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1.

目的:利用光学相干断层扫描血管成像技术(OCTA)定量分析产后6mo以上妊娠期高血压综合征(PIH)患者的视网膜微循环变化。

方法:分别测量19例PIH患者、23例正常妊娠女性(HPW)及19例未妊娠女性(CNPW)的屈光度、最佳矫正视力及眼轴长度,并使用OCTA测量三组视乳头及黄斑区血流参数、神经纤维层厚度和脉络膜厚度。所有妊娠患者数据均采集自分娩6mo以后。运用统计软件SPSS20.0,单因素方差分析比较三组间视网膜微循环相关参数的组间差异。

结果:PIH组的黄斑区无灌注区面积(FAZ)明显大于HPW组和CNPW组(均P<0.05); 三组间的黄斑区各区域视网膜浅层血管密度无差异; PIH组的视乳头各区域浅层血管密度,其中视乳头整层6mm区域、外层、下外侧、鼻外侧高于HPW组和CNPW组; 视神经纤维层平均厚度三组间无差异,但PIH组的视神经颞侧纤维层厚度明显低于HPW组和CNPW组(均P<0.05); PIH组的黄斑中心区视网膜厚度明显低于HPW和CNPW(均P<0.05); 中心凹下脉络膜厚度三组间无差异。

结论:PIH患者产后视网膜部分区域血管密度、黄斑中心区厚度及颞侧视神经纤维层厚度与HPW及CNPW组间均存在差异,提示PIH对视网膜微循环的影响可能在产后仍持续存在。  相似文献   

