车辆撞、轧致下肢毁损伤82例救治体会

载重、高速车辆撞、轧致下肢创伤 ,常造成肢体断离并复合组织缺损 ,或复杂开放性骨折合并皮肤软组织大面积缺损、血管神经断离与缺损 ,足部虽完整但严重缺乏血供等毁损伤。对这种创伤不宜行局部或远位带蒂皮 (肌 )瓣或复合组织瓣转移修复 ,用吻合血管组织瓣转移修复颇困难。 1985～ 2 0 0 0年 ,我们应用显微外科技术修复与重建下肢创伤 4 988例 ,其中车辆撞、轧致下肢毁损 82例 ,经急诊救治保存了肢体 ,并恢复功能。1　临床资料1 1　一般情况　男 71例 ,女 11例 ;年龄 19～ 2 8岁 ,平均 2 2 5岁。撞伤 5 2例 ,轧伤 2 8例 ,摔伤 2例。受伤部…     

双源CT前瞻性心电门控序列扫描冠状动脉成像准确性的多中心研究

Objective To investigate the accuracy of low-dose dual-source computed tomography (DSCT) coronary angiography in the step-and-shoot (SAS) mode for the diagnosis of coronary artery stenosis in comparison with conventional coronary angingraphy (CCA).Methods Prospective multiple-center study, 46 patients[mean age(58±9) years;bedy mass index(BMI) (25±3) kg/m2]underwent both DSCT in the SAS mode and CCA within 14 days.The inclusion criteria for contrast-enhanced CT: (1) heart rate less than 65 times/rain (bpm).(2) regular sinus rhythm, heart rate fluctuations within the range of 6 bpm. (3) holding breath well, breath-hold time is about 12-15 s.The exclusion criteria:(1) allergy to iodinecontaining contrast medium, nephropathy (serum creatinine level 120 μmol/L), heart failure and serious arrhythmias.(2) patients with coronary stents or bypass grafts.(3) heart rate can not be controlled very well (4)the patient could not take nitroglycerin.(5)BMI 30 kg/m2.(6) other heart disease: carcliomyopathy, valvular disease etc.Sensitivity, specificity, negative (NPV) and positive predictive value (PPV) were determined with CCA as standard of reference.The Kappa value between the two modalities and the two observers was calculated.Radiation dose values were measured.Results Mean heart rate during scanning was (61±6)bpm.99.19% (614/619) coronary segments were depicted with a diagnostic image quality. The vessel-based sensitivity, specificity, PPV, and NPV for the diagnosis of coronary artery stenosis were 96.2% (75/78), 88.2% (60/68), 90.4% (75/83), and 95.2% (60/63), respectively.The Kappa value between the two modalities was 0.848 (P=0.000).The mean effective dose of the SAS-CTCA was (2.95± 0.96) rosy(1.26-4.32 mSy).Conclusion In selected patients, DSCT coronary angiography in the SAS mode have good image quality, which allows for the accurate diagnosis of coronary stenosis at a low radiation dose.     

严重下肢创伤后复合组织缺损急诊修复与重建经验总结

目的 探讨严重下肢创伤后复合组织缺损修复与重建的有效方法。方法 本组164例,根据不同组织缺损或损伤情况,设计了5种修复与重建方法。结果 无1例截肢,随访5－10年,其优良率为96．3％。结论 本研究 的5种方法,基本能满足严重创伤后各种损伤组织的修复与重建,能保存肢体。     

一种人体生命体征检测的新方法

本文首先给出人体生命体征的基本定义及其呼吸、心跳的标准参考值,然后讨论目前最常见的接触式检测人体生命体征方法的原理、优缺点,最后重点讨论一种检测人体生命体征新方法－－非接触检测的原理、理论、优缺点及实验室研究现状,并给出实验室中在自由空间和穿透模拟砖墙条件下检测到人体呼吸、心跳两路信号的时域、频域检测结果。     

参芪扶正注射液治疗癌症相关疲劳及对细胞免疫、转化生长因子-β1、肿瘤坏死因子-α 表达的影响

目的探究参芪扶正注射液治疗癌症相关疲劳病人疗效及对细胞免疫、转化生长因子-β1(TGF-β1)、肿瘤坏死因子-α(TNF-α)表达的影响。方法选取北京中医药大学东直门医院2018年9月至2019年9月癌症相关疲劳病人108例,按照随机数字表法分为观察组与对照组,各54例。对照组采取对症治疗,观察组在对照组基础上给予参芪扶正注射液治疗。比较两组治疗2周后总有效率、治疗前后中医症状积分、细胞免疫(CD3+、CD4+、CD8+)、血清TGF-β1、TNF-α水平、Piper疲乏量表评分及不良反应发生情况。结果观察组总有效率(87.04%)高于对照组(66.67%)(P<0.05);治疗2周后,观察组气短、乏力、神疲积分低于对照组(P<0.05);观察组治疗2周后CD3+、CD4+高于对照组,CD8+低于对照组(P<0.05);观察组治疗2周后血清TGF-β1、TNF-α水平低于对照组(P<0.05);观察组治疗2周后躯体疲乏、情感疲乏、行为疲乏、认知疲乏评分及疲乏总分低于对照组(P<0.05);观察组不良反应发生率(12.96%)与对照组(16.67%)相比,差异无统计学意义(P>0.05)。结论参芪扶正注射液治疗CDF,能增强细胞免疫功能,有效改善病人临床症状,提高治疗效果,安全可靠,其抗CRF分子水平的机制可能与降低TGF-β1、TNF-α表达有关。     

