神经电生理定量评价大鼠脊髓损伤

[目的]评价神经电生理监测在大鼠脊髓损伤(SCI)中的意义。[方法] 50只雌性健康SD大鼠随机分成5组,每组10只。分别为假手术组,Allen's打击制备SCI 40 g·cm组、60 g·cm组、80 g·cm组和100 g·cm组。监测体感诱发电位(SEP)和经颅电刺激运动诱发电位(MEP);同时进行大鼠运动功能评分(BBB)。[结果]随损伤程度的增加,SEP和MEP潜伏期显著延长、波幅减小。损伤后各时间点,不同组别间潜伏期和波幅的差异均有统计学意义(P0.05);100 g·cm损伤后SEP和MEP波消失。随着打击程度的加重,BBB评分明显下降(P0.05)。损伤程度分组与评价指标均有显著相关性(P0.05),Spearman秩相关的R值依次为MEP潜伏期、MEP波幅、BBB评分、SEP潜伏期、SEP波幅。[结论]通过神经电生理监测指标,特别是MEP,可以准确客观地判断SCI的严重程度。     

体感诱发电位检查在先天性脊柱侧凸神经功能评估中的价值

目的 探讨体感诱发电位(SEP)检查在伴脊髓发育畸形的先天性脊柱侧凸(CS)中的诊断价值.方法 回顾性分析2001年9月到2007年9月诊治的187例CS患者临床资料,其中男性85例,女性102例;年龄3～22岁,平均13.8岁.所有患者均行全脊髓磁共振检查判断是否存在脊髓发育畸形.分析术前SEP的峰潜伏期及左、右侧峰潜伏期差值.SEP波形消失、峰潜伏期延长及峰潜伏期不对称定义为SEP异常.比较有无脊髓发育畸形患者的临床特征及SEP异常发生率的差异.结果 共有32例患者伴脊髓发育畸形.CSⅢ型(混合型)伴脊髓发育畸形比例(30.8%)高于Ⅰ型和Ⅱ型(P＜0.05).伴脊髓发育畸形组平均侧凸Cobb角大于无脊髓发育畸形组(P＜0.05),而两组平均后凸Cobb角差异无统计学意义(P＞0.05).伴脊髓发育畸形组SEP异常率与无脊髓发育畸形相比,差异有统计学意义(x2=4.70,P＜0.05).结论 SEP检查可以评估CS患者的神经功能状态,对CS伴脊髓发育畸形具有辅助诊断价值.     

常压及控制性降压下脊髓急性牵拉损伤比较研究

目的 评价控制性降压是否增加脊髓对牵拉损伤的易感性。材料与方法健康成年杂种犬6只，随机分为常压和控制性降压脊髓牵拉损伤组。观察常压及控制性降压水平下相同程度牵拉损伤后脊髓血流(SCBF)、体感诱发电位(SEP)、神经源性运动诱发电位(NMEP)改变的差异。结果 外周血有创动脉压(MABP)平均下降幅度为40．5％。经SSPS统计软件独立样本t检验，不同牵拉水平下，常压组及低压组的SCBF(％)、SEP波幅(Asep)(％)及NMEP波幅(％)无显著差异。结论 尼卡地平控制性降压不增加脊髓对牵拉损伤的易感性。     

腹腔镜胆总管切开取石术对患者术后胃肠道功能恢复、应激反应及血流动力学的影响

目的探讨腹腔镜胆总管切开取石术对患者术后胃肠道功能恢复、应激反应及血流动力学的影响。方法回顾性分析笔者所在医院于2016年1月至2016年12月期间收治的78例胆总管结石患者的临床资料,按照术式分为开腹组(行开腹胆总管切开取石术)与腹腔镜组(行腹腔镜胆总管切开取石术),各39例,比较2组患者的手术疗效、手术前后的应激反应指标和血流动力学指标。结果腹腔镜组患者的术中出血量、术后镇痛次数、胃肠道功能恢复时间及术后住院时间均少于(短于)开腹组(P0.01);腹腔镜组手术前后的血清皮质醇水平、血清游离三碘甲状腺原氨酸(FT3)水平及平均动脉压(MAP)的差值均较开腹组低(P0.05),而手术前后心率(HR)的差值较开腹组高(P0.05)。结论相比开腹胆总管切开取石术,腹腔镜胆总管切开取石术更利于改善患者的血清皮质醇及FT3水平,减轻应激反应,改善血流动力学情况,促进术后胃肠道功能的恢复,值得临床推广。     

