双侧肩胛舌骨肌合并肌皮神经变异一例

笔者在解剖一具老年男尸时,发现其两侧肩胛舌骨肌发出副肌与胸骨舌骨肌或胸骨甲状肌的肌纤维融合.同时两侧的肌皮神经与正中神经之间存在交通支变异.检索文献发现此种变异十分少见,为积累国人解剖学资料并为临床手术提供参考,现报道如下. 左侧的肩胛舌骨副肌位于肩胛舌骨肌的内侧,两者共同肌起自肩胛切迹内侧的肩胛骨上缘.该肌由外下向前内行走,在颈外静脉的深面,颈内静脉的浅面,距胸骨颈静脉切迹上方2.5 cm处,肌纤维经胸骨甲状肌的外侧缘进入并与该肌融合.副肌呈三角形,长10.9 cm,厚0.5 cm,起点处宽0.3 cm,并入处宽1.9 cm.副肌由左侧舌下神经袢发出的肌支,从前面进入支配该肌(图1).     

TV1＞TV5(TV6)综合征在冠心病诊断中的价值

关于TV1>TV5(TV6)综合征(下称TV1>TV5)能否作为诊断冠心病的参考依据之一临床存在争议。现对244例TV1>TV5患者的冠状动脉造影、次极量心电图运动试验检查结果进行分析,旨在探讨TV1>TV5在冠心病诊断中的价值。资料与方法:244例TV1>TV5患者,男126例,女98例;年龄36～78岁;平均61.8岁。病程3d～21a。参照《临床心电图学》(黄宛编,第4版)诊断标准,V1或V2导联正向T波高度大于V5、V6导联T波高度,且无ST段改变,TV1振幅>TV5(TV6),均有不同程度的胸痛、胸闷等症状。除外急性心肌梗死、陈旧性心肌梗死,预激综合征、束支传导阻滞及心室肥…     

患者参与助力医院信息化建设的思考与实践

介绍患者参与内涵,分析患者参与在医院信息化建设中的作用,探讨医院信息化建设中患者参与的方式及相关实践情况,提出建议,包括建立激励机制、加强患者宣教、提供政策支持等.     

黄连解毒汤及其拆方对高脂高糖模型小鼠血脂和血糖的影响

目的 探讨黄连解毒汤及其拆方对高脂高糖模型小鼠血脂及血糖的影响。方法 雄性KM小鼠随机分为黄连解毒汤组、黄连黄柏栀子组、黄连黄柏黄芩组、黄连黄柏组、黄连组、黄芩栀子组、辛伐他汀组、模型组、正常对照组9组。每周测量小鼠体质量,4周后检测小鼠血脂(血清总胆固醇、甘油三酯及血糖)水平。结果 与正常对照组比较,模型组的总胆固醇、甘油三酯及血糖均明显升高,差异有统计学意义(P < 0.01);与模型组比较,中药各组及辛伐他汀组的总胆固醇、甘油三酯均明显降低,黄连黄柏黄芩组、黄连黄柏组的血糖明显降低(P < 0.01,P < 0.05);其中黄连黄柏栀子组的总胆固醇、甘油三酯明显低于黄连黄柏黄芩组、黄连黄柏组、黄芩栀子组,差异有统计学意义(P < 0.01);黄连黄柏栀子组的总胆固醇低于黄连解毒汤组、黄连组,差异有统计学意义(P < 0.05);黄连解毒汤组、黄连组的总胆固醇均低于黄连黄柏黄芩组、黄连黄柏组、黄芩栀子组,差异有统计学意义(P < 0.05)。各组小鼠在给药前体质量的差异无统计学意义(P > 0.05),给药4周时黄连黄柏组、辛伐他汀组的体质量低于模型组,差异有统计学意义(P < 0.05)。结论 黄连解毒汤及其拆方组合均有降低高脂高糖模型小鼠总胆固醇、甘油三酯的作用,其中黄连黄柏栀子组的降脂效果优于黄连解毒汤组、黄连黄柏黄芩组、黄连黄柏组、黄连组及黄芩栀子组。黄连黄柏黄芩组及黄连黄柏组能降低高脂高糖饮食小鼠的血糖。     

《黄帝内经》释梦与弗洛伊德《梦的解析》理论融汇

我国现存最早的医学巨著《黄帝内经》积累了大量医学经验,释梦学说也已经系统化、理论化,这与精神分析学派的开山鼻祖弗洛伊德关于梦的理论有异曲同工之妙,本文就《黄帝内经》和《梦的解析》的理论分析,从整体观、阴阳学说、五行理论出发,探索中西理论在梦学说的交汇融合,并就释梦在医学上的作用提出相关展望。     

