鼠神经生长因子治疗Ramsay-Hunt综合征的疗效观察

摘要：目的观察鼠神经生长因子治疗Ramsay Hunt综合征的疗效。方法回顾性分析2010年1月~2013年12月收治的23例Ramsay Hunt综合征患者,随机分成两组,对照组（12例）予以常规抗病毒激素等支持对症处理,观察组（11例）在对照组治疗基础上予以鼠神经生长因子治疗。治疗前后分别对比两组患者H B面神经功能分级、起效时间、平均疗程,测定面神经传导速度。结果治疗后观察组较对照组在面神经功能分级、起效时间、平均疗程以及面神经传导速度上均有改善,差异具有统计学意义(P<0.05)。结论鼠神经生长因子治疗Ramsay Hunt综合征疗效好,临床上应尽早诊断及时治疗。

     

2004-2016年浙江省湖州市急性弛缓性麻痹病例流行病学分析

目的 了解浙江省湖州市15岁儿童急性弛缓性麻痹（AFP）病例流行病学特征,为制定防控策略提供参考依据。方法 对湖州市2004-2016年AFP病例进行描述流行病学分析,对残留麻痹影响因素进行单因素和多因素非条件logistic回归。结果 2004-2016年湖州市共报告15岁AFP病例128例,主要为散发。年平均发病率为2.32/10万。发病高峰多出现于每年1月、3月和8-10月,0~4岁组发病率较高,男性发病率高于女性,男女性别比为2.2:1。肠道病毒分离率为7.81%。10.16%的AFP病例在麻痹60 d后仍残留麻痹。多因素分析显示1岁发病、深部腱反射异常是AFP残留麻痹病例发生的危险因素。结论 提高儿童脊髓灰质炎疫苗接种率、加强临床医生培训、教育儿童养成良好卫生习惯、尽早对重症患者开展对症治疗,是降低儿童AFP病例致残率的有效措施。     

Comparison of EMG signals recorded by surface electrodes on endotracheal tube and thyroid cartilage during monitored thyroidectomy

A variety of electromyography (EMG) recording methods were reported during intraoperative neural monitoring (IONM) of recurrent laryngeal nerve (RLN) in thyroid surgery. This study compared two surface recording methods that were obtained by electrodes on endotracheal tube (ET) and thyroid cartilage (TC). This study analyzed 205 RLNs at risk in 110 patients undergoing monitored thyroidectomy. Each patient was intubated with an EMG ET during general anesthesia. A pair of single needle electrode was inserted obliquely into the TC lamina on each side. Standard IONM procedure was routinely followed, and EMG signals recorded by the ET and TC electrodes at each step were compared. In all nerves, evoked laryngeal EMG signals were reliably recorded by the ET and TC electrodes, and showed the same typical waveform and latency. The EMG signals recorded by the TC electrodes showed significantly higher amplitudes and stability compared to those by the ET electrodes. Both recording methods accurately detected 7 partial loss of signal (LOS) and 2 complete LOS events caused by traction stress, but only the ET electrodes falsely detected 3 LOS events caused by ET displacement during surgical manipulation. Two patients with true complete LOS experienced temporary RLN palsy postoperatively. Neither permanent RLN palsy, nor complications from ET or TC electrodes were encountered in this study. Both electrodes are effective and reliable for recording laryngeal EMG signals during monitored thyroidectomy. Compared to ET electrodes, TC electrodes obtain higher and more stable EMG signals as well as fewer false EMG results during IONM.     

中医辩证论治糖尿病胃轻瘫效果观察

 目的 探讨糖尿病合并胃轻瘫(diabetic gastroparesis,DGP)的中医证候及治疗。方法 选取我院收治的糖尿病合并胃轻瘫患者123例,采取数字随机法分成治疗组、对照1组和对照2组,各41例。对照1组给予西医常规治疗,对照2组则根据中医证候给予针对性治疗,治疗组给予中西医综合治疗方法,比较3组临床效果及不良反应发生率。结果 治疗组总有效率为97.56%,对照2组总有效率为95.12%,均高于对照1组的总有效率(73.17%),差异具有统计学意义(P<0.05);治疗组总有效率与对照2组比较,差异无统计学意义(P＞0.05)。治疗后不良反应发生率3组比较,差异无统计学意义(P＞0.05)。结论 中医治疗该病强调辨证论治,采用辨证论治可以收到确切的治疗效果。     

