氯诺昔康复合小剂量舒芬太尼用于妇科术后患者静脉自控镇痛

目的评价氯诺昔康复合小剂量舒芬太尼用于妇科手术后患者静脉自控镇痛的临床效果.方法选择行妇科子宫切除术的患者80例,美国麻醉医师学会(ASA)分级为Ⅰ～Ⅱ级,随机分为两组.氯诺昔康加小剂量舒芬太尼组(组Ⅰ),予氯诺昔康32 mg、舒芬太尼0.1 mg、氟哌利多2.5 mg加入0.9%氯化钠溶液至100 mL,术毕再予静脉...     

一次性双腔Supreme喉罩与ProSeal喉罩用于腹腔镜胆囊切除术气道管理的比较

目的评价双腔Supreme喉罩(SLMA)与ProSeal喉罩(PLMA)应用于腹腔镜胆囊切除术气道管理的效果。方法选择于全身麻醉下行择期腹腔镜胆囊切除术的患者100例,性别不限,年龄38~65岁,体重51~85 kg,美国麻醉医师学会分级Ⅰ~Ⅱ级,随机分为SLMA组(S组)和PLMA组(P组),每组50例。静脉注射咪达唑仑0.1 mg/kg(最大剂量为5 mg),经静脉注射丙泊酚1.5~2 mg/kg、芬太尼0.1 mg、维库溴铵0.1 mg/kg麻醉诱导后置入喉罩,并经引流管置入胃管。记录置入喉罩时间和置入情况,应用纤维支气管镜检查喉罩位置并进行评分,记录各时间点的心率(HR)、平均动脉压(MAP)、脉搏血氧饱和度(SpO2)、呼气末二氧化碳分压(petCO2)、气道峰压(ppeak)和气道密封效果。记录拔除喉罩后不良反应的发生情况、手术时间、麻醉时间、拔管时间和苏醒时间。结果两组间喉罩置入时间、置管成功率、手术时间、麻醉时间、气管插管拔管时间、苏醒时间,以及拔除喉罩后低氧血症、呛咳、咽喉痛的发生率的差异均无统计学意义(P值均>0.05)。两组均无患者发生反流、误吸。两组在各时间点的HR、MAP、SpO2...     

Relationship between serum gonadal hormone levels and synkinesis in postmenopausal women and man with idiopathic facial paralysis

ObjectiveTo investigate whether serum gonadal hormone levels are correlated to the development of facial synkinesis following Bell's palsy in postmenopausal women and man.MethodsA total of 149 patients with Bell's palsy were enrolled in this study. All patients were instructed in standard treatment strategy by expert staff from their first visit. The degree of synkinesis was evaluated at 12 months after the onset of facial nerve palsy based on the synkinesis scores of Sunnybrook facial grading system. The patients were divided into two groups by gender.ResultsSerum estradiol levels were significantly higher in patients with facial synkinesis than in patients without facial synkinesis following Bell's palsy in postmenopausal female. Male patients with facial synkinesis following Bell's palsy had a higher serum estradiol and testosterone levels. Baseline ENoG values (OR=11.144, 95% CI=1.001-124.126, p=0.008) and serum estradiol levels (OR=1.145, 95% CI=1.033-1.270, p=0.010) were the two independent predictors for facial synkinesis in postmenopausal female patients. Meanwhile, baseline ENoG values (OR=5.312, 95% CI=0.626-45.069, p=0.035), HbA1c values (OR=27.470, 95% CI=2.001-43.084, p=0.016), serum E2 levels (OR=1.298, 95% CI=1.092-1.542, p=0.003), and serum testosterone levels (OR=1.892, 95% CI=1.309-2.734, p=0.001) were the independent predictors for facial synkinesis in male patients.ConclusionSerum estradiol levels are associated with the development of facial synkinesis following Bell's palsy in postmenopausal female patients. Serum estradiol and testosterone levels are associated with the development of facial synkinesis following Bell's palsy in male patients. Serum gonadal hormone levels might be acted as potential biomarker for predicting facial synkinesis following Bell's palsy.     

