，57.6%，56.8%，53.9%，50.7%，and 48.6% in Group D， respectively.　Conclusion　Patients with a larger preoperative LAD have a lower postoperative sinus rhythm restoration rate after surgical radiofrequency ablation for the treatment of AF.

Comparison of Clinical Outcomes of Two Different Radiofrequency Ablation for the Treatment of Permanent Atrial Fibrillation of Patients with Rheumatic Valvular Heart Disease

Objective To compare short-term clinical outcomes of bipolar/unipolar radiofrequency （RF） ablation for the treatment of permanent atrial fibrillation（AF） of patients with rheumatic valvular heart disease. Methods Clinicaldata of 124 patients with rheumatic valvular heart disease and permanent AF who underwent heart valve replacement and　concomitant bipolar/unipolar RF ablation in Wuhan Asia Heart Hospital from February 2011 to December 2011 were retros-　pectively analyzed. According to different RF ablation methods，all the 124 patients were divided into bipolar group and　unipolar group. There were 62 patients in the bipolar group including 29 males and 33 females with their age of 44.20±8.61 years，and 62 patients in the unipolar group including 33 males and 29 females with their age of 46.40±9.48 years. Electrocardiogram examinations were performed at the time of intraoperative heart re-beating，the very postoperative day，7 days，1 month，3 months and 6 months postoperatively to detect restoration of sinus rhythm. Results There was no in-hospital death or ablation-related complication in either group. Aortic cross-clamp time（70.05±22.02 min vs. 54.47±20.65 min，P=0.025） and RF ablation time（25.12±3.00 min vs. 15.70±3.02 min，P=0.000）of the bipolar group were significantly longer than those of the unipolar group. At the time of intraoperative heart re-beating，the lst and 7th day after operation，　sinus rhythm restoration rates were 88.71%，87.10%，80.65% respectively in the bipolar group，85.48%，77.42%，72.58% respectively in the unipolar group，and there was no statistical difference between the two groups （P＞0.05）. In the 1st，3rd and 6th postoperative month，sinus rhythm restoration rates of the bipolar group （79.03%，75.81%，72.58% respectively）　were significantly higher than those of the unipolar group （59.68%，50.00%，48.38% respectively，P＜0.05）. Conclusion　Clinical outcomes of RF ablation for the treatment of permanent AF of patients with rheumatic valvular heart disease are satisfactory. Unipolar RF ablation has the advantage of being time-saving and easier technique，while short-term sinus rhythm restoration rate of bipolar RF ablation is higher than that of unipolar RF ablation for the treatment of permanent AF.

CT引导射频消融治疗非小细胞肺癌的临床分析

目的　评价CT引导射频消融治疗非小细胞肺癌（NSCLC）的缓解率、中位生存时间及生存率。方法　2005年12月至2007年12月复旦大学附属中山医院分部收治高龄、心肺功能差或有严重并发症无法耐受手术的NSCLC患者56例，其中男32例，女24例；平均年龄63.7岁。肿瘤直径平均2.6 （0.8～4.0） cm。组织病理学分型为：鳞状细胞癌20例，腺癌30例，肺泡细胞癌5例，神经内分泌癌1例。有11例患者临床分期为Ⅰ期。56例NSCLC患者均进行CT引导射频消融术。 结果　56例患者射频消融治疗均顺利完成，无与手术相关的死亡发生。并发症包括气胸6例、胸痛15例、发热13例、肺内出血5例、胸膜渗出1例。平均住院时间3 （2～12） d。随访至射频消融治疗后1年，肿瘤达到完全缓解共48例 （86%），中位生存时间为28.33个月；随访至3年结束时，共死亡36例，因肿瘤进展死亡32例。1年、2年总体生存率分别为84%和56%，其中Ⅰ期NSCLC患者的1年、2年总体生存率为100%和82%。 结论　射频消融为无法耐受手术或不适合手术的肺癌患者提供了一种新的治疗手段，短期疗效明显。但因其开展时间较短，能否提高患者5年生存率，其远期效果有待今后更长时间的随访和观察。