改良大鼠渐进性脑死亡模型的制作

目的 总结制作大鼠渐进性脑死亡模型的技巧并改良此模型的制作方法.方法 对经典Pratschke术式的麻醉、插管、颅内加压、脑死亡判断等环节进行探讨,建立Wistar大鼠的渐进性脑死亡模型.结果 所有动物在诱导脑死亡过程中均出现较一致的血压变化规律:诱导后期平均动脉压开始急剧升高,于颅内加压后(11±2)min时达到峰值(190±15)mm Hg,其后血压急剧下降,(20±3)min时达到谷值(70±16)mm Hg,与诱导前平均动脉压(110±18)mm Hg比较,其峰值和谷值差异均具有统计学意义(P＜0.05).共诱导40例大鼠脑死亡,37例能成功维持正常血压达6 h,手术成功率92.5%(37/40).结论 与经典Pratschke术式比较,该术式降低难度,提高手术成功率,是一种较稳定、可靠的大鼠脑死亡模型.     

体感诱发电位在建立双节段脊髓压迫模型中的作用

目的通过研究兔胸椎管形态结合体感诱发电位(SEP)建立一种胸椎双节段脊髓慢性压迫模型。方法首先对兔新鲜胸椎标本作详细的解剖学研究,选定2F Fogarty球囊导管作为压迫模型所用的球囊。成年新西兰大白兔30只,随机分为对照组(球囊不扩张)、40μl压迫组、50μl压迫组。通过T_6、T_7椎板的小孔,将导管置入硬膜外腔,再分别向头尾端插入到T_3、T_(10)水平。通过皮层SEP、Tarlov's评分、X线片及CT检查、脊髓HE染色评价该模型的可靠性。结果 40μl压迫组T_3脊髓压迫率为(42.81±5.54)%,T10脊髓压迫率为(44.74±5.85)%。50μl压迫组T3脊髓压迫率为(62.52±1.91)%,T_(10)脊髓压迫率为(63.77±2.06)%。球囊扩张后7 d 40μl压迫组SEP开始逐渐恢复,至术后28 d趋于稳定,与压迫后即刻比较SEP的潜伏期明显缩短,波幅增高,差异有统计学意义(P0.05);50μl压迫组术后SEP改变差异无统计学意义(P0.05)。40μl压迫组、50μl压迫组的SEP波幅较对照组明显降低,潜伏期明显延长,差异有统计学意义(P0.05);但40μl压迫组与50μl压迫组间差异无统计学意义(P0.05)。结论 SEP对早期脊髓损伤诊断具有敏感性和特异性,并且能反应脊髓损伤程度。脊髓压迫率为62%~64%的压迫模型的SEP更稳定,模型更可靠。     

不同剂量罗库溴铵对椎管减压植骨融合内固定术术中神经电生理监测的影响

目的 探讨不同剂量罗库溴铵对脊柱外科行椎管减压植骨融合内固定术的患者术中神经电生理监测的影响。
方法 择期行椎管减压植骨融合内固定手术的患者63例,男36例,女27例,年龄18～65岁,ASA Ⅰ或Ⅱ级,采用随机数字表分为三组,每组21例：A组、B组、C组肌松维持时罗库溴铵泵注剂量分别为6、9、12 μg·kg^-1·min^-1。记录获得基础电位时（T1）、椎弓根螺钉置入前1 min（T2）、椎管减压前1 min（T3）的体感诱发电位（SEP）及运动诱发电位（MEP）的波幅,以及术中意外体动、自主呼吸恢复及舌咬伤等情况。
结果 A组、B组和C组SEP波幅差值差异无统计学意义。与A组比较,B组右上肢T2时MEP波幅与T1时MEP波幅差值明显减小（P<0.05）,右上肢及右下肢T3时MEP波幅与T1时MEP波幅差值明显减小（P<0.05）;C组双上肢T2时MEP波幅与T1时MEP波幅差值明显减小（P<0.05）,双上肢及右下肢T3时MEP波幅与T1时MEP波幅差值明显减小（P<0.05）。与B组比较,C组左上肢T3时MEP波幅与T1时MEP波幅差值明显减小（P<0.05）。A组有5例（24%）在术中出现意外体动,B组、C组无一例意外体动（P<0.05）。A组有1例（5%）出现舌咬伤,B组、C组无一例舌咬伤。三组均未出现自主呼吸恢复的情况。
结论 椎管减压植骨融合内固定术中罗库溴铵最佳维持剂量为9 μg·kg^-1·min^-1。     

