外伤性胸骨骨折12例诊治体会

1 资料与方法 1.1 一般资料选取2001年-2008年收治的胸骨骨折患者12例,其中男9例,女3例,年龄16～60岁.车祸伤8例,压伤3例,钝器打击伤1例.合并颅脑伤3例,四肢伤4例,腹腔脏器伤3例.单纯胸骨骨折2例,合并肋骨骨折者10例,连枷胸4例.合并血胸10例,肺挫伤7例,心包积血2例,血气胸4例,支气管破裂1例.骨折发生在胸骨体7例,胸骨体下1/3 3例,胸骨柄2例.骨折移位6例.     

门诊输液患者护理及管理体会

2009年6月-2010年5月,我院门诊注射室共接待输液患者72000例,男43800例,女28200例;年龄1—93岁。其中成人18000例,儿童54000例,原发病为呼吸系统疾病40500例,循环系统疾病19700例,消化系统疾病3240例,神经系统疾病4500例,内分泌代谢性疾病420例,血液系统疾病180例,泌尿生殖系统疾病460例,门诊手术后1680例,外伤380例,外科感染98例,皮肤疾病120例,     

27例胰腺损伤的诊治体会

1996～2006年,我们共收治胰腺外伤患者27例。现将其诊治体会报告如下。 资料与方法：本组中男23例、女4例,年龄4～50岁。车祸伤14例,坠落伤4例,挤压伤4例,脚踢伤1例,刀刺伤4例;合并脾破裂9例,肠系膜根部及腹膜后血肿14例,肝破裂5例,十二指肠破裂4例,胆总管断裂1例,结肠破裂3例,胃破裂及肾破裂各2例,胸外伤5例,四肢及脊柱骨折6例,颅脑外伤1例,肠系膜上动静脉及门静脉损伤4例;21例合并失血性休克。术前明确诊断6例,术中诊断19例,     

稳心复脉汤治疗心脏早搏52例疗效观察

2005年6月～2007年8月,我们应用稳心复脉汤治疗心脏早搏52例,疗效满意.现报告如下. 临床资料:选择我院心内科早搏患者87例,男50例、女37例,年龄20～69岁.冠心病30例,高心病12例,肺心病5例,风心病5例,心肌炎23例,心肌病5例,心脏神经官能症8例.早搏类型:室性早搏51例,房性早搏26例,房室交界处早搏10例.将患者随机分为治疗组52例和对照组35例,两组一般资料具有可比性.     

小儿肺炎支原体感染胸部CT表现的研究

目的了解儿童肺炎支原体感染胸部CT表现。方法分析我科确诊支原体肺炎的49例住院患儿肺CT病灶的分布与形态。结果儿童肺炎支原体感染胸部CT特点:病变位单侧27例,双侧22例。左上叶17例,左下叶24例,右上叶18例,右中叶11例,右下叶27例,节段性病变9例。病灶呈大斑片状影43例,肺门影增浓19例,肺纹理增多18例,斑点状影17例,条索状影13例,磨玻璃样影10例,肺实变12例,肺不张6例,支气管充气征9例,肺门、纵膈淋巴结肿大4例,胸腔积液11例,空洞2例。结论肺CT对儿童支原体肺炎诊治有一定意义。     

足三里穴位注射治疗婴儿腹泻289例

1 对象和方法1.1 对象 感染性腹泻289例排除细菌性痢疾,伤寒等病。大便为黄白色水样,无粘液脓血。年龄<1岁114例,1—2岁45例,3岁以上70例;男168例,女121例。腹泻1—3 d133例,4—6 d 119例,7—9 d 27例,10 d以上10例。大便次数4—10次/d 140例,10—20 次/d 124例,>20次/d 25例。体温正常75例,38—39℃168例,39℃以上46例。呕吐3次以下112例,3—7次124例,7次以上23例。脱水轻度159例,中度130例。轻度酸中毒183例,重度27例,血清钾钠氯降低79例。大便培养183例,仅有3例培养出大肠     

