颅骨修复及V-P分流术实施时机对颅脑缺损伴脑积水患者预后的影响

目的研究颅骨修复及脑室-腹腔(V-P)分流术实施时机对颅脑缺损伴脑积水患者预后的影响。方法选择2014年1月至2015年1月60例颅脑缺损伴脑积水患者作为研究对象,随机分为两组,每组30例。观察组行同期V-P分流术和颅骨修补术,对照组先行V-P分流术,6个月后行颅骨修补术。术后随访半年,观察两组患者预后、神经功能缺损情况及并发症发生率。结果观察组预后优良率为86.67%,显著高于对照组(63.33%),差异有统计学意义(P0.05)。观察组术后6个月神经功能缺损(NIHSS)评分为(16.08±3.37)分,显著低于对照组[(19.29±2.41)分],差异有统计学意义(P0.05)。观察组术后分流过度发生率为3.33%,显著低于对照组(20.00%),差异有统计学意义(P0.05)。结论同期行V-P分流术联合颅骨修补术治疗颅脑损伤伴脑积水较分期手术可获得更佳预后,能显著改善患者神经功能,降低术后并发症发生率。     

早期同期与分期手术治疗颅骨缺损合并脑积水疗效的临床观察

目的研究早期同期与分期手术治疗颅骨缺损合并脑积水的临床疗效。方法选择2011年1月至2014年7月来就诊的40例颅骨缺损合并脑积水患者作为研究对象,随机分为两组,每组20例。对照组行脑室-腹腔分流术(V-P分流)和颅骨修补术,分期进行。观察组行V-P分流术和颅骨修补术,同期进行。观察两组术后总体疗效,随访半年,比较两组术后并发症发生情况。结果根据格拉斯哥昏迷评分(GCS)量表,治疗后,观察组轻度障碍患者显著多于治疗前和对照组治疗后,重度患者例数显著少于治疗前和对照组治疗后,差异均有统计学意义(P0.05)。观察组治疗后并发症发生率为55%,显著低于对照组的90%,差异有统计学意义(P0.05)。结论早期同期手术较分期手术治疗颅骨缺损伴脑积水效果更为显著,并发症相对较少,以术后感染发热为主,术中应坚持无菌原则,严格操作,尽量减少术后并发症。     

颅骨修补联合同侧脑室分流术治疗颅骨缺损并脑积水35例

目的探讨颅骨修补联合同侧脑室分流术治疗颅骨缺损并脑积水的临床效果及安全性。方法回顾性分析78例颅骨缺损合并脑积水患者的临床资料,均一期行颅骨修补术及脑室分流术治疗,其中颅骨修补联合同侧脑室分流术35例(同侧手术组),对侧术式43例(对侧手术组)。结果同侧手术组在手术切口长度[(28.97±4.55)cm]、手术时间[(139.00±42.27)min]和术中出血量[(174.57±79.35) ml]明显优于对侧手术组[分别为(37.15±5.83) cm、(214.07±34.35)min、(257.21±72.02)ml],差异具有统计学意义(t值分别为6.786、8.656、4.815,P均<0.001)。2组术后脑积水程度均较术前明显改善(P<0.001),但2组间脑积水程度差异无统计学意义(P>0.05)。术后出现感染、癫痫、硬膜下积液、钛板下积液、过度引流等并发症,2组间差异无统计学意义(P>0.05),而同侧手术组的颅内出血率(2.86%)明显低于对侧手术组(20.93%;χ2=4.138,P=0.042)。2组术后GCS评分均较术前改善(P<0.05),术后GCS评分比较差异无统计学意义(P>0.05)。术后6个月时,2组GOS有效率差异无统计学意义(χ2=0.005,P=0.944)。结论颅骨修补联合同侧脑室腹腔分流术与对侧术式的治疗效果一致,但具有手术时间短、术中创伤小、出血少、颅内出血风险小等优点,适合临床推广和应用。     