超声骨刀与高速磨钻在颈后路单开门椎管扩大成形术中的应用对比

目的对比分析超声骨刀与高速磨钻应用于颈后路单开门椎管扩大成形术的有效性与安全性。方法回顾性分析2014年10月至2015年12月在南方医科大学南方医院行颈后路单开门椎管扩大成形术的32例颈椎椎管狭窄症患者的临床资料,其中超声骨刀组11例、高速磨钻组21例。对比分析两组手术节段、手术时间、术中出血量、术后引流量、日本骨科学会(JOA)评分、JOA改善率、围术期并发症发生率等指标。结果超声骨刀组和高速磨钻组手术时间、术中出血量分别为(150±22)min和(169±35)min、(191±116)m L和(216±123)m L,两组比较,差异无统计学意义(P0.05);超声骨刀组术后引流量为(164±84)m L,低于高速磨钻组的(236±93)m L(P0.05)。两组患者术后神经功能明显改善,JOA评分均优于术前(P0.05),但两组术后JOA评分、改善率及改善优良率比较,差异均无统计学意义(P0.05)。超声骨刀组术中出现1例硬膜撕裂,两组均未出现脑脊液漏及伤口感染病例。结论颈后路单开门椎管扩大成形术中应用超声骨刀具有术后引流少和相对高效的优点,其安全性和有效性与高速磨钻相似。     

伴神经损害脊柱侧后凸畸形患者脊髓内移后路矫形术后神经电生理变化

目的:观察伴神经功能损害脊柱侧后凸畸形患者脊髓内移后路矫形术后神经电生理变化和功能转归。方法:2005年1月~2014年1月在我院接受脊髓内移、脊柱后路矫形内固定术治疗伴神经损害的脊柱侧后凸畸形患者14例,女6例,男8例;年龄22.0±14.5岁(6~53岁)。术前均表现为双下肢麻木,其中7例伴行走不稳;双下肢病理征均为阳性。神经功能Frankel分级:C级5例,D级9例。胸弯11例,胸腰弯3例,后凸顶椎均位于侧凸顶椎区内。术前冠状面主弯Cobb角为76.9°±33.2°(65°~100°),后凸Cobb角为71.5°±31.8°(41°~125°)。采用加拿大XLTEK肌电诱发电位仪分别于术前和术后1周检测14例患者的体感诱发电位(SEP),术中行SEP和运动诱发电位(MEP)监测。在MRI上测量顶椎区凸侧脊髓外缘至椎管内缘距离,计算脊髓内移距离。结果:术前胫后神经SEP P40的波幅与峰潜伏期为1.67±0.38μV和38.96±2.51ms,术中为1.69±0.36μV和38.15±2.14ms,术中与术前比较波幅与峰潜伏期均无显著性变化(P0.05)。术后冠状面主弯Cobb角矫正率为(50.3±20.6)%(14.5%~85%),后凸Cobb角矫正率为(39.0±17.7)%(20.8%~57.9%);顶椎区脊髓位置平均内移2.3±1.6mm(0.6~4.4mm)。术后1周时胫后神经SEP P40波幅与潜伏期为2.10±0.35μV和35.54±2.12ms,与术前比较明显改善(P0.05)。神经功能均有明显改善。结论:脊髓内移后路矫形内固定治疗伴神经损害的脊柱侧后凸畸形术后患者神经电生理指标和神经功能均明显改善。     

自制水囊宫腔填塞对前置胎盘剖宫产产后出血患者的临床效果

目的探讨自制水囊宫腔填塞对前置胎盘剖宫产产后出血患者应激反应及血流动力学的影响。方法回顾分析2017年1月至2019年12月在本院因前置胎盘行剖宫产术患者60例,分为两组各30例。对照组采用纱布填塞治疗,观察组则行自制水囊宫腔填塞,对比两组患者手术指标、应激指标、血流动力学指标、术后不良反应和并发症情况。结果对照组患者术后出血量、手术时间均高于观察组(P0.05),术前两组患者丙二醛(MDA)、超氧化物歧化酶(SOD)比较(P0.05),术后两组患者SOD均升高,且观察组水平高于对照组(P0.05);术后两组患者MDA均降低,且观察组水平低于对照组(P0.05);术前两组患者平均动脉压(MAP)、心率(HR)比较(P0.05),术后两组的MAP、HR均上升(P0.05),但观察组MAP、HR低于对照组(P0.05)。结论采用自制水囊宫腔填塞治疗前置胎盘剖宫产产后出血患者可减少患者术后出血量,缩短手术时间、减轻应激反应,对血流动力学影响较小,操作简便高效,值得临床应用。     

