12岁以下屈光不正性弱视儿童的发病调查及弱视训练对其调节功能的影响

[目的]调查12岁以下屈光不正性弱视儿童发病特点及弱视训练对其干预作用.[方法]选择2011年4月至2015年3月于本院眼科就诊的384例弱视儿童(年龄≤12岁),采用屈光仪及验光检测测定其屈光度,采用遮盖法、角膜映光法、交替遮盖法测定眼位,确定屈光状态,分析12岁以下儿童屈光不正性弱视发病特点;并对所有患儿给予弱视训练,与同期来本院体检的100例正常儿童作比较,分析弱视训练对屈光不正性弱视儿童调节功能的影响.[结果] ①384例(768眼)儿童,弱视占70.83％,3～6岁组弱视所占比例最高,其次为7～9岁组,随年龄的增大,弱视比例降低;②3～6岁组以高度弱视常见,7～9岁、10～12岁以中度弱视多见;③不同年龄弱视屈光不正均以远视型多见,近视则较少,远视散光与复性远视散光多见,其次为单纯远视;④训练后,弱视组矫正视力、调节幅度、调节灵敏度提升,屈光度、调节滞后量降低,与同组训练前对比差异有统计学意义(P<0.05),但其矫正视力、调节幅度、调节灵敏度仍低于对照组,屈光度、调节滞后量仍高于对照组(P<0.05).[结论] 3～6岁屈光不正性弱视发病率较高,且相对严重,随年龄的增加,弱视发病率降低,程度减轻,采用弱视训练,可明显改善患儿视觉调节功能.     

CT灌注成像在超早期脑梗死中的应用

Objective To investigate the role of computed tomography perfusion (CTP)in the diagnosis and differential diagnosis of hyperacute cerebral infarction. Methods After CT scan was performed in 33 patients who were clinically diagnosed as cerebral infarction ＜5 hours of symptom onset,CTP imaging was performed. CT was reexamined after 24 hours.Results CT scan did not fred abnormality in 33 patients. CTP imaging showed 15 were normal and 18 were abnormal. The regional cerebral blood flow (rCBF),regional cerebral blood volume (rCBV),and regional mean transit time (rMTT) in patients with normal CTP imaging were 32.588±5.877 ml/(100 g · min),1.205 ±0.261 ml/100 g,and 2.937±0.887 s,respectively. There were no significant differences compared to the contralateral sides (33. 208 ± 6. 740)ml/(100 g · min),1. 233 ± 0. 290) ml/100 g,and 2. 854 ± 0. 799 s) (all P ＞ 0. 05).Clinical follow up and CT reexamination confirmed that 11 patients were diagnosed as transient ischemic attack (TIA),2 were hypoglycemia,and 2 were brain stem infarction. The rCBF,rCBV,and rMTT in the ipsilateral sides of 18 patients with CTP imaging abnormality were 6. 580 ±3. 457 ml/(100 g·min),0. 803 ±0. 285 ml/100 g,and 14. 947 ±4. 665 s,respectively. There were significant differences compared to the contralateral sides (34. 756 ± 4. 126 ml/(100 g·min),1. 622 ±0.708 ml/100 g,and (3.794 ± 1. 775 s) (all P ＜0. 05). Clinical follow up and CT reexamination confirmed as cerebral infarction in the basal ganglia region. Conclusions CTP imaging can be used for the diagnosis of hyperacute cerebral infarction and has the significance of differential diagnosis.     