脑创伤与心电图的关系分析

目的探讨脑创伤与心电图的关系。方法选择180例脑创伤患者,男150例,女30例,年龄在13～55岁,轻型脑创伤120例,中型脑创伤60例,行常规十二导联心电图检查。结果 120例轻型脑创伤心电图异常者39例(占32.5%),其中窦性心动过速11例,窦性心动过缓10例,房性期前收缩4例,室性期前收缩2例,ST段下移1例,T波改变合并窦性心动过速1例。60例中型脑创伤心电图异常者42例(占70%),其中窦性心动过速8例,窦性心动过缓12例,房性期前收缩8例合并窦性心动过缓2例,室性期前收缩9例合并窦性心动过缓3例、窦性心动过速1例,ST段改变10例合并窦性心动过缓1例、窦性心动过速2例、T波改变3例,T波改变12例合并窦性心动过缓4例、窦性心动过速2例,完全性右束支传导1例。结论心电图改变与脑创伤的病情轻重有关。     

无痛内镜术在消化内镜介入治疗中的应用

各种消化道疾病的内镜介入治疗中均存在患者耐受性及操作稳定性的难题,笔者在2004年6月~2006年6月开展了2 000多例无痛内镜,其中198例用于内镜下介入治疗。现将结果报告如下。1资料与方法1.1临床资料198例内镜介入治疗患者中,胃肠道息肉患者101例,男60例,女41例;年龄19~69岁,平均50.8岁;其中食管息肉10例,胃息肉30例,结肠息肉61例。上消化道异物患者40例,男24例,女16例;年龄16~69岁,平均40.5岁;异物位于食管26例,胃13例,十二指肠1例;异物类型为小铁杵及钉子9例,动物骨头21例,义齿3例,钥匙3例,壹圆硬币2例,刀片2例;患者从吞入异物到医院就诊…     

小儿重型颅脑损伤143例治疗分析

2000年5月-2009年6月,我院共收治重型颅脑损伤患儿143例,现报告如下。临床资料：本组中,男82例,女61例;〈3岁8例,3—6岁48例,7—15岁87例;其中坠落伤53例,车祸伤28例,跌伤3l例,击打伤14例,其他伤17例;颅脑损伤为闭合性95例,内开放性38例,外开放性10例;临床表现均有不同程度的意识障碍,有颅内压增高症状128例;     

18例毛细胞白血病的临床分析

目的:探讨毛细胞白血病(HCL)的临床特点。方法:回顾性分析18例HCL患者的临床资料。结果:18例患者中,男13例,女5例,中位年龄51.5岁。腹胀是最常见主诉。初诊时脾大17例,肝大5例,淋巴结肿大6例。白细胞数增高6例,减低7例,正常5例。TRAP阳性15例,阴性3例。网状纤维增多3例,板层复合体(RLC)14例中存在1例,细胞遗传学改变7例中存在2例。11例单用干扰素治疗,8例有效,3例无效中2例行脾切除仍有效。干扰素联合脾切除3例有效。结论:HCL患者肝脾淋巴结肿大易见,网状纤维增多不多见,RLC少见,部分有细胞遗传学异常,干扰素联合脾切除是治疗的有效方法。     