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颈部筋膜及其周围间隙结构精密又复杂,当前解剖学认识尚不完全,且存在诸多争议。精细颈部筋膜解剖结构、合理运用筋膜间隙于临床指导锁骨手术麻醉方面意义重大;于颈部手术术中规范化操作,保护重要血管神经、减少术后并发症发生、改善预后等方面意义重大;于临床监测与诊治颈深部间隙感染等方面意义重大。  相似文献   
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The effectiveness of anterior serratus plane block in postoperative analgesia of thoracic surgery is beginning to emerge. Currently, there are 2 methods of anterior serratus plane block: deep serratus plane block (DSPB) and superficial serratus plane block (SSPB). In clinical practice, there is no an unified view regarding the advantages and disadvantages between 2 methods. This study aimed to observe and compare the analgesic effects of 2 methods on patients undergoing thoracoscopic lobectomy, in order to provide some suggestions for anesthesiologists when they choose anterior serratus plane block to perform postoperative analgesia for patients.Patients were randomly divided into 3 groups (21 patients/group):
  • 1.general anesthesia group (P group);
  • 2.combined general anesthesia and SSPB group (S group), and
  • 3.combined general anesthesia and DSPB group (D group).
The patients in groups S and D received 0.4 ml/kg of 0.375% ropivacaine for ultrasound-guided block after surgery. Postoperatively, flurbiprofen was used for rescue analgesia.Visual analog scale (VAS) pain scores were recorded at 6 hours, 12 hours, and 24 hours after surgery, and rescue analgesia, post-operative nausea, and vomiting were reported within 24 hours after surgery. At 6 hours, 12 hours, and 24 hours, the VAS scores and the rescue analgesia rates in groups S and D were significantly lower than those in group P (all P < .001). With prolonging time, the VAS in group D was significantly increased by 0.11 per hour as compared with that of group P (P < .0001); VAS in group D was significantly increased by 0.12 per hour as compared with that of group S (P < .0001).Ultrasound-guided anterior serratus plane block can provide adequate analgesia for patients undergoing thoracoscopy lobectomy. SSPB can significantly improve VAS scores as compared to DSPB at 24 hours.  相似文献   
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《The Journal of arthroplasty》2019,34(7):1492-1497
BackgroundSuperficial wound dehiscence after total hip arthroplasty (THA) performed through the direct anterior approach (DAA) can be treated with superficial irrigation and debridement (I&D). The incidence and treatment of this complication has been described, but there are little data on the outcomes after a superficial I&D have not been described. The purpose of this paper was to examine the clinical outcomes of DAA THAs requiring postoperative superficial I&D.MethodsA retrospective review of 1573 THAs performed using the DAA were identified utilizing a prospectively collected, single-institution joint registry. Of these 1573 cases, 18 THAs in 18 patients (1.1%) underwent a superficial I&D for superficial wound dehiscence. Outcomes studied included prosthetic joint infection (PJI) after superficial I&D, revisions, re-reoperations, complications, and clinical outcome scores.ResultsSurvivorship from superficial I&D at 1, 2, and 5 years postoperatively was 98.6% at all time points. In the 18 patients who underwent superficial I&D, this was performed an average of 37 (range 12-83) days after their THA. Female gender (hazard ratio 5.5, 95% confidence interval 1.20-32.34, P = .0271) was associated with a higher risk of undergoing superficial I&D as was body mass index >30 kg/m2 (P = .0028), >35 kg/m2 (P < .0001), and >40 kg/m2 (P = .0037). At average follow-up of 2.2 (range 0.2-5.5) years, 0 patients developed PJI. Complications included femoral revision for a painful fibrously ingrown femoral component (1), pulmonary embolus (1), and death from respiratory failure (1). Postoperative Harris Hip Scores averaged score was 86.8 (range 57-99).ConclusionsSuperficial wound dehiscence requiring superficial I&D after DAA THA occurs in about 1%-2% of patients with low risk of subsequent PJI.  相似文献   
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Regional anesthesia relies on a sound understanding of anatomy and the utility of ultrasound in identifying relevant structures. We assessed the ability to identify the point at which the superficial peroneal nerve (SPN) emerges through the deep fascia by ultrasound on 26 volunteers (mean age 27.85 years ± 13.186; equal male: female). This point was identified, characterized in relation to surrounding bony landmarks (lateral malleolus and head of the fibula), and compared to data from 16 formalin‐fixed human cadavers (mean age 82.88 years ± 6.964; equal male: female). The SPN was identified bilaterally in all subjects. On ultrasound it was found to pierce the deep fascia of the leg at a point 0.31 (±0.066) of the way along a straight line from the lateral malleolus to the head of the fibula (LM‐HF line). This occurred on or anterior to the line in all cases. Dissection of cadavers found this point to be 0.30 (±0.062) along the LM‐HF line, with no statistically significant difference between the two groups (U = 764.000; exact two‐tailed P = 0.534). It was always on or anterior to the LM‐HF line, anterior by 0.74 cm (±0.624) on ultrasound and by 1.51 cm (±0.509) during dissection. This point was significantly further anterior to the LM‐HF line in cadavers (U = 257.700, exact two‐tailed P < 0.001). Dissection revealed the nerve to divide prior to emergence in 46.88% (n = 15) limbs, which was not identified on ultrasound (although not specifically assessed). Such information can guide clinicians when patient factors (e.g., obesity and peripheral edema) make ultrasound‐guided nerve localization more technically challenging. Clin. Anat. 32:390–395, 2019. © 2019 Wiley Periodicals, Inc.  相似文献   
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Goal: Cerebral amyloid angiopathy (CAA) is the second-most common cause of nontraumatic intracerebral hemorrhages (ICH), surpassed only by uncontrolled hypertension. We characterized the percentage, risk factors, and comorbidities of patients suffering from CAA-related ICH in relation to long-term outcomes. Material and Methods: We performed retrospective analyses and clinical follow-ups of individuals suffering from ICH who were directly admitted to neurosurgery between 2002 and 2016. Findings: Seventy-four of 174 (42%) spontaneous nontraumatic lobar ICH cases leastwise satisfied the modified Boston criteria definition for at least “possible CAA.” Females suffered a higher risk of CAA-caused ICH (42 of 74, 56.8%, P= .035). Atrial fibrillation as a major comorbidity was observed in 19 patients (25.7%). Recovery (decrease of modified Rankin scale [mRS]) was highest during hospitalization in the acute clinic. One-year mortality was as follows: 14 of 25 patients (56%) with probable CAA without supporting pathology, 6 of 18, and 8 of 31 patients with supporting pathology and possible CAA, respectively. Only 10 of 74 (13.6%) had favorable long-term outcomes (mRS ≤2). Increasing numbers of lobar hemorrhages, low initial Glasgow Coma Scale, and subarachnoid hemorrhage were significantly associated with poor survivability, whereas statins, antithrombotic agents, an intraventricular hemorrhage, and midline shift played seemingly minor roles. Conclusions: Symptomatic ICH is a serious stage in CAA progression with high mortality. The high incidence of concurrent atrial fibrillation in these patients may support data on more widespread vascular pathology in CAA.  相似文献   
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患者,男,64岁。全身褐色环形斑块2年,伴瘙痒2个月。组织病理示:表皮角化不全,角化过度,可见角化不全柱,其下方棘层散在角化不良细胞,基底层灶状液化变性,真皮见团块状淋巴细胞为主的炎细胞浸润。诊断:炎症性浅表播散性汗孔角化症。给予阿维A 30 mg/d口服治疗,皮损部分消退,目前随访中。  相似文献   
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