重型颅脑损伤昏迷患者吸入性肺炎58例防治策略

<正>重型颅脑损伤昏迷患者常因呕吐及食物反流出现误吸,造成吸入性肺炎、肺不张,严重者导致呼吸衰竭或窒息,是影响重型颅脑损伤患者预后的重要因素之一。通过多年实践,采取多种措施积极防治重型颅脑损伤昏迷患者吸入性肺炎,取得了良好效果,现对2007年1月—2010年12月重型颅脑损伤昏迷合     

颅脑损伤合并颌面骨骨折临床治疗分析

随着交通业和建筑业的发展,颅脑损伤的患者逐年增多.在颅脑损伤中约有30%患者合并有颌面伤,重型颅脑损伤合并颌面伤尤属多见.如治疗不当,常可造成颌面部畸形和功能障碍而降低患者生活质量.现对我院2005年5月～2009年5月收治颅脑损伤合并颌面部骨折34例患者,进行回顾性分析和总结,就其发病情况、损伤特点及救治原则进行分析讨论,旨在提高对该合并症的认识.     

重型颅脑损伤患者气管切开的护理

<正>重型颅脑损伤患者往往有不同程度的呼吸功能障碍,是造成患者死亡的原因之一,因此保护呼吸道通畅、及时气管切开是抢救成功的关键。2007~2009年我科共收治重型颅脑损伤患者67例,其中气管切开的患者23例,现将其护理体会报道如下。     

交通事故所致颅脑损伤患者智力和记忆损害的相关分析

目的探讨交通事故所致颅脑损伤患者的智能和记忆损害及相关因素.方法对1999年1月1日至1999年12月31日间成都市公安交通管理局事故处理大队提供的成都市因交通事故造成颅脑损伤的444例存活者的心理测验、脑电图及脑影象学资料进行统计分析. 结果研究组平均智商为75.23±15.87,32.8%的患者智商低于70;56.1%的记忆商低于51.智力损害与文化程度、脑干损伤、左颞叶损伤、硬膜下的血肿/出血、≥3个脑叶损伤以及脑电图异常明显相关;记忆损害与文化程度、损伤和鉴定检查的间隔时间、脑干损伤、左颞叶损伤、硬膜下血肿/出血明显相关.结论交通事故造成颅脑损伤的患者多有不同程度的智力和记忆损害,且与左颞叶损伤、硬膜下的血肿/出血、脑干损伤、文化程度等因素有关.     

重型颅脑损伤患者精神障碍的研究分析

颅脑损伤后的精神障碍是造成精神残疾的常见原因 ,尤其是重型颅脑损伤。然而 ,精神科医生较少有颅脑损伤患者精神障碍的第一手资料 ,为此 ,我们就江苏省扬州市 1998年 9月2 4日至 2 0 0 0年 12月 2 6日内因交通事故引发的重型颅脑损伤后精神障碍的临床资料进行分析 ,试图为精神科临床医生提供有益的参考资料。对象和方法一、对象均为江苏省扬州市公安局交通警察大队及法医门诊提供的自 1998年 9月 2 4日至 2 0 0 0年 12月 2 6日因交通事故造成重型颅脑损伤的幸存者 161例。在 161例中 ,男 95例 ,女 66例 ;年龄 5～ 80岁平均 (3 6.7± 8)岁 ;…     

颅脑损伤患者的护理

事故外伤造成患者颅脑损伤在神经外科是较为常见的,尤其是重型颅脑损伤患者病情严重、损伤发生突然,护理有一定的难度.近年来,我院神经外科针对颅脑损伤患者的病情和心理特点采取相应的护理措施,收到了良好的护理效果,现总结如下.     