Cardiac complications of infectious endocarditis

Factors predisposing to cardiac complications and influencing hospital survival, were analysed in a retrospective study of 101 cases of infective endocarditis. Heart failure occurred in 52 p. 100 of our patients. A significantly greater incidence of heart failure was observed in endocarditis with no preexisting heart disease (p less than 0.01), aortic and mitral valve involvement (p less than 0.01), staphylococcus aureus infections (p less than 0.05), arrhythmias (p less than 0.001), and conduction disturbances (p less than 0.01). Significantly more patients with congestive cardiac failure died in hospital (51 p. 100) than those without congestive cardiac failure (17 p. 100) (p less than 0.001). Severe heart failure before treatment (p less than 0.05), streptococcus D endocarditis (p = 0.05), supraventricular arrhythmias (p less than 0.05), and intracardiac conduction disturbances (p less than 0.05), significantly increased the hospital mortality in patients with congestive heart failure. Electrocardiographic findings revealed arrhythmias in 34 p. 100 of cases, more commonly with mitral valve involvement (71 p. 100) and 52 p. 100 died in hospital. The development of intracardiac conduction disturbance during the course of 18 cases of endocarditis (aortic valve in 11 cases) was associated with a hospital mortality rate of 60 p. 100. The incidence of pericarditis and pulmonary embolism was 4 and 7 p. 100 respectively, and all patients died in hospital. Acute inferior myocardial infarction compatible with coronary embolism was suspected in one patient. Early cardiac valve replacement improved the hospital survival in patients with cardiac complications of infective endocarditis.     

Infective endocarditis presenting with ST segment elevation

Despite diagnostic and therapeutic advances, mortality and morbidity associated with infective endocarditis (IE) remains high. Congestive heart failure and complications such as septic embolization and aortic root abscess are the main causes. Although aortic root abscess is a common complication of IE involving the aortic valve, acute myocardial infarction (AMI) is a rare complication in patients with endocarditis, whether in the acute or later phase of infection. In most cases, the infarction is either anterior or anterolateral. To the best of the present authors' knowledge, only one case of infarction at a purely inferior site has been reported previously. In the present case, IE with an aortic root abscess presented clinically as an acute inferior wall myocardial infarction.     

Clinical features, problems in medical management and therapeutic planning in severe valvular heart disease

Clinical features and pathological findings were reviewed in 90 postmortem cases of valvular heart disease (VHD) to clarify the problems and limitations of medical management. The clinical features of severe mitral valve disease included congestive heart failure (CHF), with tricuspid regurgitation in many cases, atrial fibrillation, frequent ventricular premature beats, ventricular hypertrophy, cardiomegaly, increased pulmonary arterial pressure and abnormal hepatorenal function. The most common causes of aortic valve disease (AVD) were rheumatic fever and infective endocarditis, and the major causes of death were sudden death and intractable CHF. Autopsy in cases of AVD revealed marked left ventricular hypertrophy and dilatation, vegetations, thickening, adhesion and calcification in the aortic valve. Some patients died of cardiogenic shock due either to severely impaired cardiac function or to associated myocardial or pulmonary infarction. Abrupt onset of embolism was also related to death of the patients. The management of VHD must include the treatment of CHF and arrhythmias and the prevention of embolism. Appropriate timing for surgery and close follow-up by cardiologists is mandatory.     

风湿性心脏病合并非冠状动脉粥样硬化性心肌梗死的临床及冠脉造影分析

目的探讨慢性风湿性心脏病（风心病）合并心肌梗死的原因、临床特征、冠状动脉造影表现及治疗.方法回顾性分析18例风心病合并心肌梗死患者的临床和冠脉造影资料.结果18例患者中二尖瓣病变15例（83.3%）,其中5例合并主动脉瓣病变;单纯主动脉瓣病变3例;11（61.1%）例已行瓣膜置换术,服用华法令治疗,国际标准比值（INR）维持在2.0～2.5.合并心房颤动15例（83.3%）.18例患者均有突发胸痛病史,心电图显示前壁心肌梗死13例（72.2%）,下壁心肌梗死5例（27.8%）,其中Q波心梗7例（38.9%）,非Q波心梗11例（61.1%）.伴有心肌酶增高.冠状动脉造影显示冠脉正常14例（77.8%）,4例为急性栓塞,其中1例发生于常规冠脉造影中,另3例胸痛时造影分别为对角支、前降支及右冠脉堵塞,经介入治疗再通.全部患者存活.结论并发于风心病的心肌梗死很少见,冠状动脉栓塞是引起心肌梗死的原因,梗死部位多为前壁,延迟冠脉造影多数正常.     

