16层螺旋CT及其三维重建与多平面重组在胫骨平台骨折诊断中的应用

目的探讨16层螺旋CT(16层SCT)及其三维重建(3-D)与多平面重组(MPR)在胫骨平台骨折诊断中的应用价值。方法39例胫骨平台骨折病例经膝关节常规X线平片检查后，采用16层SCT进行膝关节的多层面螺旋CT扫描，在工作站上作3D及MPR影像后处理，就胫骨平台骨折的平片与16层SCT影像进行比较及综合分析。结果39例胫骨平台骨折中，X线平片漏诊1例髁间隆突骨折、1例内髁骨折及1例双髁骨折，此3例(7．69％)平片漏诊的骨折均为16层SCT予以诊断。16层SCT的3-D影像可清晰显示胫骨平台骨折的立体形态；MPR影像则可明确显示胫骨平台内部的骨质损伤情况如骨折的具体部位、关节面碎裂及塌陷程度、骨折移位距离。结论16层SCT能够显示X线平片难于诊断的胫骨平台隐匿性骨折；3-D及MPR成像技术十分有利于全面观察胫骨平台骨折的形态变化，是16层SCT横轴位扫描的重要补充。     

Effect of electro-acupuncture combined with early rehabilitation on motor function and expressions of CD11b/CD18 and tumor necrosis factor-α in patients with acute cerebral infarction

Objective To observe the effect of electro-acupuncture combined with early rehabilitation on the motor function and expressions of the adhesion molecules CD11b and CD18 in the polymorphonuclear leucocytes (PMN) and monocytes and serum tumor necrosis factor-α (TNF-α) levels in patients with acute cerebral infarction (ACI). Methods A total of 165 ACI patients were randomly divided into control group (group A, n=50), conventional rehabilitation group (group B, n=50) and comprehensive rehabilitation group (group C, n=65). The expressions of CD11b and CD18 in the PMN and monocytes and serum TNF-α levels were determined before and at 1, 2, and 4 weeks after the treatment. Thirty-two healthy subjects were also recruited as the normal control group (group N). The neurological function of the subjects was evaluated by modified Edinburgh-Scandinavia stroke scale (MESSS) and Fugi-Meyer Assessment (FMA), and their activity of daily living (ADL) was assessed using Barthel index (BI). Results The CD11b/CD18 expression in the PMN and MN and serum TNF-α level in groups A, B and C were significantly higher than those in group N before and 1 week after the treatment (P<0.05). CD11b/CD18 expression and serum TNF-α level were significantly lower in groups B and C than in the group A at 1 week after the treatment, and significantly lower in group C than in group B (P<0.05). At 2 weeks of treatment, CD11b/CD18 and TNF-α were significantly lower in groups B and C than in the group A, being the lowest in group C (P<0.05). The scores of mESSS in both groups B and C were lower than that in group A, and the scores were lower in group C than in group B. Group C showed higher FMA scores than group B, both having higher scores than group A. At 4 weeks of treatment, the mESSS scores were significantly lower, hut the FMA and ADL score significantly higher in groups B and C than in the control group (P<0.05), and the differences were more obvious in group C. Groups B and C had greater effective rate than group A (P<0.05), and the rate was the highest in group C (P<0.05). Conclusion Electro-acupuncture combined with early rehabilitation promotes the recovery of motor function in ACI patients probably by regulating the expressions of the adhesion molecules CD11b and CD18 on the PMN and monocytes and the serum levels of TNF-α.     

三叉神经痛患者立体定向术的配合与护理

目的:总结三叉神经痛患者立体定向治疗的术中配合以及患者的心理护理,确保手术顺利完成,减少术后并发症,促进康复。材料和方法:115例三叉神经痛患者应用自行研制的DZY-C型立体定向仪行经皮穿刺三叉神经节,注射甘油或无水酒精。对患者进行围手术期的护理及心理护理,术中主动配合手术,术后预防并发症并指导患者功能锻炼。结果:115例患者穿刺均一次成功,注射药物后疼痛消除115例;随访12～36个月复发3例,经再次穿刺治疗后疼痛消除。结论:耐心地进行心理护理使患者积极配合手术,进行充分的术前术位训练,术中配合医师安放好患者体位以及保持有效的局部麻醉效果能确保手术的顺利完成;术后注意预防口腔及面部并发症,加强口腔颜面的功能锻炼,对病人的术后康复十分重要。     