Prophylactic infusion of phenylephrine is effective in attenuating the decrease in regional cerebral blood volume and oxygenation during spinal anesthesia for cesarean section

BackgroundHypotension induced by spinal anesthesia for cesarean section causes a decrease in maternal regional cerebral blood volume and oxygenation. We used near-infrared spectroscopy to determine whether prophylactic infusion of phenylephrine attenuates these decreases.MethodsSixty patients undergoing bupivacaine spinal anesthesia for cesarean section were randomly divided into one of three intravenous infusion groups: saline (P0), phenylephrine 25 (P25) or 50 µg/min (P50). Mean arterial pressure, heart rate and near-infrared spectroscopy measurements were made at one-minute intervals for 20 minutes, and oxyhemoglobin, deoxy-hemoglobin and total-hemoglobin concentrations and tissue oxygenation index were determined. Mean changes in the values between baseline and each measurement time after intrathecal injection were compared.ResultsSignificant decreases in mean arterial pressure were seen in group P0 compared to P25 and P50 (P <0.01). Heart rate decreased in a dose-dependent manner during phenylephrine infusion (P0 vs. P25 and P50, P25 vs. P50; P <0.05). Significantly higher total-hemoglobin levels were observed in the phenylephrine groups versus the P0 group (P <0.01). The largest decrease in tissue oxygenation index was found in the P50, followed by P0 and P25 groups (P0 vs. P25 and P50, P25 vs. P50; P <0.05).ConclusionProphylactic infusion of phenylephrine, especially at 25 µg/min, can effectively suppress decreases in regional cerebral blood volume and regional cerebral blood oxygenation after induction of spinal anesthesia for cesarean section.     

The adverse hemodynamic effects of laparoscopic cholecystectomy

Recent studies suggest that significant physiologic derangements can occur during laparoscopic surgery. Eighteen patients admitted for laparoscopic cholecystectomy were studied. The mean age was 46.7 (range 19–78). A standard anesthetic technique, reverse Trendelenburg positioning, and an abdominal insufflation pressure of 15 mmHg with CO₂ were used with all subjects. Central venous pressure (CVP) and arterial pressures were measured invasively. Stroke volume and cardiac index were calculated using quantitative transesophageal echocardiography. Baseline measurements were taken after induction. Additional measurements were taken at 15-min intervals throughout the procedure. There was a statistically significant increase in mean arterial pressure (15.9%), systolic blood pressure (11.3%), diastolic blood pressure (19.7%), and CVP (30.0%) from control baseline values. Significant decreases in stroke volume (29.5%) and cardiac index (29.5%) occurred within 30 min of the induction of pneumoperitoneum and positioning (P<0.05, ANOVA). Laparoscopic cholecystectomy significantly and reversibly decreases cardiac performance. Compromised patients may be at increased risk for complications not previously recognized with this procedure.     

Effects of hypothermia and sternal retractors on median nerve somatosensory evoked potentials

