右枕后位分娩危险因素临床分析

目的 探讨右枕后位的危险因素,保障母婴安全.方法 回顾性分析3755例分娩产妇的病例资料.结果 3 755例中枕后位513例,其中右枕后位405例,占78.95%;正常分娩159例,占30.99%.不同年龄及妊娠期不同偏好卧位产妇右枕后位的发生率比较,差异有显著性意义(均P＜0.01).结论 右枕后位的危险因素可能与孕妇的年龄及偏好卧位有关,应进行相关健康教育,及时准确地识别及正确处理,以保证母婴健康.     

基层医院开展护理查房演示的方法与成效

为提高护理查房质量，护理部组织开展形式多样的护理查房演示，使护理人员掌握护理查房的方法和技巧，持续改进了护理查房质量，提高了护理人员的综合素质，激励了护士长角色，激发了护理人员的学习热情。     

基层医院开展护理查房演示的方法与成效

为提高护理查房质量,护理部组织开展形式多样的护理查房演示,使护理人员掌握护理查房的方法和技巧,持续改进了护理查房质量,提高了护理人员的综合素质,激励了护士长角色,激发了护理人员的学习热情.     

徒手旋转胎头助产的方法与效果分析

目的探讨徒手旋转胎头助产的方法与临床效果。方法选择笔者所在医院收治的头位难产的患者80例,随机分为两组,对照组行常规自然分娩,观察组行徒手旋转胎头助产,对两组患者分娩方式和产后并发症进行比较分析。结果观察组33例自然分娩,占82.5%,对照组17例自然分娩,占37.7%,观察组自然分娩率明显优于对照组（P〈0.05）。观察组剖宫产率和助产率明显低于对照组（P〈0.05）。观察组1例产伤、1例产后出血、1例新生儿轻度窒息;对照组8例产伤,7例产后出血,7例新生儿轻度窒息,观察组明显低于对照组产后并发症发生率（P〈0.05）。结论早期对胎位及骨盆情况进行了解,及时发现胎头位置异常并恰当处理,可降低对母婴的损伤程度,使产程缩短,剖宫产率及并发症发生率明显降低。     

头部去骨瓣减压术后早期两种头位护理方法的效果观察

头部去骨瓣减压术后病人常规采用健侧卧位 ,长时间则易发生枕疮、习惯性健侧偏头 ,且颅骨缺损综合征发生率较高。 1 999年 1 0月至 2 0 0 0年 1 0月 ,我们对头部手术后形成减压窗的病人早期行健—患侧交替头位护理 ,论证其可行性。报告如下。1　资料与方法1 .1　一般资料本组 91例 ,按入院单、双日随机分为两组。观察组 46例 ,男 31例、女 1 5例 ,平均年龄 42 .65岁。重度颅脑损伤 1 8例、高血压性脑出血 2 1例、恶性脑肿瘤 3例、其它 4例。减压窗位于颞顶部 2 1例、额颞顶部 7例、额颞部 9例 (其中双额颞部 6例 )、颞部 9例。减压窗平均面…     

Posterior Reversible Encephalopathy Syndrome in Liver Transplant Patients: Clinical Presentation,Risk Factors and Initial Management

Posterior reversible encephalopathy syndrome (PRES) is an uncommon but well‐known complication after transplantation diagnosed by characteristic radiological features. As limited data on this complex syndrome exist we sought to better define the incidence, clinical presentation and risk factors for PRES in liver transplant (LTx) patients. We conducted a retrospective analysis of 1923 adult LTx recipients transplanted between 2000 and 2010. PRES was diagnosed radiologically in 19 patients (1%), with 84% of cases occurring within 3 months post‐LTX. We compared this cohort of PRES patients to 316 other LTx recipients also requiring radiographic imaging within 3 months after LTx for neurological symptoms. Seizure was the most common clinical manifestation in the PRES group (88% vs. 16%, p< 0.001) and 31% had an intracranial hemorrhage. Those with hemorrhage on imaging were more likely to be coagulopathic. PRES patients were significantly more likely to have had alcoholic liver disease and infection/sepsis. These factors may be related to a common pathway of vascular dysregulation/damage that appears to characterize this complex syndrome. Intracranial bleeding and seizures may be the end result of these phenomena. The relationship of these associated factors to the hypothesized pathophysiology of PRES is discussed.     

