中西医结合卒中单元对脑卒中恢复期患者的影响

目的 研究中西医结合卒中单元对脑卒中恢复期患者的影响.方法 456例脑卒中恢复期患者随机分为中西医结合组(中西组)和对照组,两组均按卒中单元模式实施治疗,中西组再加用中药辨证施治和针灸治疗.观察项目有:并发症发生率、Barthe指数(BI)、脑卒中残损评定法(SIAS)、牛津残障量表(OHS)、简明精神状态检查表(MMSE)、牛津残障量表(HRSD)等.结果 中西组并发症发生率低于对照组(P<0.05 ),中西组MMSE、HRSD出入院差值分别为(11.21±4.76)分与(-17.31±3.72)分,对照组分别为(7.57±2.28)分与(-9.12±2.42)分,两组比较有统计学意义(P<0.05),中西组SIAS、BI出入院差值分别为(24.76±12.32)分与(25.21±11.69)分,对照组分别为(16.17±6.49)分与(13.77±9.03)分,两组比较有统计学意义(P<0.05).中西组出院后2月随访OHS评测,轻中度残障者比例高于对照组(P<0.01),住院及随访期间,两组病死率及卒中复发率比较无统计学意义.结论 中西医结合卒中单元相对于西医卒中单元,对脑卒中恢复期患者更有益.     

电子支气管镜6000例次的体会

我院开展电子支气管镜术已达6000例次,年龄自15～58岁,大多用于诊断,治疗、药物灌注、危重窒息病人抢救等。历次术后并发症有较大的出血1例、哮喘发作2例、声门痉挛10例,经及时处理都转危为安,未发生文献报道的如:心脏停搏、气胸、纵隔气肿、感染发热、麻醉药过敏或中毒等并发症,今将我们的体会初步总结如下。一、电子支气管镜的安全性问题     

颈丛神经阻滞甲状腺手术辅助瑞芬太尼对麻醉效果和呼吸功能的影响

目的 观察瑞芬太尼加强甲状腺手术颈丛神经阻滞麻醉的效果和对呼吸功能的影响.方法 一侧甲状腺腺瘤行单纯腺瘤切除或单侧甲状腺次全切除术的患者40例,分为瑞芬太尼组(A组)和芬太尼+氟哌利组(B组),每组20例.施颈丛神经阻滞.手术开始后A组静脉输注瑞芬太尼0.05～0.1 μg· kg-1·min-1,B组静注芬太尼、氟哌利多.观察2组麻醉效果以及不同时点:基础(TO)、颈丛阻滞后10 min (T1)、手术开始(T2)、手术开始后10 min(T3)、肿瘤切除时(T4)和术毕(T5)时的RR、SpO2、SBP、HR值.结果 A组麻醉效果优良率高于B组(P<0.05).2组颈丛阻滞后各时点SBP、HR均较基础值升高(P<0.05或<0.01).肿瘤切除时(T4)的SBP、HRA组明显低于B组(P<0.05或<0.01).A组T3 、T4 、T5时RR、SpO2明显低于基础值(P<0.05或<0.01)并明显低于(T3RR除外)B组(P<0.05或<0.01).结论 以0.05～0.1 μg· kg-1·min-1的速度持续输注瑞芬太尼可以完善甲状腺手术颈丛神经阻滞麻醉效果,但对呼吸功能产生一定程度抑制.     

小剂量芬太尼麻醉诱导对气管插管心血管反应的影响

通过观察小剂量芬太尼 (F)在咪唑安定 (M)、依托咪酯 (E)、琥珀胆碱 (S)全麻诱导中对气管插管心血管反应的影响 ,以了解其有效性及与各麻醉诱导药物的最佳组合。1　资料与方法1 1　一般资料　气管内全麻患者 6 0例 ,无心血管及内分泌系统疾患 ,ASAⅠ～Ⅱ级 ,其中男 2 8例 ,女 32例 ,年龄 17～ 72岁 ,体重 4 5～ 86kg ,随机分为 4组 :Ⅰ组 (对照组 )、Ⅱ组 (M F组 )、Ⅲ组 (E F组 )、Ⅳ组 (S F组 ) ,每组 15例 ,各组患者一般情况具有可比性。1 2　麻醉方法　术前用药阿托品 0 5mg ,苯巴比妥钠 0 1g肌注。Ⅰ组诱导药物依次为咪唑安…     

济安舒能用于乳腺癌术后换药疗效观察

目的：探讨济安舒能在乳腺癌术后治疗中的换药效果。 方法：将124例病人随机分为观察组和对照组各62例,观察组选用济安舒能喷洒换药临床疗效。结果：两组创面愈合时间、治疗总有效率比较差异有统计学意义。结论：济安舒能治疗乳腺癌术后能缩短创面愈合时间,防止创面恶化,提高乳腺癌术后愈合治疗效果。     