颅骨缺损并脑积水的脑外伤患者分流术后不同时期行颅骨缺损修补术治疗的效果及安全性

目的探究颅骨缺损并脑积水的脑外伤患者分流术后不同时期行颅骨缺损修补术治疗的效果及安全性。方法回顾性分析2013年8月至2019年7月中国人民解放军联勤保障部队第九二四医院收治的86例颅骨缺损并脑积水的脑外伤患者的临床资料,按治疗方案不同分为2组,各43例。对照组采用脑室-腹腔分流术后择期颅骨缺损修补术治疗,观察组采用脑室-腹腔分流术+颅骨缺损修补术同期治疗。采用Glasgow预后评分(GOS)评估预后质量,采用Glasgow昏迷评分(GCS)评估意识状况,采用Fugl-Meyer评分评估肢体运动状况,采用美国国立卫生研究院卒中量表(NIHSS)评估神经功能缺损程度,记录2组患者分流术前及颅骨缺损修补术后1周的预后、意识状况、肢体运动功能、神经功能缺损程度;记录2组患者术后1个月并发症发生情况;比较2组患者术后6个月的临床疗效。结果术前,2组患者各项功能量表评分比较,差异均无统计学意义(P>0.05)。观察组术后1周的GOS评分、GCS评分、Fugl-Meyer评分分别为(4.58±0.33)、(13.02±1.33)、(78.32±5.92)分,均高于对照组的(3.25±0.34)、(9.21±1.58)、(61.47±4.71)分,而其NIHSS评分为(13.25±2.10)分,低于对照组的(20.17±2.15)分,差异均有统计学意义(P<0.05)。观察组术后并发症发生率(9.30%)明显低于对照组(30.23%),差异有统计学意义(P<0.05)。观察组治疗总有效率(93.02%)明显高于对照组(81.40%),差异有统计学意义(P<0.05)。结论与分流术后择期颅骨缺损修补术治疗相比,对颅骨缺损并脑积水的脑外伤患者经分流术+颅骨缺损修补术同期治疗可取得更为满意的治疗效果,有助于改善意识状况,提高肢体运动功能,减轻神经功能缺损程度,且可预防术后并发症发生,有利于提高治疗预后质量。     

重度颅脑损伤术后患者颅骨缺损修补时机的研究

目的探讨重度颅脑损伤患者进行大骨瓣减压术后颅脑损伤的修补时机,为重度颅脑损伤患者提供高质量的预后,保证患者的生命安全。方法本研究纳入我院2010²013年收治的130例重型颅脑损伤患者为研究对象,根据颅骨损伤修补的时机将患者分为超早期组、早期组和长期组,根据格拉斯哥昏迷评分(GCS)、格拉斯哥预后评分(GOS)和并发症发病率对3组进行统计学分析。结果对130例患者进行颅骨缺损修补术后2周时,超早期组、早期组和长期组的患者GCS和GOS评分差异无统计学意义(P>0.05)。术后6个月随访发现,三组之间GCS和GOS评分比较有统计学意义(均P<0.05),超早期组与早期组GCS和GOS评分无统计学差异(P>0.05),但长期组相较于超早期组与早期组的评分结果差(均P<0.05)。在临床并发症方面,三组并发症比较差异有统计学意义(均P<0.05)。超早期组并发症发病率最高,而早期组和长期组无统计学差异(P>0.05)。结论本研究通过对比超早期、早期和长期的颅骨修补术后患者临床症状可以发现,超早期与早期对患者进行颅骨修补术可以较好地恢复患者的神经功能,GCS与GOS评分没有太大区别,而且可以保护脑组织免受大气压的影响。     

颅骨修补术同期行分流术对脑外伤后脑积水患者神经功能及预后的影响

目的：研究颅骨修补术同期行分流术对脑外伤后脑积水患者神经功能及预后的影响。方法：选择2018年6月~2019年6月收治的82例脑外伤后脑积水患者,根据随机数字表法分为对照组和观察组,每组41例。对照组先实施脑室-腹腔分流术,并于术后2~3个月后施以颅骨修补术,观察组同期行颅骨修补术与脑室-腹腔分流术治疗。观察两组术后3个月手术疗效、预后情况评分、术后并发症发生情况及术前、术后3个月神经功能变化。结果：观察组手术总优良率（95.12%）高于对照组（78.05%）,差异具有统计学意义（P＜0.05）;术后3个月,观察组NIHSS评分较对照组低,差异具有统计学意义（P＜0.05）;术后3个月,观察组GOS评分较对照组高,差异具有统计学意义（P＜0.05）;观察组术后并发症发生率较对照组低,差异具有统计学意义（P＜0.05）。结论：应用颅骨修补术同期行分流术可有效改善脑外伤后脑积水患者神经功能及预后效果,降低术后并发症,疗效较高。     

