重型颅脑损伤患者气管切开早期不同吸痰方式对疗效的影响

目的探讨气管切开早期不同吸痰方式对重型颅脑损伤患者的临床疗效。方法以本院收治的38例重型颅脑损伤患者为研究对象,将其随机平均分为实验组和对照组各19例。分别给予优化吸痰法和常规吸痰法,观察分析2组血气变化及黏膜出血、肺部感染的发生率。结果实验组动脉血压分压、氧合指数较对照组高,动脉二氧化碳分压低于对照组,黏膜出血、肺部感染发生率较对照组低,差异均有统计学意义(P0.05)。结论优化吸痰方式能够降低重型颅脑损伤气管切开早期患者的黏膜出血、肺部感染发生率,值得在临床推广。     

纤维支气管镜在脑出血术后肺部感染患者中的治疗作用

目的 探讨纤维支气管镜在脑出血术后肺部感染患者中的治疗作用.方法 将脑出血术后并肺部感染已行气管切开患者56例随机分为观察组和对照组,对照组给予内科常规治疗,观察组在常规治疗的基础上,加行纤维支气管镜吸痰及灌洗.结果 观察组和对照组肺部感染治疗有效率分别为85.7%和53.6%,肺部感染控制时间分别为(9.2±2.1)d和(16.3±2.9)d,观察组治疗有效率显著高于对照组(P＜0.05),肺部感染控制时间明显短于对照组(P＜0.05).结论 纤维支气管镜在脑出血术后并肺部感染的治疗中安全有效,且无严重并发症,有较高的临床应用价值.     

优化吸痰法与传统吸痰法在脑外伤患者气管切开中的应用比较

目的 对比优化吸痰法与传统吸痰法在脑外伤患者气管切开中的应用价值.方法 选取我院于2010-04-2013-03收治80例接受气管切开的脑外伤患者,将所有患者随机分为实验组与对照组各40例.实验组接受负压插管的优化吸痰法,对照组接受传统吸痰法.比较2组患者在住院过程中的血气分析参数、肺部感染及气道黏膜出血的发生情况.结果 实验组第3天、第5天、第7天的PaO2与PaO2/FiO2明显高于对照组（P〈0.05）,且第7天的PaCO2明显低于对照组（P〈0.05）;实验组肺部感染发生率与气道黏膜出血率明显低于对照组（均P〈0.05）.结论 优化吸痰法在脑外伤患者气管切开中预防肺部感染及维持呼吸道正常通气的效果优于传统吸痰法,值得推广.     

不同吸痰方式对颅脑损伤患者肺功能及肺感染的影响

目的分析不同吸痰方式对于颅脑损伤患者肺功能及肺感染的影响。方法 2012-10-2013-03于我院住院治疗的重型颅脑损伤患者63例,随机分为联合吸痰组(32例)和常规吸痰组(31例),分析联合吸痰组和常规吸痰组心率、呼吸次数、日吸痰量、痰黏稠度、不同时间氧分压、二氧化碳分压、PaO2/FiO2、黏膜出血发生率及肺部感染发生率。结果联合吸痰组和常规吸痰组心率及呼吸次数差别无统计学意义(P0.05);联合吸痰组的日吸痰量为(85.71±4.13)mL,常规吸痰组的日吸痰量为(62.26±6.97)mL,联合吸痰组的日吸痰量显著高于常规吸痰组(P0.05);联合吸痰组的痰液黏稠度显著低于常规吸痰组(P0.05);联合吸痰组第1、3、7天的氧分压、PaO2/FiO2均显著高于常规吸痰组(P0.05),二氧化碳分压显著低于常规吸痰组(P0.05);联合吸痰组的黏膜出血发生率及肺部感染发生率显著低于常规吸痰组(P0.05)。结论支气管镜灌洗联合浅部吸痰能够改善颅脑损伤患者的通气、换气功能,减少气道黏膜损伤,控制肺部感染,护理工作离不开临床医师配合,支气管镜灌洗联合浅部吸痰用于颅脑损伤患者是新型护理与临床结合的模式。     

纤维支气管镜治疗脑梗死并肺部感染的临床观察

目的 探讨纤维支气管镜在脑梗死并肺部感染患者中的治疗作用.方法 将脑梗死并肺部感染患者56例随机分为观察组和对照组,对照组给予内科常规治疗,观察组在常规治疗的基础上,加行纤维支气管镜吸痰及灌洗.结果 观察组和对照组肺部感染治疗有效率分别为85.7%和53.6%,肺部感染控制时间分别为(9.3±2.6) d和(16.5±3.1) d,观察组治疗有效率显著高于对照组(P<0.05),肺部感染控制时间明显短于对照组(P<0.05).结论 纤维支气管镜在脑梗死并肺部感染的治疗中是安全有效的,且无严重并发症,有较高的临床应用价值.     