Mirizzi综合征的诊断和治疗

Mirizzi综合征是胆囊结石引起的一种少见并发症,术前临床症状无特殊,诊断较困难,或术中损伤了胆管才发现,目前不少学者和医院仍视为腹腔镜胆囊切除术的禁忌证;是对腹腔镜外科医师的一种考验[1]。随物理诊断技术的进步,对本综合征的认识进一步加深,治疗方法也越来越多。本文就Mirizzi综合征作一简要综述。     

NINJ2基因多态性与大动脉粥样硬化型脑梗死的关系

目的对神经损伤诱导蛋白2（nerve injury induced protein2,NINJ2）基因多态性与大动脉粥样硬化型脑梗死（artery atherosclerotic cerebral infarction,LAA）的相关性进行研究,为其临床研究提供依据。方法选择128例我院诊断为LAA的患者作为病例组,同期随机抽取112例健康体检对象作为对照组．根据既往研究的阳性结果及HapMap数据库,选择NINJ2基因rs11833579及rs108493732个单核苷酸多态性（SNP）位点。采用PCR-RFLP技术进行2个SNP基因分型,分析2SNP位点多态性与LAA的相关性。结果病例组、对照组基因型及等位基因频率分布均符合Hardy-Weinberg平衡检验（P〉0．05）。两组间rs11833579与rs10849373基因型（P=0．512、0．514）、等位基因频率（P=0．811、0．713）及显性模型（P=0．544、0．656）比较均无统计学意义（P〉0．05）;但两组间rs11833579位点隐性模型（AA＋AG）比较差异有统计学意义（P=0．033）。NINJ2基因rs11833579的GA＋AA基因型在后循环动脉粥样硬化中的频率高于其他基因型,差异具有统计学意义（P〈0．05）。结论NINJ2基因rs11833579位点隐性模型（AA＋AG）与LAA的发生存在密切相关性。但仍需对单体型及易感基因和环境因素的交互作用进行研究,以进一步分析NINJ2基因与LAA的相关性。     

CT灌注成像在超早期脑梗死中的应用

Objective To investigate the role of computed tomography perfusion (CTP)in the diagnosis and differential diagnosis of hyperacute cerebral infarction. Methods After CT scan was performed in 33 patients who were clinically diagnosed as cerebral infarction ＜5 hours of symptom onset,CTP imaging was performed. CT was reexamined after 24 hours.Results CT scan did not fred abnormality in 33 patients. CTP imaging showed 15 were normal and 18 were abnormal. The regional cerebral blood flow (rCBF),regional cerebral blood volume (rCBV),and regional mean transit time (rMTT) in patients with normal CTP imaging were 32.588±5.877 ml/(100 g · min),1.205 ±0.261 ml/100 g,and 2.937±0.887 s,respectively. There were no significant differences compared to the contralateral sides (33. 208 ± 6. 740)ml/(100 g · min),1. 233 ± 0. 290) ml/100 g,and 2. 854 ± 0. 799 s) (all P ＞ 0. 05).Clinical follow up and CT reexamination confirmed that 11 patients were diagnosed as transient ischemic attack (TIA),2 were hypoglycemia,and 2 were brain stem infarction. The rCBF,rCBV,and rMTT in the ipsilateral sides of 18 patients with CTP imaging abnormality were 6. 580 ±3. 457 ml/(100 g·min),0. 803 ±0. 285 ml/100 g,and 14. 947 ±4. 665 s,respectively. There were significant differences compared to the contralateral sides (34. 756 ± 4. 126 ml/(100 g·min),1. 622 ±0.708 ml/100 g,and (3.794 ± 1. 775 s) (all P ＜0. 05). Clinical follow up and CT reexamination confirmed as cerebral infarction in the basal ganglia region. Conclusions CTP imaging can be used for the diagnosis of hyperacute cerebral infarction and has the significance of differential diagnosis.     