同期颅骨修补术及脑室-腹腔分流术治疗大骨瓣减压后慢性脑积水

目的评价同期颅骨修补术及脑室-腹腔分流术治疗大骨瓣减压后慢性脑积水的临床效果。方法选取2009年2月至2013年7月收治的颅脑损伤行大骨瓣减压后慢性脑积水患者52例,按随机数字表法分组,分别采用同期颅骨修补术及脑室-腹腔分流术（VPS）（观察组30例）及传统的先行VPS再行颅骨修补治疗（对照组22例）,统计2组患者术后GCS、GOS评分及并发症发生情况。结果观察组患者的昏迷指数显著降低（P〈0.05）;对于GOS评分而言,虽2组患者总体预后状况比较差异无统计学意义,但观察组预后良好率较对照组显著升高（P〈0.05）;观察组患者的并发症以分流管堵塞、硬膜下积液/血肿最为常见,并发症发生率为33.3%,而对照组出现并发症多以分流过度、感染为主,并发症发生率为40.9%,组间比较差异无统计学意义（P〉0.05）。结论同期行VPS及颅骨修补术,可及早恢复大脑的解剖形态,促进脑正常生理功能的恢复,对于去骨瓣减压术后脑积水的治疗具有良好的疗效。     

颅骨修补术同期行VPS治疗去骨瓣减压术后合并交通性脑积水的效果观察

目的探讨颅骨修补术同期行VPS治疗骨瓣减压术后合并交通性脑积水的效果。方法选择某院2015-06—2016-12收治的颅脑损伤去骨瓣减压术后合并交通性脑积水患者15例(观察组),同时进行经脑室腹腔分流术联合颅骨修补术,另选择2014-01—2015-05收治的颅脑损伤去骨瓣减压术后合并交通性脑积水患者15例为对照组,先行脑室腹腔分流术,6个月后再行颅骨修补术,观察两组治疗效果。结果观察组和对照组的总有效率分别为86.7%和60.0%,观察组优于对照组,组间比较,P0.05;两组的GCS评分均明显提高,与治疗前比较,差异有统计学意义,P0.05;术后观察组GCS评分高于对照组,组间比较,差异有统计学意义,P0.05;观察组和对照组的并发症发生率分别为13.3%和26.7%,观察组低于对照组,组间比较,P0.05。结论颅骨修补术同期行VPS治疗骨瓣减压术后合并交通性脑积水是一种有效、切实、可行的治疗手段。     

中早期脑室腹腔分流术治疗重型颅脑外伤术后继发交通性脑积水的临床效果

选取74例重型颅脑外伤术后继发交通性脑积水患者,随机分为早期组和中期组各37例;早期组脑室腹腔分流术、颅骨修补术同期进行,对照组脑室腹腔分流术后1~2w再行颅骨修补术。随访并采用格拉斯哥昏迷评分(GCS)、格拉斯哥预后评分(GOS)评分评估两组手术治疗效果及预后,并了解两组术后并发症发生情况。早期组预后优良率为94.59%,显著高于中期组的78.38%(P0.05);早期组术后恢复GOS良好率为59.46%,显著高于中期组的35.14%(P0.05);早期组术后并发症发生率为8.11%,明显低于中期组的27.03%(P0.05)。早期脑室腹腔分流术治疗重型颅脑外伤术后继发交通性脑积水的临床效果更好,并发症少,对患者恢复程度、预后发展均有积极影响。     

外伤性颅骨缺损并脑积水同期手术治疗分析

目的 探讨外伤性颅骨缺损并脑积水同期手术治疗的效果及并发症处理.方法 2006-2009年我们对21例外伤性颅骨缺损并脑积水患者进行同期手术治疗,除2例轻度脑积水行单纯颅骨成形术外,余19例并中、重度脑积水患者,在颅骨成形手术的同时行了脑室-腹腔(V-P)分流术.结果 本组病例术后无死亡,20例切口愈合良好,1例出院时伤口愈合欠佳,出院后切口长期不愈,遂致钛板外露,术后2年来院拆除钛板后伤口愈合,1例术后8个月因V-P分流管梗阻,发生重度脑积水,来院再次进行V-P分流术.结论 外伤性颅骨缺损并脑积水两者同期手术是可行的,有利于脑保护和神经功能的恢复.     