The potential use of virtual reality in vestibular rehabilitation of motion sickness

ObjectiveMotion sickness (MS) can be triggered by direct or indirect stimuli due to mismatches in the visual-vestibular autonomic pathways. Various studies in the literature have shown that virtual reality technologies can generate provocative stimuli for MS. Therefore, our primary aim is to investigate the usability of virtual reality systems in MS rehabilitationMethods20 normal and 19 MS patients were included. A total of six virtual reality rehabilitation sessions (VRrs) with a game called “Roller Coaster Dreams” playable via PlayStation VR Head Mounted Display were applied thrice a week for 2 weeks, or twice a week for 3 weeks. Participants were evaluated at the pre-rehabilitation phase twice and after third and sixth rehabilitation sessions with the sensory organization test (SOT). The effectiveness of the rehabilitation program was statistically analyzed by comparing the results of SOTs.ResultsAll SOT results of the patient group were compared each other to evaluate the effectiveness of rehabilitation. According to the post-hoc comparisons, a statistically significant difference was found between the 1st, 2nd, 3rd, and 4th SOT- Equilibrium Scores; Condition 2 (p = 0.043), Condition 3 (p = 0.006), Condition 4 (p = 0.031), Condition 5 (p = 0.002) and Condition 6 (p = 0.040). There is no difference obtained in Condition 1 (p > 0.05). The Equilibrium Scores of SOT 3rd and SOT 4th were similar and 4th SOT-Equilibrium Scores were the highest among all SOT measurements. The results show that while the first three sessions were accepted as an orientation and adaptation sessions, 4^th, 5^thand 6^th sessions are habilitation sessions.ConclusionsVR proved to be significantly effective and useful for MS rehabilitation. Additionally, observations indicated that using VR makes rehabilitation fun, increases the efficiency of the process, and reduces the risk of inadaptability to exercise.     

小儿肺咳颗粒联合头孢西丁钠治疗小儿支气管肺炎的临床研究

目的 探讨小儿肺咳颗粒联合头孢西丁钠治疗小儿支气管肺炎的临床疗效。方法 选取2020年11月-2022年11月上海健康医学院附属崇明医院儿科收治的136例支气管肺炎患儿,按照随机数字表法分为对照组和治疗组,每组各68例。对照组患者静脉滴注注射用头孢西丁钠,1 g加于0.9%氯化钠注射液100 mL,1次/d。治疗组在对照组基础上口服小儿肺咳颗粒,3 g/次,3次/d。两组用药7 d。观察两组的临床疗效和临床症状好转时间,比较两组患儿白细胞（WBC）、中性粒细胞（NEUT）、白细胞介素-8（IL-8）、血清样淀粉蛋白A （SAA）、血清降钙素原（PCT）、C反应蛋白（CRP）水平。结果 治疗后,治疗组总有效率97.06%,显著高于对照组的85.29%（P<0.05）。治疗后,治疗组发烧、咳嗽、气喘、肺部啰音等症状好转时间均显著短于对照组（P<0.05）。治疗后,两组WBC、NEUT水平均显著低于治疗前（P<0.05）;治疗后,治疗组WBC、NEUT水平低于对照组（P<0.05）。治疗后,两组IL-8、PCT、SAA、CRP水平均较治疗前显著降低（P<0.05）;治疗后,治疗组IL-8、PCT、SAA、CRP水平显著低于对照组（P<0.05）。结论 小儿肺咳颗粒联合头孢西丁钠治疗小儿支气管肺炎效果确切,能有效降低肺炎相关症状,增强患儿的免疫能力,降低机体炎性反应,值得临床借鉴应用。     

岛状皮神经营养血管皮瓣在四肢远端创面修复中的应用

目的探讨利用岛状皮神经营养血管皮瓣修复四肢远端创面的临床效果。方法 利用岛状皮神经营养血管皮瓣修复四肢远端创伤38例,其中低旋转点腓肠神经营养血管皮瓣14例,隐神经营养血管皮瓣5例,足背皮神经营养血管皮瓣3例,掌背皮神经营养血管皮瓣8例。前臂内侧皮神经营养血管皮瓣4例,前臂后侧皮神经营养血管皮瓣4例。术前运用彩色超声血流成像技术探查供血穿支位置、管径、血流及伴行静脉,评价血管质量,为皮瓣设计提供参考。结果 34例皮瓣完全成活。1例腓肠神经营养血管皮瓣远端1cm坏死,1例隐神经营养血管皮瓣中末1/3坏死,创面愈合。2例掌背皮神经营养血管皮瓣远端局部坏死,换药后创面愈合。结论皮神经营养血管皮瓣修复手足远端创伤,成活率较高,操作简单,可较好地满足手足形态恢复和功能重建的需要。     