Background: Somatosensory evoked potentials (SEPs) are altered by hypothermia, which is often used during cardiopulmonary bypass (CPB). However, the effect of hypothermia on SEP amplitudes is unclear. Also, the sternal retractors used during open heart surgery are reported to cause brachial plexus distension and SEP changes. Methods: Median nerve SEPs under hypothermic CPB were studied in 29 elective patients scheduled for open heart surgery. In 23 patients who underwent left internal mammary artery (IMA) dissection, the effects of sternal retractors on cortical SEP before the initiation of CPB were investigated. Results: A latency shift of all SEP components was detected when nasopharyngeal temperature decreased from 35.7(SD 0.4)°C to 27.8(SD 0.25)°C. The mean cortical N₂₀ latency was increased by 39% (P< 0.0001), cervical N₁₃ by 33% (P < 0.0001), and peripheral N₉ by 27% (P <0.0001). The latency changes were reversible when normothermia was restored. The effect of hypothermia on SEP amplitudes was more complex. The mean amplitude of N₂₀ decreased from 2.7 μV to 2.2 μV (P < 0.05) and the amplitude of N₁₃ from 2.5 μV to 2.0 μV (P < 0.0001). In contrast, the N₉ component showed an increase from 1.4 μV to 2.1 μV (P <0.0001) during hypothermia. The sternal retractors did not cause significant cortical SEP amplitude changes during IMA dissection or sternotomy. Also, the latency changes were small, although significant (P < 0.05). Conclusion: Despite the moderate amplitude changes produced by hypothermia, SEPs can be successfully monitored during hypothermia. Theoretically, the different behaviour of amplitude in peripheral and cranial components of SEP during hypothermia is interesting. Hypothermia has a more profound effect on synaptic transmission, represented by the cortical N₂₀ latency, than on the peripheral nerve conduction velocity. Intraoperative monitoring of temperature is essential whenever SEPs are recorded. The sternal retractors were not responsible for the intraoperative SEP changes.     

多种模式与单种模式神经电生理监测在重度颈椎后纵韧带骨化椎体次全切术中的对比研究

目的：探讨多种模式神经电生理监测与单种模式神经电生理监护在重度颈椎后纵韧带骨化椎体次全切钛网植骨内固定术中的应用对比。

方法：2015年4月至2018年6月在上海中医药大学附属曙光医院骨科住院治疗的重度颈椎后纵韧带骨化患者32例,其中男21例,女11例;年龄45~73岁,中位数59岁;病程6~72个月,中位数39个月。主要表现为四肢麻木疼痛、无力,下肢脚踩棉花感,站立行走不稳,随着症状的逐渐加重出现四肢瘫痪、大小便障碍等,颈椎后纵韧带骨化患者进行多种模式的体感诱发电位、运动诱发电位和肌电图模式监测。

结果：术中8例体感诱发电位波幅监测出现异常;其中5例为颈椎前路减压术中出血,放置止血棉过多,导致脊髓受压而出现体感诱发电位波形异常,及时去除止血棉后恢复正常;3例因收缩压下降导致体感诱发电位波形出现异常,由收缩压升高纠正。12例运动诱发电位监测波幅出现异常,9例因术中误触神经根引起,及时调整位置后恢复正常;3例因术中吸入肌松剂干扰引起。11例肌电图波形异常,其中9例经调整手术操作后能恢复正常波形,2例经短暂观察后自行恢复至正常,所有患者术后运动诱发电位波形好转（P<0.05）。术后2例出现脑脊液漏,术后7 d后自行愈合,术后所有患者未出现脊髓神经并发症。

结论：在重度颈椎后纵韧带骨化行椎体次全切钛网植骨内固定术中进行多种模式神经电生理监测,可实时了解脊髓和神经功能状态,明显降低术中损伤脊髓、神经的发生率,有效提高手术的安全性。     

Hemodynamic effects of laparoscopic radiofrequency ablation of liver tumors versus laparoscopic hepatic ultrasound examination

Study ObjectiveTo compare the hemodynamic changes that occur during laparoscopic radiofrequency ablation of liver metastases with those occurring during laparoscopic ultrasound hepatic examination alone.DesignProspective, observational study.SettingOperating rooms of a university-affiliated hospital.Patients40 ASA physical status 2 and 3 patients with liver metastases.Interventions20 patients underwent laparoscopic radiofrequency ablation of liver tumors following laparoscopic ultrasound examination, and 20 had laparoscopic ultrasound examination alone. The anesthetic technique was standardized.MeasurementsThe primary endpoint of the study was the number of episodes of mean arterial pressure (MAP) < 70 mmHg. Secondary endpoints were significant differences between the groups in MAP, heart rate, cardiac index, ejection fraction (EF; both measured with thoracic bioimpedance), calculated systemic vascular resistance index (SVRI), and central venous pressure.Main ResultsThe number of episodes of MAP < 70 mmHg did not differ between groups: there were 9 episodes in the ultrasound alone group and 7 in the radiofrequency group (P = 0.668). Cardiac index, EF, and SVRI were similar between groups. Central venous pressure was slightly higher in the radiofrequency group [11.99 (10.8-13.2) mmHg vs. 10.3 (9.2-11.4) mmHg, P = 0.04].ConclusionsHemodynamic profiles were similar when comparing laparoscopic radiofrequency ablation of liver metastases with laparoscopic ultrasound hepatic examination alone.     