原发性干燥综合征合并Ⅰ型肾小管酸中毒继发低血钾性麻痹的临床特点

 目的 探讨原发性干燥综合征合并Ⅰ型肾小管酸中毒继发低血钾性麻痹的临床特点。方法 对18例原发性干燥综合征合并Ⅰ型肾小管酸中毒继发低血钾性麻痹患者临床资料进行回顾性分析,总结其临床特点。结果 11例以低血钾性麻痹为首发症状,7例以眼干、口干为首发症状。18例均表现为发作性四肢无力,10例出现代谢性骨病,其中9例诊断骨质疏松,1例诊断骨软化症。结论 原发性干燥综合征合并Ⅰ型肾小管酸中毒继发低血钾性麻痹有典型临床表现,早期诊断可以早治疗。     

温针灸联合中医辨证治疗周围性面瘫及对表面肌电图的影响

目的:探讨温针灸联合中医辨证治疗周围性面瘫的临床疗效以及对患者表面肌电图(s EMG)检测指标的影响。方法:选取2016年5月至2017年12月成都市第三人民医院收治的周围性面瘫患者60例,随机分为观察组与对照组,每组30例。对照组采用常规穴位进行针灸治疗,观察组应用温针灸联合中药辨证治疗,2周为1个疗程,2组患者共治疗2个疗程,于治疗前后应用House-Brackmann(H-B)面神经功能评价分级系统评价患者面神经功能恢复情况,治疗结束后采用s EMG观察患者面部肌群恢复情况,统计临床疗效。结果:治疗后,观察组治疗有效率96.67%显著高于对照组的80.00%(P0.05);治疗后2组患者H-B评分均较治疗前有所下降,且治疗后14 d、21 d、28 d观察组低于对照组(P0.05);观察组痊愈时间较对照组短(P0.05)。治疗结束后,观察组颊肌群、口轮匝肌群、额肌群及鼻肌群RMS值均高于对照组(P0.05)。结论:温针灸联合中医辨证治疗周围性面瘫可明显改善患者面神经功能,提高治疗有效率,缩短治疗时间;同时s EMG可客观准确地进行预后评估。     

胰岛素促进低血钾型周期性麻痹机制的研究进展

低血钾型周期性麻痹（hypokalemic periodic paralysis,HPP）是一组与细胞内外K+跨膜转移异常相关的疾病。该病在发病前通常伴有明显的诱因,这些诱因均可导致体内胰岛素水平升高,促进细胞外K+向细胞内转移,从而诱发HPP的发作。HPP患者骨骼肌细胞膜上存在通道基因CACNA1S或SCN4A突变。胰岛素在突变基础上激发HPP的发作。作者对其相关机制的研究进展进行综述。     

Downhill Skiing Injuries

In brief: Lower extremity injuries are common in downhill skiing. Fifty-three percent of the skiing injuries in one study, and 81% in another, were below the knee. Twelve case reports are presented and their treatment is discussed. The author suggests that skiers undertake a physical fitness program to increase stamina and elasticity of muscles and ligaments.     

2012年天津市河西区急性弛缓性麻痹病例监测结果

目的评价天津市河西区2012年急性弛缓性麻痹（AFP）监测系统以及病例的流行病学特征,提升监测工作质量。方法采用描述流行病学方法分析河西区2012年AFP监测病例数据。结果2012年监测AFP病例68例,其中天津市病例30例,外省市病例38例。其中63例采集到双份粪便标本,合格便标本61例,合格便标本采集率89．71％。其他工作亦达到监测工作标准要求。结论AFP病例监测系统的敏感性达到要求。     

Temporary vocal fold immobility after chemocauterization of the pyriform sinus fistula opening with trichloroacetic acid

Pyriform sinus fistula (PSF) is a rare branchial pouch anomaly. Circumferential chemocauterization of the opening with trichloroacetic acid (TCA) is a simple, reliable treatment of choice with little morbidity. However, we experienced two cases of vocal fold immobility after chemocauterization of the PSF opening with TCA. Vocal fold mobility recovered spontaneously within 8 weeks in both cases. Herein, we report these cases in addition to a review of the literature.