还原型谷胱甘肽对糖尿病酮症酸中毒患者氧化应激的影响

目的: 探讨还原型谷胱甘肽(reduced glutathione,GSH)治疗糖尿病酮症酸中毒(diabetic ketoacidosis,DKA)患者时对氧化应激的影响。方法: 将47例DKA患者分为常规治疗组23例,加用GSH治疗组24例,检测2组患者治疗前后血超氧化物歧化酶(superoxide dismutase,SOD)活性、总抗氧化能力(total antioxidant capacity,TAC)、丙二醛(malondialdehyde,MDA)和晚期蛋白氧化产物(advanced oxidation protein products,AOPP)含量。结果: DKA患者应用GSH治疗后SOD和TAC均显著升高,且与常规治疗组治疗后差异均有统计学意义(P < 0.01),而治疗后AOPP较则明显降低,与常规治疗组治疗后差异有统计学意义(P < 0.01)。结论: GSH在治疗DKA时可明显降低氧化应激水平,对机体有保护作用。     

16层螺旋CT血管成像在胸部大动脉急症诊断中的应用价值

急性肺动脉栓塞、急性主动脉夹层是常见的胸部大动脉急症,二者临床症状及生化指标多有重叠,早期明确诊断对降低死亡率、选择合理的治疗方案有重要意义。16层螺旋CT由于其更快的扫描速度、更薄的扫描层面为临床胸部大动脉急症的诊断提供了快速准确的检查手段。     

常规MRI和1H-MRS在职业性锰暴露致中枢神经损害中的应用价值

Objective MRI and MR hydrogen proton spectroscopy (1H-MRS) were used to detect the abnormal signal and alteration of metabolites, in order to explore the efficacy of these method in evaluating the damages of central nervous system (CNS) induced by occupational manganese exposure.Methods Eighteen workers exposed to manganese without any manganism symptoms, 12 workers with slightly chronic manganese poisoning, and 19 healthy workers were scanned using routine MRI sequence and 1H-MRS.The blood manganese concentration was also collected for each subject.On cerebral axial T1 WI,the signal intensities of ipsilateral globus pallidus and frontal white matter were measured in the visually brightest area (try to select the signal homogeneous region), and the globus pallidus index (PI) was then calculated.The 1H-MRS data was calculated to get the values of the peak height of N-acetylaspartate (NAA), choline (Cho), inositol (mI) and creatine (Cr) and the ratios of NAA/Cr, Cho/Cr, and mL/Cr were also calculated.One way ANOVA was used to compare the values of PI, NAA/Cr, Cho/Cr, mI/Cr and MnB among the three groups, and the correlations between PI and the time span of manganese exposure or blood manganese concentration were analyzed by Pearson correlation analysis.Eight workers exposed to manganese were followed up one year, and their PI , NAA/Cr before and after follow-up were compared by t test.Results Fourteen of 18 cases exposed to manganese without any manganism symptoms showed symmetrically high intensity signal on T1 WI, while the T2 WI were normal.No high signal intensity was observed on T1WI in any of the healthy workers or manganese poisoning workers.We found that the average PI in manganese exposed group (1.16 ±0.09) was significantly higher (F =24.79 ,P =0.O00)than those of the poisoning ( 1.05 ± 0.07 ) and control groups ( 1.01 ± 0.05 ).The blood manganese concentration in manganese exposed group, the poisoning group and the control group were (0.051 ±0.024), (0.047 ±0.018 ), ( 0.043 ± 0.020 ) μg/ml respectively, which was not significantly different ( F = O.623, P =0.541 ) and did not exceed the upper limit of normal reference value ( < 0.10 μg/ml ).There was a significantly correlation between PI and the time span of manganese exposure ( r = 0.67, P = 0.002 ),however, there was no correlation between PI and blood manganese concentration ( r = 0.20, P = 0.427 ).Furthermore, the NAA/Cr ratio decreased variously in the manganese poisoning group ( 1.22 ± 0.07 ) which was significantly lower( F = 4.120, P = 0.023 ) than those of the poisoning( 1.33 ± 0.13 ) and control groups ( 1.31 ±0.13).No statistical significanees were found in the ratios of Cho/Cr and mI/Cr among these three groups(P>0.05).No obvious changes of the PI and NAA/Cr were found in the 8 manganese exposed workers after 1 year follow-up.Conclusion Manganese exposure could lead to the high intensity signal on T1 WI, therefore the increased PI may be the biomarkers of central nerve system damages caused by the occupational manganese exposure.     

64层螺旋CT在主动脉夹层支架置入术前及术后的应用与评价

目的：评价64层螺旋CT血管造影对主动脉夹层术前诊断及介入术后评估的价值。方法：回顾性分析我院行腔内隔绝术的14例主动脉夹层的术前及术后64层螺旋CT血管造影征象,并与DSA结果进行比较,分析2种方法对主动脉夹层的术前诊断及支架置入术后疗效评估的价值。结果：64层螺旋CT、DSA均对14例患者做出主动脉夹层的诊断和正确分型;2种方法均能清晰显示主动脉夹层真假腔及内膜片。64层螺旋CT共显示14例患者破口共27个,覆膜支架破口封堵术后内漏2个;DSA显示破口19个,介入术后内漏1个;两者在显示破口方面有明显差异（χ2=4.926,P=0.026）。结论：64层螺旋CT血管造影对主动脉夹层的诊断及介入术前及术后评估的价值优于DSA。