胸椎错位并心律异常13例临床报告

目的 探讨脊柱源性心律紊乱的主要发病部位。方法 对13例脊柱病变引发的心律紊乱，主要以纠正上胸段错位为主，采用理筋、整脊和功能锻炼治疗。结果 经治疗均临床治愈，随访半年以上无复发。结论 脊源性心律紊乱主要部位在胸椎。     

改良Kugel补片前入路腹膜前修补腹股沟疝(附35例报告)

目的 探讨改良Kugel补片前入路腹膜前修补腹股沟疝效果. 方法 2004年5月～2006年6月,应用改良Kugel补片修补腹股沟疝35例.手术要点：疝囊高位游离后将其翻转还纳腹腔,围绕内环口游离一个10 cm×10 cm的腹膜前间隙,将改良Kugel补片置于游离的腹膜前间隙,用2-0的Prolene线将固定带的上瓣固定于联合腱,下瓣固定在腹股沟韧带反折处. 结果 手术时间（47±10）min,术后均未使用止痛剂,术后住院天数（6±4）d.全组伤口一期愈合,无伤口浆液肿及感染发生.35例术后随访1～25个月,平均13.2月,其中26例随访＞12个月,无复发. 结论 改良Kugel补片修补腹股沟疝具有伤口疼痛和肿胀轻的优点, 特别适合Ⅲ、Ⅳ型疝修补.     

经峡部径路行甲状腺手术的术式改进

目的探讨经峡部径路行甲状腺手术的临床价值。方法回顾性分析10年间575l例行甲状腺手术患者的临床资料。按手术方式分为两组：经峡部径路甲状腺切除术的3288例为改良组；同期施行传统切除术式的2463例为常规组。比较两种手术方式对手术时间、术中出血、术后引流及并发症的影响。结果改良组手术时间较常规组明显缩短（P〈0．01），术中出血量、喉返神经神经损伤率、术后气管局部不适及低钙血症的发生率明显减少（P〈0．01），术后引流量减少（P〈0．05），患者对手术耐受性好，术后出血发生率两组无统计学差异。结论经峡部径路行甲状腺手术可明显缩短手术时间；减少术中出血量，以及降低喉返神经损伤、术后出血、低钙血症等并发症的发生。     

One-year outcome after first-ever stroke according to stroke subtype, severity, risk factors and pre-stroke treatment. A population-based study from Tartu, Estonia

The aim of the current study was to evaluate the outcome at 1 year following a first-ever stroke based on a population-based registry from 2001 to 2003 in Tartu, Estonia. The outcome of first-ever stroke was assessed in 433 patients by stroke risk factors, demographic data and stroke severity at onset using the Barthel Index (BI) score and the modified Rankin Score (mRS) at seventh day, 6 months and 1 year. Female sex, older age, blood glucose value >10 mmol/l on admission and more severe stroke on admission were the best predictors of dependency 1 year following the first-ever stroke. At 1 year, the percentage of functionally dependent patients was 20% and the survival rate was 56%. The use of antihypertensive/antithrombotic medication prior to stroke did not significantly affect the outcome. The survival rate of stroke patients in Tartu is lower compared with other studied populations. The outcome of stroke was mainly determined by the initial severity of stroke and by elevated blood glucose value on admission. Patients with untreated hypertension had more severe stroke and trend for unfavourable outcome compared with those who were on treatment.     

Inter-rater reliability of the original and modified Barthel Index,and a comparison with the Functional Independence Measure

The Barthel Index (BI), the Modified Barthel Index (MBI) and the Functional Independence Measure (FIM) are all widely used by occupational therapists as assessment tools for clinical decision-making and outcome measurement. All of these tools have demonstrated validity and the BI and the FIM have demonstrated inter-rater reliability. The MBI has been modified to increase sensitivity; however, there have been no publications on the inter-rater reliability of this tool following the changes. The purpose of this research was to examine the inter-rater reliability of two versions of the Barthel Index, and draw some comparisons between this assessment tool and the FIM. Twenty-five patients with neurological and orthopaedic conditions were assessed by three occupational therapists using the three tools. The method of analysis selected was percentage agreement and intraclass correlation coefficient. The results indicated that both the original and modified versions of the Barthel Index possess good inter-rater reliability. As all three tools have demonstrated adequate reliability and validity, it is suggested that clinicians select the most sensitive tool that best meets their clinical needs, and use this assessment tool in its standardized format.     