脑梗死并肺部感染行纤维支气管镜检查的临床观察

目的 观察脑梗死并肺部感染行纤维支气管镜检查的效果.方法 脑梗死并发肺部感染80例患者随机分为观察组和对照组.2组均给予常规治疗,观察组加用纤维支气管镜进行吸痰和灌洗治疗.对比分析2组临床治疗效果、体温恢复正常时间和感染控制时间.结果 观察组总有效率95.0％,优于对照组的75.0％(x2=6.64,P=0.039);观察组患者的感染控制时间和体温恢复时间均较对照组短(P＜0.05).结论 脑梗死并发肺部感染患者使用纤维支气管镜进行吸痰和灌洗治疗,有助于迅速控制肺部感染.     

盐酸氨溴索结合高流量加温湿化氧疗在重型颅脑损伤气管切开病人中的应用

目的 探讨盐酸氨溴索结合高流量加温湿化氧疗在重型颅脑损伤气管切开病人气道湿化中的应用效果。方法 2011年11月至2013年1月收治重型颅脑损伤并气管切开的患者86例,按入院顺序分为对照组（43例,0.45%氯化钠溶液气管内持续滴液湿化组）和观察组（43例,盐酸氨溴索结合高流量加温湿化氧疗）。结果 与对照组相比,观察组病房环境温度无明显变化（P>0.05）,但是气管切开处温度、相对湿度和绝对湿度均明显增高（P<0.05）;观察组Ⅲ度粘痰和形成痰痂发生率明显低于对照组（P<0.05）,但是Ⅰ度粘痰比例明显增高（P<0.05）;观察组动脉氧分压和氧饱和度明显增高（P<0.05）,而二氧化碳分压无明显变化（P>0.05）;观察组发生刺激性咳痰、气道粘膜出血、肺部感染和纤维支气管镜吸痰发生率明显降低（P<0.05）。结论 采用盐酸氨溴索高流量加温湿化氧疗系统用于重型颅脑损伤气管切开病人气道湿化,效果满意,是一种理想的气道湿化方法。     

早期气管切开对严重颅脑损伤病人合并肺部感染的疗效分析

目的探讨严重颅脑损伤病人合并肺部感染的原因,分析早期气管切开的治疗效果。方法回顾性分析116例严重颅脑损伤(GCS评分≤8分)合并肺部感染病人的临床资料,平均分为两组,观察组早期(伤后1~2 d)采用气管切开,对照组采用常规方法治疗,分析对比两组的疗效。结果与对照组比较,治疗后观察组的美国国立卫生研究院卒中量表(NIHSS)评分明显降低,总有效率明显提高,差异有统计学意义(P0.001)。观察组病人在抗生素使用时间和住院时间短于对照组(P0.05),并发症发生率低于对照组,差异有统计学意义(P0.05)。结论早期气管切开能有效降低严重颅脑损伤病人合并肺部感染的并发症发生率,提高治疗效果。     

纤维支气管镜在重型颅脑损伤患者救治中的应用

目的 探讨纤维支气管镜在治疗重型颅脑损伤并肺部感染患者中的意义. 方法 对26例重型颅脑损伤并肺部感染患者行43次纤维支气管镜吸痰、支气管肺泡灌洗治疗.观察治疗前后患者呼吸系统症状、血氧饱和度(SaO2)、氧分压(PaO2)、二氧化碳分压(PaCO2)的变化情况,判断纤维支气管镜在重型颅脑损伤患者治疗中的作用. 结果 所有患者24h内体温下降,呼吸困难等症状减轻或消失;X线胸片示肺部浸润阴影缩小或不张的肺叶复张/或部分复张;血气分析结果 示血PaO2、SaO2较治疗前明显提高,差异有统计学意义(P<0.05). 结论 纤维支气管镜在重型颅脑损伤并肺部感染患者救治中应用安全、有效,值得在临床推广应用.     

