创伤性心搏骤停复苏中辅以特殊急救技术的应用

目的　研究特殊急救技术在创伤性心搏骤停的复苏过程中应用的效果。方法　在创伤性心搏骤停病人进行常规心肺脑复苏的同时 ,应用外周静脉穿刺中心静脉置管、手控式通气与机械通气相结合、体液复苏、急诊开胸心肺复苏、紧急床旁临时心脏起搏等特殊急救技术进行救治。结果　 2 2例创伤性心搏骤停病人 ,10例复苏成功。结论　对创伤性心搏骤停病人应尽快、尽早、有效地实施心肺脑复苏 ,同时快速综合应用特殊的急救技术有助于常规复苏的成功     

Hangman骨折的颈后路CerviFix系统固定治疗

目的探讨颈后路CerviFix系统固定C_(2～3)治疗Hangman骨折的适应证及疗效。方法2002年6月~2004年1月在新鲜的Hangman骨折患者中选择6例C_(2～3)不稳(MRI示C_(2～3)椎间盘形状和信号无明显改变、前纵韧带连续)行颈后路C2椎弓根螺钉、C3侧块螺钉的CerviFix系统固定术。6例患者中LevineEdwardsI型2例,IIa型3例,IIb型1例;脊髓损伤Frankel分级D级1例,E级5例。结果手术均顺利完成,未发生手术并发症,术前脊髓损伤FrankelD级的1例术后恢复至E级,骨折于术后6~12周愈合;颈椎无畸形、活动无明显受限,颈部无明显不适,未出现内固定物松动、断裂方面的并发症;2例于术后1年骨折愈合后取出内固定物并且C_(2～3)仍保持稳定。结论颈后路CerviFix系统固定C_(2～3)选择性治疗部分Hangman骨折,术后可以获得骨折端良好的复位固定和C_(2～3)间稳定性的即刻重建,为骨折愈合和C_(2～3)间韧带修复创造条件,疗效满意。其适应证为C椎间盘和韧带解剖结构完整但不稳定的Hangman骨折。     

Asthma Severity: The Patient's Perspective

Background: Although asthma is a common condition, limited epidemiological data exists on the distribution or course of asthma severity. We know even less about how patients or parents rate the severity of their or their child's asthma or what factors they associate with more severe asthma. A large nationally diverse sample of asthma patients' self-assessment of severity is available but has not been analyzed to look at asthma severity from the patients' perspective. Method: Data from the “household” and “event” files from the 1999 Medical Expenditure Panel Survey were combined to obtain a distribution of patient-reported asthma severity and the health care utilization, medication usage, and personal characteristics associated with different levels of self-reported severity for that subgroup that answered the chronic disease portion of the survey. Results: Almost two thirds of patients (63% of adults) or parents (65% of children) described their or their child's asthma as very or somewhat serious. Among both children and adults, more severe asthma was associated with greater numbers of missed school and workdays, and lower overall health status. The associated differences in health utilization varied by age. Models of severity based on available NAEPP criteria explained less than 10% of the participant's variation in self-reported asthma severity. Conclusion: Parents and patients with asthma appear to use different metrics than physicians and researchers to define the more severe categories of asthma. This disparity suggests the need for an asthma measure that is more widely understood, and accepted by patients and clinicians to serve as a tool to improve asthma-related communications and the achievement of mutually determined therapy goals.     

Traumatic spinal cord injury: a neuropathological study on the longitudinal spreading of the lesions

Eight patients died after traumatic spinal cord injuries. At autopsy, neuropathological examination revealed longitudinal spreading of cord lesions in two of these patients. One developed progressive paralysis 43 h after fracture of the fifth cervical (C5) vertebra and died 38 days after injury. Necrotic lesions extended upward to the medulla oblongata and downward to the C7 cord segment. Pencil-shaped necrosis (C7–T4) and marginal spongiosis (C7–T2) were also found. A second patient died 5 months after C5 subluxation with tetraplegia. His spinal cord was severely compressed at C4/5 and pencil-shaped necrosis, which had become partially cystic, extended upward to C3 and downward to T1; marginal spongiosis was also found in C4–C5. In both cases, complete necrosis without cell reaction was found in several cord segments, including the initially impacted segment. These findings suggest that intra- and extramedullary circulatory impairment occurred not only at the initial impact level, but also in the adjacent levels. Increased intramedullary pressure, resulting from this circulatory disturbance, in combination with a narrowed spinal canal, may induce the upward and downward spreading of the lesion. Received: 22 February 1996 / Revised, accepted: 11 July 1996     

Global versus factor-related impression of severity in Parkinson's disease: a new clinimetric index (CISI-PD).