脑卒中患者日常生活能力的评定

采用Ｂａｒｔｈｅｌ指数对１２０例脑卒中住院患者在发病后５￣６周进行日常生活活动（ＡＤＬ）能力的证实。因脑卒中遗留的功能不全，ＡＤＬ的受损率达６６．７％，肢体的Ｂｒｕｎｎｓｔｒｏｍ功能分级与ＡＤＬ积分高度相关，相关性下肢高于上肢；多元逐步回归分析显示，躯体（偏瘫）和心理（认知障碍和抑郁因素）影响ＡＤＬ的能力。认为ＡＤＬ能力的提高，不仅依赖于肢体功能障碍的改善，提高认知功能，改善情感状况，对于脑卒中患     

异丙酚在无抽搐电休克治疗麻醉中的应用

目的 :研究异丙酚在无抽搐电休克治疗 (MECT)麻醉中的应用效果及安全性。方法 :34例首次住院的精神分裂症患者随机分为异丙酚组和硫喷妥钠组 ,每组 17例 ,每例完成 1个疗程 6次MECT治疗 ,每组完成 10 2人次治疗 (n =10 2 )。每次治疗时 ,异丙酚组给予异丙酚静脉麻醉 ,硫喷妥钠组给予硫喷妥钠静脉麻醉 ,全麻诱导后皆静注琥珀酰胆碱 ,待肌肉松弛后行MECT治疗。全程监测患者心电图、血氧饱和度、血压、心率、脉搏 ,并观察记录自主呼吸恢复时间。苏醒时间和不良反应 ,进行前瞻性研究。结果 :与硫喷妥钠组相比 ,异丙酚组自主呼吸恢复快 ,苏醒快 ,无咳嗽 ,呃逆 ,呕吐等不良反应 ,两组差异显著。而异丙酚组注射点疼痛发生率显著高于硫喷妥钠组。结论 :在MECT中应用异丙酚静脉麻醉是一种更安全、有效的方法。     

复方红芪减方对周围神经再生影响的实验研究

目的　研究复方红芪提取液进行减方后对周围神经再生的作用。方法　建立钳夹损伤大鼠双侧坐骨神经的动物模型。按术后每日灌服药物的不同将 40只SD雄性大鼠随机均分为 4组。对照组 :灌服生理盐水 ;复方红芪组 :灌服复方红芪提取液 2ml ;减方组 :灌服复方红芪减方后提取液 2ml;补阳还五汤组 :灌服补阳还五汤 2ml。术后 2周及 4周 ,观察坐骨神经功能指数、运动神经传导速度及单位视野有髓神经纤维计数。结果　坐骨神经功能指数 :红芪组和减方组与对照组、红芪组与减方组的差异均有显著意义 (P >0 .0 5 ) ,且减方组优于红芪组 (P >0 .0 5 )。有髓神经纤维计数 :复方红芪组优于对照组 (P<0 0 1) ,减方组明显优于对照组 (P <0 .0 1) ,而红芪组与减方组间无显著差异。运动神经传导速度 :红芪组、减方组、补阳还五汤组与对照组相比 ,均优于对照组 (P <0 .0 5 ) ,但前 3组间无明显差异。结论　复方红芪减方提取液早期可以促进周围神经再生 ,药效更为专一 ,且优于传统方剂补阳还五汤。     

67Ga心肌炎症显像对小儿病毒性心肌炎的诊断价值

目的 :探讨6 7Ga心肌显像对小儿病毒性心肌炎 (VMC)诊断的临床价值。方法 :静脉注射6 7Ga 枸橼酸盐 ,48h、72h后开始显像 ,观察心脏部位放射性浓聚情况 ,并计算心 /肺 (H/L)指数 ,根据H/L指数判断心肌炎性病变的严重程度 (H/L指数 >1.2为阳性 )。结果 :78例病毒性心肌炎患儿中 ,50例阳性 (占 64% ) ,其中急性期阳性率为 84% ,恢复期阳性率为 50 % ,慢性期为 2 9% ,急性期阳性率明显高于恢复期和慢性期 (P<0 .0 5)。结论 :心肌6 7Ga放射性浓聚与心肌炎病变程度呈正相关 ,直接反映了病变心肌的炎症反应情况 ,对诊断VMC有较高的临床价值 ,并对VMC治疗、预后有指导作用