血管内介入术中脑血管痉挛的发病原因及处理对策

目的分析血管内介入术后脑血管痉挛发生的原因,总结其治疗方案。方法选取2012年3月~2014年3月于我院接受血管介入术治疗的80例患者作为研究对象,随机将其分为观察组与对照组两组,均为40例。两组均给予脑血管痉挛预防治疗,对照组给予尼莫地平注射液治疗方案,观察组给予盐酸法舒地尔注射液治疗,观察两组患者预防效果,总结血管内介入术中患者脑血管痉挛发生原因与处理对策。结果观察组痊愈18例,显效14例,好转3例,总有效率高达87.5%,明显高于对照组的67.5%,组间对比差异显著(P<0.05);观察组5例患者发脑血管痉挛,发生率为12.5%,术后3~4d 1例,5~8d 4例;对照组14例发生脑血管痉挛,占35.0%,术后3~4d 2例,5~8d 9例,9~14d 3例;对照组脑血管痉挛发生率明显高于对照组(P<0.05)。结论盐酸法舒地尔在降低血管内介入术中脑血管痉挛的发生率方面效果显著,值得推广。     

法舒地尔辅助治疗对脑动脉瘤栓塞术患者NIHSS评分及预后的影响

目的探讨法舒地尔辅助治疗对脑动脉瘤栓塞术患者临床效果的影响。方法采用随机数表将我院2018年1月～2019年6月收治的脑动脉瘤栓塞术患者分成对照组和观察组各30例。对照组给予患者尼莫地平治疗,观察组给予患者法舒地尔加尼莫地平治疗。比较两组美国国立卫生研究院卒中量表(NIHSS)评分、Glasgow昏迷评分(GCS)及预后效果。结果观察组患者预后改善率为93.33%,明显高于对照组的66.67%,差异有统计学意义(P<0.05);治疗后,观察组患者NIHSS评分为(7.89±3.25)低于对照组的(10.78±3.89),观察组GCS评分为(13.36±1.12)高于对照组的(11.25±2.01),差异有统计学意义(P<0.05)。结论脑动脉瘤栓塞术患者实施法舒地尔治疗的效果较好,可以有效的降低神经功能损伤程度,改善其预后。     

脑苷肌肽联合法舒地尔对急性脑梗死患者脑动脉血流参数的影响

目的探讨脑苷肌肽联合法舒地尔对急性脑梗死患者脑动脉血流参数的影响。方法选取收治的120例急性脑梗死患者为研究对象,随机分为对照组和观察组各60例,对照组单用法舒地尔静脉滴注治疗,观察组采用脑苷肌肽联合法舒地尔静脉滴注治疗,对比两组临床疗效与动脉血流参数指标,并记录两组不良反应情况。结果观察组总有效率明显高于对照组,观察组全血低切黏度、全血高切黏度、血浆黏度等脑动脉血流指标均低于对照组,差异具有统计学意义(P0.05);两组不良发生发生率对比,差异无统计学意义(P0.05)。结论脑苷肌肽联合法舒地尔治疗急性脑梗死,可改善脑动脉血流,无严重不良反应,临床应用安全高效,有利于促进患者康复。     

血管内介入栓塞术治疗脑动脉瘤的临床疗效

目的探讨血管内介入栓塞术治疗脑动脉瘤的临床疗效。方法选取我院2017年3月～2019年1月收治的脑动脉瘤患者110例,采用随机数字表法分成对照组和观察组各55例。对照组行开颅手术治疗,观察组行血管内介入栓塞术,对比两组患者的临床疗效以及术后并发症的发生情况。结果观察组治疗总有效率为67.27%,对照组为63.64%,差异无统计学意义(P0.05);观察组术后脑血管痉挛、短暂性脑缺血和脑积水等并发症发生率低于对照组,差异有统计学意义(P0.05)。结论血管内介入栓塞术与开颅术治疗脑动脉瘤均是有效的治疗方式,临床疗效相近,但行血管内介入栓塞术的脑动脉瘤患者术后并发症发生率较少,预后更佳,值得临床推广。     