Celecoxib is as efficacious as naproxen in the management of acute shoulder pain

This study compared the analgesic efficacy and safety of the cyclo-oxygenase-2 specific inhibitor celecoxib with the non-specific non-steroidal anti-inflammatory drug, naproxen, in patients with acute shoulder pain. Adult patients with shoulder pain, onset within the previous 14 days and shoulder pain of > or = 40 mm on a 100 mm visual analogue scale (VAS), were treated with oral doses of celecoxib or naproxen for 14 days and followed by a visit at day 42 in a double-blind, randomized study. The primary efficacy assessment was change in maximum pain at rest on a 100 mm VAS at day 14 compared with baseline. In addition, secondary efficacy pain and functional assessments were analysed at baseline, day 14 and day 42. A total of 202 patients were included in the trial (99 celecoxib 400 mg/day; 103 naproxen 1 g/day). The difference in change from baseline at day 14 in maximum pain at rest was not statistically significant between the two treatment groups, but was numerically higher for celecoxib than for naproxen (-47.9 +/- 2.5 versus -42.3 +/- 2.5, respectively). According to the limits of the 95% confidence interval of the difference between groups (-12.52; 1.38), celecoxib appeared to be at least as effective as naproxen. All secondary efficacy measures followed the same pattern, showing similarity between the two treatments with a trend in favour of celecoxib. The incidences of adverse events were similar for both groups. Fewer patients experienced epigastric pain with celecoxib (seven patients versus 14 with naproxen). This adverse event led to discontinuation in two patients receiving celecoxib and five receiving naproxen. Celecoxib 400 mg/day was at least as effective as naproxen 1 g/day in managing pain in this condition.     

Valdecoxib is as efficacious as diclofenac in the treatment of acute low back pain

OBJECTIVE: To compare the efficacy of valdecoxib 40 mg q.d. (with a second dose on day 1) with diclofenac 75 mg b.i.d. in the treatment of acute low back pain. METHODS: This was a multicenter, randomized, double-blind study. Patients with acute low back pain, class 1a or 2a (Quebec Task Force), with a visual analog scale score >/=50 mm (on a 100-mm scale) and moderate to severe pain on a categorical scale, were randomized to valdecoxib 40 mg q.d. (with a second dose on day 1) or diclofenac 75 mg b.i.d. for 7 days (170 patients per group). The primary efficacy end point was change in pain intensity (visual analog scale, mm) from baseline to day 3 for the per-protocol population. RESULTS: Least squares mean reductions in pain intensity from baseline to day 3 were similar for valdecoxib (-42.02 mm) and diclofenac (-41.43 mm). Valdecoxib was comparable to diclofenac as the lower limit of the 95% confidence interval of the estimated difference (0.59 mm; 95% confidence interval, -3.40 to 4.59 mm) was within the prespecified noninferiority margin of -10 mm. The overall incidence of adverse events was similar for valdecoxib (28%) and diclofenac (26%). No statistically different moderate or severe upper gastrointestinal adverse events were reported, although they were numerically greater for diclofenac (8) than for valdecoxib (3). DISCUSSION: Valdecoxib 40 mg q.d. (with a second dose on day 1) provides effective relief for acute low back pain, and was at least as efficacious as diclofenac 75 mg b.i.d., with a nonsignificant but numerically lower incidence of gastrointestinal adverse events.     

3种不同职业人群亚健康现状及其预防对策

目的探讨教师、铝作业和养路作业职业人群的亚健康状态发生现状及影响因素,以便为采取相应对策提供科学依据。方法采用统一表格对891名志愿者作答卷调查,所有结果均用Excel建立数据库,SAS软件统计分析。结果亚健康状态总发生率为66.89%;51～55岁年龄组亚健康状态发生率均明显高于其他组,具有极显著意义(P>0.01),其中潜临床和前临床状态人数占比例也较高(69.5%)。随着文化程度的提高,亚健康状态发生率则明显降低。毕业班教师、电解工人和一线养路工人的亚健康状态发生率(79.12%、92.96%和92.1%)分别明显高于其他组,差异均具有极显著的意义(P>0.01)。结论3组职业人群亚健康状态发生率高达66.89%。主要因素是:工作、生活压力过大,人际关系处理欠妥、缺乏体育锻炼和自我保健意识差等。故应引起政府部门及社会各界高度重视,采取相应的预防对策。     

Assessing the Reactive as Well as the Sensory Component of Headache Pain

SYNOPSIS
The traditional numerical scale used for measuring headache intensity was compared with an adjectival scale developed by Tursky (1976) designed to assess both the intensity and reactive components of the pain experience. As predicted Tursky's intensity adjectives correlated highly with the numerical ratings of intensity whereas all correlations involving the affective adjectives were significantly lower in magnitude. These results support the hypothesis that Tursky's procedure measures two different aspects of pain and suggest that research would profit from the incorporation of similar multi-component self-report measures.