乌司他丁对危重患者器官功能保护作用的研究

目的 探讨乌司他丁对危重患者器官功能的保护作用及其机制.方法 将2005年10月-2007年7月入住本院重症加强治疗病房(ICU)的60例危重患者随机分为治疗组(30例)和对照组(30例).对照组接受常规治疗;治疗组在常规治疗基础上加用乌司他丁,依病情每次静脉给予200～400 kU,每日2～4次,疗程5～7 d.均于两组患者入ICU即刻及3、5和7 d清晨抽取肘静脉血检测丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、肌酐(Cr)、尿素氮(BUN)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)及氧合指数(PaO2/FiO2);并记录是否使用呼吸机辅助呼吸、是否进行血液透析治疗以及终点结果.结果 治疗组呼吸机使用率(23.3%)、肝功能障碍率(3.3%)、肾功能异常率(10.0%)及病死率(3.3%)均明显低于对照组(分别为63.3%、23.3%、46.7%、10.0%,P<0.05或P<0.01).治疗组上述各指标的改善程度也明显好于对照组,其中5 d和7 d时AST、BUN、Cr及PaO2/FiO2差异有统计学意义(P<0.05或P<0.01),而ALT、APTT、FIB则差异无统计学意义(P均0.05).仅对照组有1例进行血液透析.结论 乌司他丁对危重患者肝、肾、肺功能有明显保护作用,能降低危重患者多器官功能障碍综合征(MODS)的发生率及病死率.     

基于行动研究法构建的延伸护理对慢性肾功能衰竭血液透析患者自我管理及肾功能的影响

目的探讨基于行动研究法构建的延伸护理在慢性肾功能衰竭(CRF)血液透析患者中的应用效果。方法选取2019年7月至2021年7月我院收治的CRF患者94例,按照随机数字表法将其分为两组,每组各47例。对照组采取常规干预,观察组实施基于行动研究法构建的延伸护理,干预2个月。比较两组自我管理能力、肾功能和护理满意度。结果观察组干预后自我护理能力测定量表(ESCA)评分高于对照组,血清肌酐(SCr)、血尿素氮(BUN)和血尿酸(UA)均低于对照组,护理满意度为95.74%,高于对照组的82.98%,差异有统计学意义(P<0.05)。结论基于行动研究法构建的延伸护理能够提升患者自我管理能力,改善肾功能,从而促进护理满意度的提升。     

Early risk factors for death in neonates with persistent pulmonary hypertension of the newborn treated with inhaled nitric oxide北大核心CSCD

Objective To evaluate the early risk factors for death in neonates with persistent pulmonary hypertension of the newborn (PPHN) treated with inhaled nitric oxide (iNO). Methods A retrospective analysis was performed on 105 infants with PPHN (gestational age ≥34 weeks and age <7 days on admission) who received iNO treatment in the Department of Neonatology, Children's Hospital of Nanjing Medical University, from July 2017 to March 2021. Related general information and clinical data were collected. According to the clinical outcome at discharge, the infants were divided into a survival group with 79 infants and a death group with 26 infants. Univariate and multivariate Cox regression analyses were used to evaluate the risk factors for death in infants with PPHN treated with iNO. The receiver operating characteristic (ROC) curve was used to calculate the cut-off values of the factors in predicting the death risk. Results A total of 105 infants with PPHN treated with iNO were included, among whom 26 died (26/105, 24.8%). The multivariate Cox regression analysis showed that no early response to iNO (HR=8.500, 95%CI: 3.024-23.887, P<0.001), 1-minute Apgar score ≤3 points (HR=10.094, 95%CI: 2.577-39.534, P=0.001), a low value of minimum PaO2/FiO2 within 12 hours after admission (HR=0.067, 95%CI: 0.009-0.481, P=0.007), and a low value of minimum pH within 12 hours after admission (HR=0.049, 95%CI: 0.004-0.545, P=0.014) were independent risk factors for death. The ROC curve analysis showed that the lowest PaO2/FiO2 value within 12 hours after admission had an area under the ROC curve of 0.783 in predicting death risk, with a sensitivity of 84.6% and a specificity of 73.4% at the cut-off value of 50, and the lowest pH value within 12 hours after admission had an area under the ROC curve of 0.746, with a sensitivity of 76.9% and a specificity of 65.8% at the cut-off value of 7.2. Conclusions Infants with PPHN requiring iNO treatment tend to have a high mortality rate. No early response to iNO, 1-minute Apgar score ≤3 points, the lowest PaO2/FiO2 value <50 within 12 hours after admission, and the lowest pH value <7.2 within 12 hours after admission are the early risk factors for death in such infants. Monitoring and evaluation of the above indicators will help to identify high-risk infants in the early stage. © 2022 Xiangya Hospital of CSU. All rights reserved.