Managing embolic myocardial infarction in infective endocarditis: current options

Systemic embolization is common in infective endocarditis and is known to occur in 45-65% of cases. Coronary artery embolism has been seen in as many as 60% of cases at necropsy. However, it only rarely has been described as resulting in transmural myocardial infarction. In most cases, coronary embolism is inferred from circumstantial evidence. We present two patients with myocardial infarction in the setting of acute infective endocarditis. Current issues regarding the management of myocardial infarction in infective endocarditis are described in this article. We also describe the first documented case of Lactobacillus jensenii endocarditis leading to myocardial infarction. Possible factors, which may be instrumental in producing endocarditis with this organism, are also discussed.     

Infective endocarditis presenting as ST-elevation myocardial infarction: an angiographic diagnosis

While systemic embolic events occur with relative frequency in infective endocarditis (IE), coronary embolization remains an uncommon cause of ST elevation myocardial infarction. Herein we report a case of ventricular fibrillation and anterior ST elevation myocardial infarction occurring in a patient initially presenting with septic shock. Angiography proved diagnostic for IE of a native bicuspid aortic valve complicated by root abscess and left anterior descending artery occlusion. Histologic examination of the embolectomy specimen from the left anterior descending artery confirmed the presence of thrombus and bacteria. The present case highlights difficulties in identifying and managing patients with coronary embolism of vegetations from IE.     

Fatal intracerebral hemorrhage following thrombolytic therapy of embolic myocardial infarction in unsuspected infective endocarditis

Cerebral hemorrhage occurs in 0.2% of patients under the age of 60 years treated with thrombolytic therapy for acute myocardial infarction. A case of fatal cerebral hemorrhage following TPA therapy for myocardial infarction due to probable coronary artery embolism during unsuspected native valve infective endocarditis is reported.     

Detection and evaluation of infectious endocarditis

Based on the findings of 50 patients with infective endocarditis, 37 affecting the aortic, six the mitral and seven both the aortic and mitral valves, in addition to analysis of predisposing factors, prominent signs and symptoms distinctive for the clinical entity were assessed (Tables 1 to 3). Preexistent conditions such as aortic valve lesions including bicuspid aortic valve as well as mitral valve lesions including mitral valve prolapse were proven in 66%. Factors which may have compromised host defense mechanisms such as cachexia and chronic alcohol or intravenous drug abuse were present in isolated cases. In 38% of the patients, a diagnostic or therapeutic manipulation, suspected to have given rise to the bacteremia, antedated the onset of endocarditis. Malaise, fatigue and chills were the most frequent symptoms (Table 4). Fever and cardiac murmurs were observed in all patients, anemia and bacteremia in 74% of the patients, respectively (Tables 4 to 6). In blood cultures, the most common microorganisms were found to be hemolytic and nonhemolytic streptococci accounting for 65% of positive findings, followed by enterococci and gram-negative bacteria each with 14% respectively (Table 6). Congestive heart failure predominated among cardiac complications with its occurrence in 84% of the patients. Valvular ring or myocardial abscess, aortic or sinus of Valsalva aneurysm, occasionally with perforation, were found in 24% of our patients. Coronary embolism was documented in 6%; infection-associated pericarditis was observed only rarely (Table 7). Extracardiac complications involved the skin, central nervous system, spleen and kidneys, respectively, in 20 to 30% of the patients. Complications afflicting the eyes, lungs, gastrointestinal tract and the musculo-skeletal system were seen with a lesser frequency of 0 to 12% (Table 8). The diagnosis of infective endocarditis, rendered highly-probable by the constellation of fever, cardiac murmur, bacteremia and anemia, necessitates, however, confirmation through cardiac examinations. In this respect, electrocardiographic and radiologic findings are of limited value, although they may be useful in the detection of cardiac complications. In 6% of the patients, positive criteria for myocardial infarction were indicative of coronary embolism and, i 30%, atrioventricular or fascicular block suggested the presence of abscess formation (Table 9). As radiologic evidence of heart failure, 74% of the patients were found to have pulmonary vascular congestion (Table 10).(ABSTRACT TRUNCATED AT 400 WORDS)     

Etiology and pathogenesis of thromboembolism.