奥曲肽在上消化道大出血救治中的临床应用

目的:研究分析奥曲肽在上消化道大出血救治中的临床疗效与安全性。方法:在2010年2月~2014年10月来我院治疗上消化大出血患者中选取80例,随机分为观察组与对照组各40例。观察组患者先静脉推注0.1 mg奥曲肽,然后在0.9%氯化钠注射液250 ml中加入0.1 mg奥曲肽,持续静脉滴注8 h;对照组患者在0.9%氯化钠注射液250 ml中加入10~20 U的垂体后叶素,持续静脉滴注8 h,两组均治疗2~5 d。结果:对照组总有效率(67.50%)显著低于观察组(95.00%),差异有统计学意义,P0.05,表明观察组止血效果显著优于对照组;观察组患者的再出血率与病死率均低于对照组,差异均有统计学意义,P0.05。结论:奥曲肽能有效治疗上消化道大出血,安全性高,值得临床广泛应用。     

左氧氟沙星治疗盆腔炎患者的临床治疗效果分析

选取2014年2月~2015年4月笔者就职医院妇产科收治的盆腔炎患者84例,按随机数法分为观察组和对照组各42例,对照组患者使用氧氟沙星0.2g+0.9%氯化钠注射液200ml静脉滴注,观察组患者使用盐酸左氧氟沙星0.2g+0.9%氯化钠注射液200ml静脉滴注,两组静注均为每日2次,连续10d为一个完整疗程。对两组患者的临床治疗效果进行评价,比较两组的总治疗有效率和不良反应发生率,对所有患者进行为期1年的随访,比较随访期间妇科盆腔炎的复发率。结果观察组的总治疗有效率92.86%(39/42)高于对照组71.43%(30/42),差异具有统计学意义(P0.05);观察组的不良反应发生率9.52%(4/42)低于对照组26.19%(11/42),差异具有统计学意义(P0.05);在随访期间,观察组的复发率与对照组相较更低,差异具有统计学意义(P0.05)。在对妇科盆腔炎患者的抗感染治疗中,左氧氟沙星的临床疗效更佳,不良反应更少,且能有效减少复发率,安全性高,疗效确切,应大力推广。     

前列地尔联合尼莫地平治疗蛛网膜下腔出血后脑血管痉挛41例临床疗效观察

目的探讨尼莫地平联合前列地尔治疗蛛网膜下腔出血(SAH)后脑血管痉挛(CVS)的临床效果。方法选取我院收治的SAH后CVS患者82例,按随机数字表法分为对照组和观察组各41例。对照组在常规治疗基础上加用尼莫地平治疗,观察组在对照组基础上加用前列地尔治疗。对比两组患者临床疗效、大脑中动脉平均血流速度(MCAVm)及认知功能。结果观察组治疗总有效率为90.24%,显著高于对照组的70.73%,差异有统计学意义(P0.05);两组患者MCAVm和蒙特利尔认知评估量表(MOCA)评分均较治疗前有明显改善,且观察组优于对照组,差异有统计学意义(P0.05);两组并发症发生率和死亡率比较,无显著性差异(P0.05)。结论尼莫地平联合前列地尔治疗SAH后CVS,临床疗效显著,可降低大脑中动脉血流速度,改善脑血管痉挛,提升患者认知功能。     