交通事故所致颅脑损伤患者智力和记忆损害的相关分析

目的探讨交通事故所致颅脑损伤患者的智能和记忆损害及相关因素.方法对1999年1月1日至1999年12月31日间成都市公安交通管理局事故处理大队提供的成都市因交通事故造成颅脑损伤的444例存活者的心理测验、脑电图及脑影象学资料进行统计分析. 结果研究组平均智商为75.23±15.87,32.8%的患者智商低于70;56.1%的记忆商低于51.智力损害与文化程度、脑干损伤、左颞叶损伤、硬膜下的血肿/出血、≥3个脑叶损伤以及脑电图异常明显相关;记忆损害与文化程度、损伤和鉴定检查的间隔时间、脑干损伤、左颞叶损伤、硬膜下血肿/出血明显相关.结论交通事故造成颅脑损伤的患者多有不同程度的智力和记忆损害,且与左颞叶损伤、硬膜下的血肿/出血、脑干损伤、文化程度等因素有关.     

重型颅脑损伤患者精神障碍的研究分析

颅脑损伤后的精神障碍是造成精神残疾的常见原因,尤其是重型颅脑损伤.然而,精神科医生较少有颅脑损伤患者精神障碍的第一手资料,为此,我们就江苏省扬州市1998年9月24日至2000年12月26日内因交通事故引发的重型颅脑损伤后精神障碍的临床资料进行分析,试图为精神科临床医生提供有益的参考资料.     

脑干反射对重型颅脑损伤长期意识障碍的清醒预测及预后评估

目的：探讨脑干发射(BSR)对重型颅脑损伤长期意识障碍患者的清醒及预后评估中的作用。方法选择2013年8月至2015年8月期间120例重型颅脑损伤患者为研究对象。统计BSR分级、GCS分级与重型颅脑损伤患者清醒率的关系及相关性、重型颅脑损伤患者BSR分级与GOS评分的关系、BSR分级与预后的关系及相关性。结果 BSR不同分级间患者清醒率差异有统计学意义(P<0.01);GCS分级中无Ⅰ级患者,GCS不同分级间患者清醒率差异有统计学意义(P<0.01);BSR分级与重型颅脑损伤清醒率呈明显负相关(r=-0.672,P=0.005),GCS分级与重型颅脑损伤清醒率无明显相关性(r=-0.135,P=0.298);BSR分级预测重型颅脑损伤清醒的敏感性和特异性分别为80.6%和87.5%,准确率达83.3%。由于GCS分级无Ⅰ级,其与重型颅脑损伤患者清醒情况无相关性,因此无法用于重型颅脑损伤患者清醒的预测;重型颅脑损伤患者BSR分级与GOS评分之间差异有统计学意义(P<0.01);重型颅脑损伤患者BSR不同分级之间患者预后差异有统计学意义(P<0.01);重型颅脑损伤患者BSR分级Ⅰ~Ⅱ级患者预后明显好于BSR分级Ⅲ~Ⅳ级;BSR分级与重型颅脑损伤预后呈明显负相关(r=-0.636,P=0.000)。结论 BSR分级可用于重型颅脑损伤长期意识障碍患者清醒状况和预后的预测;BSR分级与重型颅脑损伤患者清醒及预后关系密切,BSR分级越高,重型颅脑损伤患者清醒的概率越低,预后越差。     

探讨影响重型颅脑损伤患者预后的常见严重并发症及其监护措施

目的分析对重型颅脑损伤患者预后产生影响发生率较高的严重并发症,据结果制定相关监护措施。方法此次研究对象资料主要来自2017年至2018年本院收治的重型颅脑损伤患者30例,对纳入研究范围内患者的相关基线资料进行回顾性分析,归纳收集常见影响预后的严重并发症,分析相关监护措施。结果对重型颅脑损伤患者预后造成影响的常见并发症主要有颅内高压、肺部感染、低氧血症和消化道出血等。结论重型颅脑损伤作为临床危急重症,其预后质量受到多种因素影响,其中并发症影响程度相对较大,又以颅内高压、肺部感染、低氧血症和消化道出血等会对原发病治疗造成严重消极影响,对此类患者应密切关注并采取有效措施干预,改善相关临床症状。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.