肥胖患者腹腔镜胆囊切除术围手术期呼吸道并发症的预防

目的探讨腹腔镜胆囊切除术围手术期肥胖患者肺部并发症的原因、处理及预防办法。方法回顾性分析90例肥胖患者腹腔镜胆囊切除术资料。结果围手术期预防措施有效,仅有1例患者术后出现肺不张,保守治疗后治愈。结论认识到肥胖患者围手术期肺部特有并发症,并给予适当的处理方式,可取得良好效果。     

优质护理在妊娠高血压综合征产妇产后出血护理中的临床价值分析

目的观察分析优质护理在妊娠高血压综合征产妇产后出血护理中的临床价值。方法选择我院2018年1月-2018年12月150例妊娠高血压综合征产后出血患者为本次研究对象,按照是否给予优质护理干预将所有患者分为对照组(75例:常规护理)与实验组(75例:优质护理),比较两组患者预后情况。结果实验组患者平均产后2h出血量、产后12h出血量、24h出血量均少于对照组对照组,差异有统计学意义(P0.05)。实验组新生儿出生时Apgar评分以及新生儿体质量相关数值均优于对照组,差异有统计学意义(P0.05)。实验组产妇产后并发症发生率(4.00%)明显低于对照组,差异有统计学意义(P0.05)。结论妊娠高血压综合征产后出血患者优质护理干预效果明显优于常规护理,有较高的临床推广价值。     

不同药物治疗急性脑梗死对患者血清炎症因子的影响

目的研究阿托伐他汀和葛根素注射液治疗急性脑梗死患者期间对其血清炎症因子的影响。方法选择2013年1~12月我院神经内科收治的128例急性脑梗死患者为研究对象,按照治疗方法分成A组与B组,每组各64例,A组口服阿托伐他汀治疗,B组使用葛根素注射液治疗,比较分析两组患者的临床疗效及血脂、血清炎症因子水平与颈动脉粥样硬化等指标变化。结果 B组的治疗有效率为98.4%,显著优于A组的89.1%,两组比较差异有统计学意义(P<0.05)。B组治疗后的总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高敏C反应蛋白(hs-CRP)及基质金属蛋白酶-9(MMP-9)水平均较A组降低,高密度脂蛋白胆固醇(HDL-C)水平升高,差异具有统计学意义(P<0.05)。B组治疗后的颈动脉内膜中层厚度(IMT)与斑块面积均低于A组治疗后差异具有统计学意义(P<0.05)。结论与阿托伐他汀疗效比较,葛根素注射液治疗效果更确切,抑制血清炎症因子效果更显著,可以明显降低血脂水平及有效逆转颈动脉粥硬化。     

小剂量重组组织型纤溶酶原激活剂治疗的脑梗死1例报告

正溶栓剂量问题一直是业界讨论的重点。2016年ENCHANTED试验在全球范围内首次证实小剂量重组组织型纤溶酶原激活剂(rt-PA)与常规剂量rt-PA无差异[1]。我院收治1例小剂量rt-PA预后佳的患者,现报告如下。1病例患者,男,71岁。因"突发头晕、呕吐伴神志不清1h"于2016年6月12日入院。患者于入院前1 h无明显诱因下突发头晕,伴恶心、呕吐,呕吐物为胃内容物。血压190/100     

白内障超声乳化吸除术对黄斑中心凹视网膜脉络膜厚度的影响

[目的]探讨白内障超声乳化吸除术对黄斑中心凹视网膜脉络膜厚度的影响.[方法]选择2016年7月至2017年2月于本院行白内障超声乳化吸除术治疗的45例(78眼)患者的临床资料,所有患者均有完整术前、术后眼底光学相干断层成像仪(OCT)检查资料及黄斑中心凹视网膜厚度(CRT)、中心凹下脉络膜厚度(SFCT)测量结果,分析白内障手术对患者CRT、SFCT的影响.[结果]术后1个月,患者CRT增厚,与术前比较差异有统计学意义(P<0.05),术后3、6个月降低,恢复至术前水平;术后1周到术后3个月患者SFCT均有增厚,但与术前对比差异无统计学意义(P>0.05),术后6个月患者SFCT降低,与术前值接近.[结论]白内障患者超声乳化吸除术后CRT、SFCT均呈一过性增厚表现,且SFCT增厚持续时间较长.