股骨多段闭合骨折病人术前凝血功能的变化

目的 探讨股骨多段闭合骨折病人术前凝血功能的变化。方法 选择创伤股骨多段闭合骨折后当天入院的病人20例,年龄19-45岁,ASA Ⅰ级,为试验组(Ⅰ组);选择健康成年人15人,年龄21-39岁,作为对照组(Ⅱ组);Ⅱ组于清晨空腹采上肢静脉血标本,Ⅰ组病人入院后于骨折的第2天、第6天(手术当天清晨)空腹采上肢静脉血样本,检测血栓弹力图(TEG)指标[R时间、K时间、α角、血栓最大幅度(MA)、血栓硬度(G)]、D-二聚体浓度(D-Di)、血小板计数(PLC)及血小板聚集率(PAgR)的变化。结果 Ⅱ组TEG指标、D-Di、PLC及PAgR均在正常范围。与Ⅱ组比较,Ⅰ组骨折后第2天,K时间缩短(P<0.05),α角、MA、G及D-Di增高(P<0.01);骨折后第6天,R时间缩短(P<0.05),α角、MA、G、D-Di、PLC及PagR增高(P<0.01)。与骨折后第2天比较,Ⅰ组骨折后第6天MA、G、PLT及PAgR增高(P<0.05或0.01)。结论 病人创伤骨折后凝血功能24 h内增强,随时间的延长至术日呈高凝状态,应加强术中管理,并采取相应措施预防术中静脉血栓的发生。     

AC·T5diff血细胞分析仪临床应用评价

目的通过实验探讨AC·T5diff血细胞分析仪的主要性能,并作初步评价。方法采用国际血液学标准化委员会(ICSH)所推荐的血液分析仪评价方案,以门诊患者的EDTA-K2抗凝静脉血或末梢血作样本对AC·T5diff进行精密度、线性、携带污染率、白细胞分类和相关性分析。结果WBC、RBC、HCT、PLT、Hb的精密度、线性分析及携带污染率均在仪器说明书规定的范围内,白细胞五分类与人工显微镜法比较中性粒细胞、淋巴细胞、单核细胞、嗜酸性粒细胞和嗜碱性粒细胞的相关系数分别为0.911、0.867、0.793、0.721和0.653;与东亚NE1500血细胞分析仪相比,上述参数的相关系数r分别为0.990、0.994、0.991、0.972和0.998。结论AC·T5diff血细胞分析仪性能优良,速度快,用血量少,各项测试参数准确、可靠,适合大、中型医院门诊推广使用。     

综合评价方法在护理管理中的应用

综合评价方法在护理管理中的应用广东佛山市中医院何小珍，陈子星，郭少英随着护理管理水平的不断提高，综合评价方法得到越来越多的应用，更加显示出其优越性和重要性。发达国家较重视综合评价方法的研究，这是因为，综合评价涉及到工作的责任（例如法律责任）；护理服务...     

智能化医疗仪器内备用电池引起的故障分析

智能化医疗仪器内备用电池引起的故障分析佛山市中医院罗燕伟（５２８０００）例一故障现象：一台Ｏｌｙｐｍｓ冷光源，十次有九次在开机后光量度及风量度设置上升到最本，需重新设置。且检测照相机连接出错误“Ｆａｕｌｔ”标志。检查：打开机壳后，发现内部很多灰尘。清...     

惠普43120A除颤器替换维修实例

针对惠普43120A除颤器在使用过程中出现无显示的故障，本文从DC-DC转换器入手，进行替换维修，提高了该设备的使用率，为医院节省了医疗资源。     

中药调剂在辩证施治上的重要性

中药调剂在辩证施治上的重要性广东省佛山市中医院（５２８０００）雷兰顿，倪雪渔近年来中药调剂存在的问题比较严重，中药调剂的质量问题在全国也有一定的普遍性，它直接影响了中医临床疗效［１］。要解决这一问题，除采用一些相应的措施外，抓紧中药调剂人员业务素质的...