纤支镜肺灌洗术治疗重度颅脑损伤合并肺部感染的临床疗效

目的观察纤维支气管镜肺灌洗术治疗重型颅脑损伤(sTBI)合并肺部感染的临床疗效。方法选取80例sTBI合并肺部感染患者为研究对象,将其随机分为观察组和对照组各40例。对照组给予常规治疗方案,观察组在常规治疗方案的基础上加用纤维支气管镜肺灌洗术治疗。对2组患者的治疗效果、治疗前后的动脉血气指标及治疗期间的不良反应情况进行观察和分析。结果观察组患者的疗效优于对照组且临床有效率高于对照组(U=4.825,χ~2=11.250,P0.05),观察组治疗后的各项动脉血气指标均优于对照组(t=2.754~5.477,P0.05),2组患者各项不良反应的发生率及总发生率与对照组比较差异均无统计学意义(χ~2=3.117、2.051、1.013,P0.05)。结论应用纤维支气管镜肺灌洗术治疗sTBI合并肺部感染,可提高治疗效果,改善患者的动脉血气指标,有利于降低患者的病死率并改善预后,不良反应较轻,安全性较高。     

Intraoperative Neurophysiological Monitoring

ABSTRACT

Objective: To investigate the efficacy and safety of portable fibrobronchoscopy on the non-severe ischemic stroke-associated pneumonia (SAP) patients with dysphagia.

Methods: A total of 86 non-severe ischemic SAP patients with dysphagia were randomly and equally divided into the treatment group and control group. The control group was given routine sputum suction, anti-infection drugs, and sputum-reducing drugs. The treatment group was treated with fiber-optic bronchoscopic sputum suction and alveolar lavage, and drug treatment same as the control group. The blood gases, inflammatory factors, clinical pulmonary infection score (CPIS), adverse reactions, and modified Rankin Scale (mRS) were compared.

Results: The blood gases, serum inflammatory factors including procalcitonin (PCT), C-reactive protein (CRP), and tumor necrosis factor-α (TNF-α), and CPIS in the treatment group were superior to those in control group (P < 0.05). No significant difference was found in the incidence of adverse reactions between the two groups (P > 0.05). The mRS scores of the treatment group were significantly lower than those of control group 3 months after discharge.

Conclusion: Sputum suction and alveolar lavage with portable fibrobronchoscope can significantly improve the hypoxia and pulmonary infections, reduce the inflammatory response, and thus improve the prognosis, rendering suction and alveolar lavage with portable fibrobronchoscope as a safe and effective treatment for non-severe ischemic SAP patients with dysphagia.     

选择钢板在桡骨远端不稳定性骨折治疗中的作用

摘要 目的：探讨不同类型钢板在治疗桡骨远端不稳定性骨折中的疗效及临床价值。 方法：以“锁定加压钢板,T型钢板,桡骨远端,骨折,内固定”为中文关键词;以“Locked compression plate, T plate, Distal radius, fracture, internal fixation” 为英文关键词,应用计算机检索(2006-02/2010-03)相关文章。纳入与有关桡骨远端不稳定型骨折内固定治疗的文章;排除重复研究或Meta分析类文章。共纳入28篇文献。 结果：桡骨远端不稳定性骨折内固定治疗以T型接骨板、掌侧锁定加压钢板、多轴锁定钢板及π钢板为主,而锁定钢板因能提供较好的生物稳定性,目前临床广泛应用。 结论：钢板治疗桡骨远端不稳定性骨折临床疗效满意,对比普通T型接骨板,锁定钢板能提供更好的骨折块稳定性,保护血运,且并发症少,可作为治疗此种骨折的首选方法之一。 关键词：锁定加压钢板;T型钢板;桡骨远端;骨折;内固定     

实践导向教学法在脑血管病教学中的应用

实践导向教学法是目前脑血管病教学中常用的教学方法,主要包括案例教学法、模拟教 学法、思维冲击法等。与传统教学方法相比,实践导向教学法在提高学生的教学参与度和优化临床思 维方面更有优势,但也对教师的教学能力和学生的主动学习能力有更高的要求。在临床教学中,应通 过提高教师的教学水平、增加教学全面评价体系等方法来改善实践导向教学法的教学效果。     

Detection of functional connectivity using temporal correlations in MR images

Functional connectivity among brain regions has been investigated via an analysis of correlations between regional signal fluctuations recorded in magnetic resonance (MR) images obtained in a steady state. In comparison with studies of functional connectivity that utilize task manipulations, the analysis of correlations in steady state data is less susceptible to confounds arising when functionally unrelated brain regions respond in similar ways to changes in task. A new approach to identifying interregional correlations in steady state data makes use of two independent data sets. Regions of interest (ROIs) are defined and hypotheses regarding their connectivity are generated in one data set. The connectivity hypotheses are then evaluated in the remaining (independent) data set by analyzing low frequency temporal correlations between regions. The roles of the two data sets are then reversed and the process repeated, perhaps multiple times. This method was illustrated by application to the language system. The existence of a functional connection between Broca's area and Wernicke's area was confirmed in healthy subjects at rest. An increase in this functional connection when the language system was actively engaged (when subjects were continuously listening to narrative text) was also confirmed. In a second iteration of analyses, a correlation between Broca's area and a region in left premotor cortex was found to be significant at rest and to increase during continuous listening. These findings suggest that the proposed methodology can reveal the presence and strength of functional connections in high-level cognitive systems.     