In Parkinson's disease (PD), the Clinical Global Impression of Severity (CGIS) is often used as an additional outcome in clinical trials. It is hypothesized that this measure summarizes clinical assessment and is mainly influenced by the rating of four domains, namely, motor signs, disability, motor complications, and cognitive impairment. Ratings of these four factors were combined to form a new Clinical Impression of Severity Index for Parkinson's Disease (CISI-PD). A sample of 150 PD patients was evaluated using the following scales: Hoehn and Yahr staging, Schwab and England scale, Unified Parkinson's Disease Rating Scale, Scales for Outcomes in Parkinson's Disease-Motor Scale, CGIS, and CISI-PD. The results show that the CGIS is closely related to the above-mentioned measures (r=0.49-0.89). CISI-PD correlation with these scales was very similar (r=0.55-0.91), to the extent that the difference between corresponding coefficients was systematically less than 0.10. A multiple regression model showed that 92% of the CIGS variance was explained by the four CISI-PD items. Finally, the CISI-PD displayed adequate psychometric properties, with satisfactory internal consistency (alpha=0.90) and convergent (r>0.75) and known-groups validity. The CISI-PD is a valid and reliable measure that expands the information obtained via the CGIS.     

孕妇创伤性颅脑损伤临床特点与治疗

为提高孕妇颅脑损伤的救治水平,作者对22例孕妇颅脑损伤的临床资料进行分析,并观察东莨菪碱治疗作用。结果表明,脑挫裂伤合并脑内灶性出血多见(14/22),颅内血肿发生率低(8/22)。东莨菪碱对高颅压患者具有一定的降颅压作用。本组9例开颅手术,13例保守治疗。随访:2例轻残,20例治愈;婴、幼儿发育正常。结论:孕妇颅脑损伤及时正确处理,不影响正常妊娠。东莨菪碱尤其适用于妊娠高血压合并脑外伤患者。     

外伤性增生性玻璃体视网膜病变的电镜观察

目的：探讨外伤性增生性玻璃体视网膜病变（traumatic proliferative vitreoretinopathy,tPVR)细胞增生的特征。方法：对10例tPVR的玻璃体切除标本进行了透射电镜观察。结果：tPVR的增生特征以成纤维细胞及胶原纤维为主。3例标本可见吞噬细胞及色素颗粒，4例标本可见少数视网膜色素上皮（RPE）细胞，3例可见血管组织。结论：tPVR以纤维增生为主；玻璃体出血可引起以巨噬细胞为主的炎症反应，刺激增生；有血管参与tPVR的增生过程。     

外伤性颈内动脉海绵窦瘘栓塞治疗

目的通过对15例外伤性颈内动脉海绵窦瘘(TCCF)的血管内可脱球囊栓塞治疗，总结球囊栓塞的优点。方法15例TCCF均使用球囊栓塞。结果其中14例次性栓塞成功．1例不全栓塞，经随访半年仍获满意疗效。所有病例颈内动脉均保持通畅。结论球袭栓塞应作为治疗TCCF的首选方法。     

彩色多普勒超声在急性阴囊肿痛诊断中的应用

目的评价彩色多普勒超声(CD)在急性阴囊肿痛诊断及鉴别诊断中的应用价值。方法应用CD对53例急性阴囊肿痛患者进行急诊检查。观察阴囊内容物的形态、回声、结构及血流变化。经手术或临床治疗随访证实诊断。结果53例阴囊急症中,37例经非手术治疗及超声随访证实诊断,16例经手术及病理确诊。CD诊断准确率98%(52/53)。其中,睾丸扭转92%(12/13),睾丸、附睾炎100%(28/28),阴囊外伤100%(9/9),阴囊皮肤感染100%(3/3)。结论CD不仅能够区别睾丸扭转和炎症,并能鉴别肿瘤与炎症,还可评价阴囊外伤的程度及预后,因而它可作为诊断急性阴囊肿痛的首选方法。     

小儿外伤性脑梗塞的早期诊断与治疗(附36例临床观察)

目的探讨小儿外伤性脑梗塞的诊断与治疗。方法对36例小儿外伤性脑梗塞进行临床观察及脑CT、MRI扫描。结果确切的头颈部外伤史，伤后抽搐、无严重意识障碍．1～6d后出现偏瘫、失语等临床表现，头颅CT、MRI检查可提高小儿外伤性脑梗塞早期诊断的准确性。结论小儿外伤性脑梗塞以基底节区多见。给予脱水，扩血管及神经保护剂、钙离子通道拮抗剂、激素等药物应用治疗预后良好。