Thrombus formation in the left atrium and left ventricle is primarily due to stasis of blood which causes activation of the coagulation system. Migration of thrombotic material into the circulation depends on the dynamic forces of the circulation. Atrial fibrillation is the commonest underlying cardiac disorder predisposing to thromboembolism. Rheumatic mitral stenosis, left atrial enlargement, prior myocardial infarction, hypertension, and echocardiographic left ventricular hypertrophy are risk factors for thromboembolic stroke in elderly patients with chronic atrial fibrillation. Non-valvular atrial fibrillation accounts for 45% of cardiac sources of thromboembolic stroke and includes patients with ischemic heart disease, hypertension, thyrotoxic heart disease, hypertrophic cardiomyopathy, chronic sinoatrial disorder, and idiopathic atrial fibrillation. 15% of cardiac sources of thromboembolic stroke are associated with acute myocardial infarction, 10% with left ventricular aneurysm and mural thrombi remote from an acute myocardial infarction, 10% with rheumatic valvular heart disease, and 10% with prosthetic cardiac valves. Mitral valve prolapse, mitral annular calcium, nonischemic cardiomyopathies, infective endocarditis, nonbacterial thrombotic endocarditis, left atrial myxoma, paradoxical embolism associated with congenital heart disease, calcific aortic stenosis, and complex atherosclerotic plaque within the proximal aorta also contribute to thromboembolism.     

Value of echocardiographic findings in predicting cardiovascular complications in infective endocarditis.

Echocardiography allows the detection of vegetations and estimation of valvular dysfunction in patients with infective endocarditis. The value of echocardiographic findings in predicting cardiac and other vascular complications in infective endocarditis is not well understood. Identification of high-risk patients and early surgery may improve their prognosis. The authors reviewed echocardiographic findings and related them to the development of congestive heart failure, systemic embolism, and the need for surgery or the risk of death without surgery in patients with infective endocarditis. There were 125 episodes of endocarditis in 114 patients (84 episodes [67%] in men) with a mean age +/- standard deviation of 37 +/- 7 years. Vegetations were detected by echocardiography on at least 1 valve in 87 episodes (70%); on the mitral valve in 36 episodes (29%); on the aortic valve in 21 episodes (17%); and on the tricuspid valve in 45 episodes (36%). Severe aortic regurgitation was present in 9 episodes (7%) and severe mitral regurgitation in 4 instances (3%). In 12 of 21 episodes (57%) of vegetations on the aortic valve compared with 15 of 104 patients (14%) without vegetations on the aortic valve (p < 0.001), and in 8 of 9 instances (89%) of severe aortic regurgitation compared with 19 of 116 episodes (16%) without severe aortic regurgitation (p<0.00001), the patients developed congestive heart failure. In 18 of 55 episodes (33%) of vegetations on the aortic/mitral valve compared with 17 of 70 episodes (25%) without vegetations on the aortic valve/mitral valve (p = NS), the patients developed systemic embolism. In 13 of 21 episodes (62%) of vegetations on the aortic valve compared with 19 of 104 episodes (19%) without vegetations on the aortic valve (p < 0.001), and in 8 of 9 episodes (89%) of severe aortic regurgitation compared with 24 of 116 episodes (21%) without severe aortic regurgitation (p < 0.00001), the patients either had surgery or died without surgery. Echocardiographic findings do not reliably predict the risk of systemic embolism in patients with infective endocarditis. Vegetations on the aortic valve and severe aortic regurgitation detected by echocardiography predict a high risk of developing congestive heart failure, and for the combined outcome of requiring surgery, or dying without surgery in infective endocarditis. Early surgery may improve the outlook for survival of these patients.