A new microelectrophoretic procedure for delivery of horseradish peroxidase

A new procedure for microelectrophoretic delivery of horseradish peroxidase (HRP) is described. A dilute solution (1.5–3% w/v) of fluorescein isothiocyanate-conjugated HRP is deposited according to a standard microelectrophoretic method and the tissue reacted according to a sensitive histochemical procedure. A major advantage of this method is the reduced secondary diffusion of the enzyme present at the injection site.     

The development of the Purkinje cell in the cerebellar cortex of the opossum

Premotor neurons sending their axons to the trigeminal motor nucleus were observed in the cat by light and electron microscopy after labeling the neurons retrogradely or anterogradely with horseradish peroxidase (HRP). After HRP injection into the trigeminal motor nucleus, retrogradely labeled neurons were seen most frequently in the parvocellular reticular formation bilaterally. Many labeled neurons were also seen contralaterally in the intermediate zone at the rostralmost levels of the cervical cord and its rostral extension into the caudalmost levels of the medulla oblongata. Additionally, some neurons were labeled ipsilaterally in the mesencephalic tri-geminal nucleus, contralaterally in the main sensory trigeminal nucleus and the trigeminal motor nucleus, and bilaterally in the oral and interpolar sub-nuclei of the spinal trigeminal nucleus. Only a few labeled neurons were seen in the confines of the gigantocellular reticular formation. All labeled neurons were small or of medium size; no large neurons were labeled. After HRP injection into the regions around the trigeminal motor nucleus or the parvocellular reticular formation, axodendritic terminals containing HRP granules were found contralaterally within the trigeminal motor nucleus. Some of these labeled terminals were filled with round synap-tic vesicles and others contained pleomorphic synaptic vesicles. The varied morphology of labeled axon terminals was considered to reflect the functional heterogeneity of the premotor neurons for the trigeminal motor nucleus.     

大鼠局灶性缺血再灌注后大脑皮质ADM及其mRNA的表达

目的探讨肾上腺髓质素（ADM）与脑缺血再灌注损伤的关系。方法采用线栓法制成大鼠大脑中动脉缺血再灌注模型，阻断血流2h进行再灌注。应用免疫组织化学法和RT—PCR法检测不同时间段大鼠局灶性脑缺血再灌注后大脑皮质ADM及其mRNA的表达，并进行动态观察。结果正常大鼠大脑皮质有ADM及其mR—NA的表达，假手术组ADM及其mRNA表达略高于正常组，P〉0．05；大鼠脑缺血再灌注后大脑皮质ADM及其mRNA过表达，与正常对照组及假手术组相比差异显著，P〈0．05。动态观察发现，脑缺血2h再灌注2h，大脑皮质ADM及其mRNA即表达，再灌注22h达高峰，至1w仍明显多于正常对照组，P〈0．05。结论脑缺血再灌注后ADM及其mRNA呈现规律性过表达。     

MUAP values of two facial muscles in normal subjects and comparison of two methods for data analysis

Introduction: This study aimed to obtain normal MUAP values in 2 facial muscles and to compare the results of different analysis methods. Methods: The frontalis muscle of 36 and the mentalis muscle of 28 normal subjects were examined, and mean and outlier values of all MUAP parameters were calculated with the automatic method. Next, manual editing of the recorded raw data provided new sets of values for comparison. Results: The frontalis muscle MUAPs have significantly shorter duration, smaller amplitude and a lower number of turns and phases compared with those of mentalis. Higher MUAP duration values in the frontalis were the only significant difference after the comparison of the different analysis methods. Conclusions: The set of normal values for frontalis and mentalis in this study could be useful in routine practice. Careful manual editing of the frontalis MUAPs is recommended for more accurate determination of their duration. Muscle Nerve 46: 346-350, 2012.     

Cerebellar volume decreases in the tottering mouse are specific to the molecular layer

The volume of the cerebellum as a whole and the volume of the molecular layer per Purkinje cell in adult tottering () and tottering/leaner () mice were reduced when compared with normal age-matched wild type mice (+/+). No changes in the volume of the granule cell layer or white matter layer were detected, suggesting that the mutation effects were limited to the molecular layer of the cerebellum. The density of Purkinje cells and the total number of Purkinje cells did not vary between groups. The cerebellar and body weights were decreased in and mice compared with +/+ mice.