盐酸法舒地尔治疗急性脑梗死的临床疗效及对血液流变学和血浆内皮素-1的影响

目的探讨盐酸法舒地尔治疗急性脑梗死的临床疗效及对血液流变学和血浆内皮素-1的影响。方法选取2012年1月至2013年6月进行治疗的急性脑梗死患者88例,采用随机的方法分为研究组(n=44)和对照组(n=44),对照组患者给予常规治疗,研究组患者在对照组的基础上给予盐酸法舒地尔治疗,观察比较两组的疗效、血液流变学和血浆内皮素-1水平的变化。结果治疗后,对照组总有效率为79.55%,显著低于研究组的93.18%(χ2=8.318,P0.05)。治疗后对照组红细胞沉降率、血细胞比容、纤维蛋白原、红细胞聚集指数、全血高切黏度分别为(23.32±8.01)mm/h、(39.56±3.56)%、(2.65±0.82)g/mL、(4.33±0.73)、(3.87±0.41)mPa·s明显高于研究组的(21.62±8.56)mm/h、(38.43±3.43)%、(2.45±0.82)g/mL、(4.14±0.76)、(3.65±0.40)mPa·s,差异有统计学意义(t=3.79,5.54,3.43,6.92,3.14,均P0.05)。两组患者的血浆内皮素-1的水平经治疗后均显著下降,差异有统计学意义(t=5.24,7.62,均P0.05),治疗后两组患者的血浆内皮素-1的水平比较差异有统计学意义(t=2.10,P0.05)。结论盐酸法舒地尔治疗急性脑梗死具有较好的临床疗效,可以显著改善血液流变学状态,降低血浆内皮素-1水平,是治疗急性脑梗死的较佳选择。     

探讨生理盐水与高渗盐水联合N-乙酰半胱氨酸雾化吸入治疗支气管肺炎的疗效

目的探讨对支气管肺炎患者应用生理盐水与高渗盐水联合N-乙酰半胱氨酸雾化吸入治疗的效果。方法选取2018年1～8月期间,我院收治的患有支气管肺炎患者300例,采取随机数字表法分为对照组和观察组各150例。两组均给予吸入用N-乙酰半胱氨酸雾化治疗,对照组在此基础上联合生理盐水(0.9%的氯化钠注射液)治疗,观察组联合高渗盐水(3%的氯化钠注射液)治疗。观察对比两组患者的咳嗽、痰音消失时间、住院时间、总有效率及药物不良反应等情况。结果经过治疗后,观察组的总体有效率为96.67%显著高于对照组的80.67%,差异有统计学意义(P0.05);观察组患儿咳嗽消失时间(3.01±0.38)d、痰音消失时间(3.12±0.29)d和平均住院时间(6.33±0.29)d显著低于对照组患儿咳嗽消失时间(7.33±1.23)d、痰音消失时间(7.29±1.19)d和平均住院时间(8.56±0.39)d,差异有统计学意义(P0.05);两组不良反应发生率无显著差异(P0.05)。结论给予支气管肺炎患者应用高渗盐水联合N-乙酰半胱氨酸雾化吸入治疗效果显著,临床症状消失时间缩短,安全可靠,值得在临床上推广使用。     

法舒地尔联合依达拉奉治疗蛛网膜下腔出血后脑血管痉挛

目的：讨论分析法舒地尔联合依达拉奉治疗蛛网膜下腔出血后脑血管痉挛的效果。方法：选取我院2009年1月～2013年8月收治的蛛网膜下腔出血后脑血管痉挛患者65例,随机分为观察组和对照组,观察组给予法舒地尔联合依达拉奉治疗,对照组给予法舒地尔治疗。治疗2周后比较分析两组患者的临床症状及治疗效果。结果：治疗后两组患者症状均有缓解,观察组总有效率为96.97%,对照组总有效率为68.75%,两组差异明显（P〈0.05）,具有统计学意义;部分患者治疗过程中出现剧烈头痛、恶心呕吐、抽搐等并发症,其中观察组发生率为18.18%,对照组发生率为46.88%,两组比较差异明显（P〈0.05）,具有统计学意义。结论：法舒地尔联合依达拉奉治疗蛛网膜下腔出血后脑血管痉挛相较于传统的治疗方法疗效良好、副作用小、并发症少,值得临床广泛推广。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.