Hypertonic saline and dextran in normovolaemic and hypovolaemic healthy volunteers increases interstitial and intravascular fluid volumes

Background : Hypertonic saline (HS) is increasingly used for fluid resuscitation in hypovolaemic patients. Although the effects of HS have been investigated in animal models, controlled studies in healthy human individuals are few. Aim : The effects of iv. hypertonic saline 75 mg . ml^-1 in dextran 70, 60 mg . ml^-1 (HSD) infusion on fluid shifts between the interstitial and intravascular fluid spaces, diuresis and haemodynamics were studied in normovolaemic and moderately hypovolaemic healthy volunteers. Material and methods : Nine fasting subjects received 4 ml . kg^-1 HSD as a 10-min infusion in a normovolaemic situation. Seven days later they served as their own controls in a hypovolaemic situation after 10% of the calculated blood volume had been withdrawn during a 15-min period. Before and after the HSD infusion, interstitial colloid osmotic pressure (COP_i) and interstitial fluid hydrostatic pressure (P_i) were measured on the lateral part of the thorax. During the study, blood sampling and pressure measurements were performed through a radial artery cannula, and central venous pressure measured through a catheter in the cubital vein. Results : In these awake and normovolaemic healthy volunteers, HSD infusion caused a transitory unpleasant sensation of headache and heat in the thorax up to the throat. A transitory haemodynamic effect was found with increased heart rate (HR), increased mean arterial pressure (MAP) from 77 ± 5 mmHg to 92 ± 13 mmHg (P<0.05) and CVP increase from 5 ± 1 mmHg to 8 ± 1 mmHg (P<0.05) after end of infusion. A haemodilution with increase in calculated blood volume lasting longer than the MAP increase was observed, with decreased COP_i from 14.4 ± 2.2 mmHg to 12.1 ± 2.0 mmHg (P<0.05). The diuresis measured at 180 min was higher in the normovolaemic than in the hypovolaemic situation. More pronounced effects of the infused fluid (HSD) on calculated blood volume, interstitial compartment and CVP were observed during moderate hypovolaemia. Conclusions : HSD infusion resulted in increased calculated blood volume with increased HR, MAP, and CVP. These effects were greater in a hypovolaemic situation. The haemodilution was most likely caused by fluid shifts from the intracellular compartment to the interstitial and vascular fluid spaces, eventually increasing diuresis.     

膀胱动脉化疗栓塞联合经尿道膀胱肿瘤电切术治疗T1及T2a期膀胱癌

目的 观察膀胱动脉化疗栓塞(BACE)联合经尿道膀胱肿瘤电切术(TURBT)治疗T1及T2a期膀胱癌的价值。方法 纳入48例接受TURBT治疗的T1或T2a期膀胱癌患者,根据TURBT前接受BACE与否分为BACE组(n=24)和对照组(n=24)。比较2组TURBT术中出血量、手术时间、术后住院时间、术后复发率、无进展生存率及生存率,分析BACE联合TURBT的疗效。结果 BACE后,BACE组24例肉眼血尿均消失;8例出现恶心、呕吐、局部皮肤瘙痒及下腹部疼痛等症状,经对症处理后均于1周内消失。BACE组TURBT术中出血量、手术时间及术后住院时间均少于对照组(P均<0.05),术后12个月及24个月肿瘤复发率均低于、无进展生存率均高于对照组(P均<0.05)。结论 BACE联合TURBT可有效治疗T1及T2a期膀胱癌。     