A超和IOL Master测量人工晶状体度数的差异性研究

目的：比较A超和IOL Master在人工晶状体度数测量方面的差异性。
　　方法：选取226例230眼年龄相关性白内障患者,术前分别采用A超和IOL Master测量眼轴长度、自动验光仪测量角膜曲率,使用SRK-T公式计算需要植入的人工晶状体度数,术后3 mo使用自动验光仪测量角膜曲率,用综合验光仪检查患者屈光状态并分析。
　　结果：所有患眼使用A超和IOL Master测得的平均眼轴长度分别为23.48±1.94、23.75±1.96mm,两组数据对比差异有统计学意义(P<0.05);随机分组后A超组术前平均角膜曲率为43.94±1.81D,术后为43.98±1.87D,两者比较差异无统计学意义(P>0.05),IOL Master组术前平均角膜曲率为44.10±1.57D,术后为44.11±1.58D,两者比较差异无统计学意义( P>0.05);A 超组和 IOL Master 组术后的平均绝对屈光误差( mean absolute refractive error,MAE)分别为0.47±0.27、0.41±0.19D,两组比较差异有统计学意义(P<0.05)。
　　结论：IOL Master在人工晶状体度数测量中略优于A超测量。     

吗啡镇痛对晚期肝癌患者血清TNF-α及IL-6水平影响的分析

目的考察吗啡镇痛对晚期肝癌患者血清TNF-α及IL-6水平影响。方法将120例晚期肝癌患者随机分为曲马多缓释片组和吗啡组,每组60例。曲马多缓释片组给予曲马多缓释片片口服治疗,吗啡组给予口服硫酸吗啡缓释片治疗。比较两组患者镇痛效果、不良反应和血清TNF-α及IL-6水平。结果吗啡组镇痛效果显著优于曲马多缓释片组(P<0.05)。吗啡组患者不良反应发生率显著高于曲马多缓释片组(P<0.05)。吗啡组患者镇痛后1周和1个月时血清TNF-α及IL-6水平显著低于曲马多缓释片组(P<0.05)。结论吗啡镇痛可有效降低晚期肝癌患者血清TNF-α及IL-6水平。     

应用单侧多功能外固定器治疗股骨转子间骨折（附74例报告）

我院自１９９１ 年以来应用单侧多功能外固定器治疗股骨转子间骨折７４ 例。骨折中后期支架动力化使骨折部位相互挤压致骨痂按生理需要塑造。平均临床愈合时间为 ７０ 天。随访效果良好,骨折全部愈合;无髋内翻、肢体短缩、死亡等严重并发症出现。此法具有操作简单、创伤小、出血少、活动早、康复快、感染率低等优点,值得推广运用。     

慢性阻塞性肺疾病频发加重表型患者危险因素分析

目的分析导致慢性阻塞性肺疾病频发急性加重表型患者,频发加重的可能危险因素。方法收集2016年01月至2017年01月在上海交通大学医学院附属新华医院崇明分院呼吸科住院患者中被诊断为慢阻肺急性加重期的患者,根据患者急性加重发作频率,纳入51例频发急性加重表型患者并随访1年,观察1年内再次频发加重的患者比例及临床特征,采用logistic回归对可能危险因素进行分析比较。结果二分类logistic回归分析发现,高龄(年龄≥77岁)、男性、未戒烟、CAT≥14分以及FEV 1pred<50%均可能是慢阻肺频发加重表型患者急性加重的危险因素,多元logistic回归分析结果表明CAT≥14分的患者急性加重≥2次的风险[OR(95%CI)]为[2.53(1.17–6.3),P=0.0374],而FEV 1pred<50%的患者急性加重≥2次的风险[OR(95%CI)]为[8.69(1.68~47.1),P=0.0074],提示FEV 1pred<50%和CAT≥14分可能为慢阻肺频发加重表型患者发生急性加重的独立危险因素。结论FEV 1pred<50%、CAT≥14分为慢阻肺频发加重表型患者发生急性加重的独立危险因素。