骨肉瘤高转移细胞SOSP-M_1生物学稳定性及组织学起源的鉴定

目的　检测人骨肉瘤细胞高转移亚系SOSP M1 在裸小鼠体内传代过程中的生物学稳定性并鉴定其组织学特性。　方法　利用原位移植将细胞系在 33只裸鼠体内连续传代 ,组织块培养收集各代肺转移灶的肿瘤细胞 ,观察各代肿瘤细胞致瘤率、转移率、形态结构、骨形成蛋白、波形蛋白、肌动蛋白、神经元特异性烯醇化酶的表达情况以及遗传学方面的变化。　结果　各代肿瘤细胞致瘤率均为 10 0 % ,体内增殖稳定 ,肺转移率在 80 %以上。其显微及超微结构形态、抗原表达、染色体数目及结构变化均符合人骨肉瘤的特征。　结论　该细胞亚系在裸鼠体内传代生物学特性相对稳定 ,是人骨肉瘤实验研究的良好模型。     

军训应力性骨折106例影像特征

应力性骨折临床有时容易误诊为骨髓炎或肿瘤性病变。本研究搜集了2002～2006年发生应力性骨折的新入伍战士106例,复习不同部位应力性骨折的影像学资料,结合国内外文献,分析该病的特征及发病原因,旨在提高对本病的认识,科学训练,尽可能避免或减少应力性骨折的发生。     

鼻内镜下Nd:YAP激光治疗鼻腔乳头状瘤

自2001年10月以来我们采用Nd:YAP激光治疗鼻腔乳头未见复发.状瘤25例,疗效满意,报告如下.     

双源CT低剂量前瞻性心电触发序列扫描在冠状动脉血管成像的应用

Objective To evaluate low-dose CT coronary angiography with prospective electrocardiogram (ECG)-triggering using dual-source CT scanner.Methods Sixty-eight patients who underwent coronary CT angiography using a dual-source CT scanner were divided into 2 groups: group A (38 cases) and group B (30 cases).Prospective ECG-triggering sequence scan mode was employed for group A.Inclusion criteria included: heart rate <70 bpm, sinus rhythm, and heart rate fluctuation less than 10 bpm.Data acquisition was set at 70% of the RR-interval.Retrospective ECG-gating helical scan was performed for group B.Inclusion criteria included heart rates < 70 bpm and sinus rhythm.The exclusion criteria included heart failure and serious arrhythmias.In both groups, patients with a BMI≥24 kg/m2 were examined with a tube voltage of 120 kV, whereas patients with a BMI <24 kg/m2 were examined with a tube voltage of 100 kV.All images were transferred to a workstation for further processing and analysis.The imaging quality was evaluated.The imaging quality of coronary artery segments were compared with rank sum test between the two groups, and the radiation dose were compared with t test.Results A total of 476 coronary artery segments were evaluated in group A and 372 segments were evaluated in group B.The mean score of imaging quality for coronary artery segments in group A was 3.48±0.59 and that in group B was 3.53±0.58.There was no statistical difference in imaging quality between the two groups (Z=-1.432, P=0.187).The effective dose was on average (2.51±0.54) mSv (range 1.3--3.3 mSv) in group A, whereas on average (14.55±3.54) rosy (range 7.1--20.2 mSv) in group B.There was a statistical difference between the two groups (t=18.484, P=0.000).Conclusions Low-dose prospective ECG-triggering sequence scan in dual-source CT coronary angiography is feasible in patients with low heart rate and regular cardiac rhythm.This scan mode can substantially reduce radiation doses while preserving good diagnostic image quality.     

双源CT前瞻性心电门控序列扫描冠状动脉成像准确性的多中心研究

目的 与常规冠状动脉造影(CCA)对照,研究双源CT(DSCT)前瞻性心电门控序列扫描冠状动脉成像(SAS-CTCA)对冠状动脉狭窄诊断的准确性.方法 前瞻性的多中心研究,46例可疑冠心病患者[平均年龄(58±9)岁,体质量指数(BMI)(25±3)kg/m2]均进行了SAS-CTCA检查,并于14 d以内完成CCA检查.患者纳入标准:(1)心率控制在65次/min(bpm)以下;(2)窦性心律,心律规整,心率波动范围在6 bpm以内;(3)呼吸配合良好,屏气时间可达到12～15s.排除标准:(1)碘对比剂过敏、肝肾功能不全(血肌酐120 μmol/L)、心功能不全及严重心律不齐患者;(2)冠状动脉支架置入或冠状动脉搭桥患者;(3)心率快,而不能服用美托洛尔控制心率者;(4)不能服用硝酸甘油者;(5)体质量指数(body mass index,BMI)30 ks/m2 ;(6)其他心脏疾患:如心肌病、瓣膜病等.2名评价者分析SAS-CTCA及CCA的结果,计算SAS-CTCA对于冠状动脉狭窄诊断的敏感性、特异性、阳性预测值、阴性预测值,计算2名评价者间、两种检查方法之间的Kappa值,并对辐射剂量进行统计.结果 检查过程中患者的平均心率为(61±6)bpm,99.19%(614/619)的冠状动脉节段达到可供诊断的图像质量.与CCA相比,以冠状动脉血管为单位,SAS-CTCA在显示冠状动脉病变方面的敏感性、特异性、阳性预测值、阴性预测值分别为96.2%(75/78)、88.2%(60/68)、90.4%(75/83)、95.2%(60/63).两种检查方法之间的Kappa值为0.848(P=0.000).SAS-CTCA的平均有效剂量为(2.95±0.96)mSv.结论 在严格控制入选标准的前提下,SAS-CTCA检查可以在降低辐射剂量的同时获得满意的图像质量,并对诊断冠状动脉狭窄具有较高的可信性.