超声骨刀在退变性胸腰椎侧后凸畸形截骨矫形术中的应用

目的探讨超声骨刀在退变性胸腰椎侧后凸畸形截骨矫形术应用中的有效性及安全性。方法回顾性分析2013年3月—2015年6月本院确诊为胸腰椎退变性侧后凸畸形且采用多节段经关节突截骨术(SPO)治疗的43例患者临床资料,其中超声骨刀组(19例)、高速磨钻组(24例)。分析对比两组手术截骨节段、单节段截骨时间、术中出血量、术后引流量、住院时间、侧凸Cobb角、后凸Cobb角、矢状面C7铅垂线与骶骨后上缘间水平距离(SVA)改变情况、日本骨科学会(JOA)评分及JOA改善率、视觉模拟量表(VAS)评分、围手术期并发症发生率等指标。结果 43例患者手术均顺利完成。两组单节段截骨时间、术中出血量、术后引流量及住院时间比较,超声骨刀组均优于高速磨钻组,差异有统计学意义(P0.05)。两组患者术后脊柱序列恢复满意,侧后凸及SVA矫正率差异无统计学意义(P0.05)。两组患者术后神经功能均明显改善,术后JOA评分改善率、VAS评分改善率两组间比较差异均无统计学意义(P0.05)。两组术中均未出现神经损伤等手术并发症,高速磨钻组出现硬膜囊损伤脑脊液漏2例。结论应用超声骨刀可以安全、有效地完成退变性胸腰椎侧后凸畸形的截骨矫形手术。与高速磨钻相比,超声骨刀的应用可显著减少手术时间、术中出血量及住院时间。     

经导管抽吸血栓联合接触性溶栓治疗急性中-高危与高危肺血栓栓塞

目的 观察经导管抽吸血栓联合接触性溶栓（CDT）治疗急性中-高危与高危肺血栓栓塞（PTE）的效果。方法 对28例急性中-高危或高危PTE患者于置入下腔静脉滤器后行经导管抽吸血栓及CDT;观察治疗后临床症状有无改善,对比治疗前及治疗后72 h动脉血气分析、凝血功能、血常规、肺动脉压（PAP）及右心室直径/左心室直径（RV/LV）等,记录治疗相关并发症。随访观察治疗后1、3、6个月及1年PAP及肺动脉血栓清除效果。结果 治疗后26例症状明显改善,2例死于呼吸衰竭。4例穿刺点出血,均经保守治疗后好转。相比治疗前,治疗后72 h,26例存活者血pH、动脉氧分压、血纤维蛋白降解产物及D-二聚体水平均升高,而心率、N-末端B型利钠肽原、PAP及RV/LV均下降（P均<0.05）。治疗后1、3、6个月及1年PAP均较治疗前降低,肺血栓清除率均较治疗前升高（P均<0.05）;未见活动性出血及PTE复发。结论 经导管抽吸血栓联合CDT可安全、有效地治疗急性中-高危与高危PTE。     

Zur Meßsicherheit der oszillometrischen Blutdruckmeßgeräte Dinamap 1846 und HP M-1008B

Using the PTB simulator, which emits real signals from patients, we examined the precision of the oscillometric blood pressure measurement with the Dinamap 1846 (Critikon) and the HP M-1008B (Hewlett Packard). For this purpose we simultaneously registered invasive arterial pulsewave, cuff pressure and cuff pressure oscillations of 20 patients from our intensive care unit and stored them in the database of the simulator. The invasive reference blood pressure values were determined following the recommendations given by the Association for the Advancement of Medical Instrumentation. The invasive system showed a cut-off frequency of 35?Hz; the damping constant was 0.21. With 49 record signals from patients we carried out 15 simulated measurements each. From a total of 49 bio-signals from patients the Dinamap 1846 was able to process 41 signals and the HP M-1008B 47 signals. The mean error of the oscillometric blood pressure measurement of the systolic, diastolic and mean arterial pressure amounted to ?2.50?mmHg, 3.35?mmHg (P<0.05) and 1.51?mmHg with the Dinamap 1846 and to ?8.5?mmHg (P<0.001), ?5.15?mmHg (P<0.001) and ?5.58?mmHg (P<0.001) for the HP M-1008B. The 95% confidence limit for the systolic, diastolic and the mean arterial pressure amounts to 56?mmHg, 30?mmHg and 35?mmHg for the Dinamap 1846 and 50?mmHg, 38?mmHg and 35?mmHg for the HP M-1008B. The differences between that two instruments could be caused by the different algorithms for the calculation of blood pressure values and different artefact detection and elimination techniques. The results of the performance tests we achieved with the PTB simulator correspond to the results of other clinical examinations. The American Association for the Advanecement of Medical Instrumentation recommends a maximum mean error of 5±8?mmHg. None of the examined instruments lay within these limits. Due to the systematic and stochastic errors, we think that the Dinamap 1846 (Critikon) and the HP M-1008B (Hewlett Packard) do not achieve performance levels that are adequate for measuring critically ill patients.