俯卧位背侧人路后腹腔镜肾囊肿去顶术的临床分析（附12例报告）

目的：探讨俯卧位经背侧人路后腹腔镜肾囊肿去顶术的方法和疗效。方法：回顾性分析俯卧位经背侧入路后腹腔镜肾囊肿去顶术治疗12例单纯性肾囊肿患者的临床资料。其中男7例,女5例,年龄为31～67岁,平均42．6岁。术前均行泌尿系B超、静脉尿路造影（IVu）和肾脏CT平扫及增强检查明确囊肿大小、数量及位置,证实与肾盂集合系统不相通。囊肿直径4．5～12．0cm,平均7．6cm。结果：12例患者均在后腹腔镜下顺利完成手术。手术时间30～105min,平均48．5min;术中出血量5～25ml,平均14．2ml;术后住院时间3～6天,平均4．8天。围手术期未出现并发症。随访12~20个月,平均15．3个月,未见囊肿复发。结论：俯卧位背侧入路后腹腔镜肾囊肿去顶术治疗单纯性肾囊肿安全可行。经背侧入路后腹腔镜手术的成功实施为临床手术路径的研究提供一种新的思路。     

Lenke 5C型青少年特发性脊柱侧凸病人行后路脊柱融合术后持续性冠状面失衡的危险因素分析

目的 探讨Lenke 5C型青少年特发性脊柱侧凸（adolescent idiopathic scoliosis,AIS）病人行后路脊柱融合术后持续性冠状面失衡（persistent coronal imbalance,PCI）的危险因素。方法 回顾性分析2015年1月至2020年1月在西安交通大学附属红会医院行后路脊柱融合术且随访2年以上的112例Lenke 5C型AIS病人的临床资料。根据病人术后2年的冠状面平衡状态分为PCI组和非PCI组。PCI定义为术后冠状面失衡持续时间≥2年。测量并比较两组病人术前、术后即刻和术后2年的各项冠状面参数和矢状面参数;采用脊柱侧凸研究学会-22评分量表（Scoliosis Research Society-22,SRS-22）评估病人临床疗效。并进一步对上述相关因素进行多元二分类Logistic回归分析确定PCI的独立危险因素。结果 112例病人中,50例（44.6%）术后发生即刻冠状面失衡,其中12例（10.7%）冠状面失衡持续至术后2年。多元二分类Logistic回归分析显示,年龄较大［比值比（odds ratio,OR）=1.841,95%可信区间（confidence interval,CI）：1.147~2.132,P=0.001］、术前胸弯柔韧性较差（OR=1.308,95% CI：1.041~2.015,P=0.016）、术前胸腰弯/腰弯顶椎偏移较大（OR=2.291,95% CI：1.120~4.719,P=0.001）、术前下端固定椎（lowest instrumented vertebra,LIV）倾斜角较大（OR=2.141,95% CI：1.491~3.651,P=0.011）、术后即刻冠状面失衡（OR=5.512,95% CI：4.531~6.891,P=0.001）是发生PCI的独立危险因素。PCI组术后2年SRS-22量表满意度和总分均显著低于非PCI组（P＜0.05）。结论 年龄较大、术前胸弯柔韧性较差、术前胸腰弯/腰弯顶椎偏移较大、术前LIV倾斜角较大和术后即刻冠状面失衡是预测PCI的重要参数。PCI对Lenke 5C型AIS病人后路脊柱融合术后临床效果产生不良影响。     

Clinical Risk Factors for Fracture in Diabetes: A Matched Cohort Analysis

The objective was to determine which individuals with diabetes are at increased risk for fracture. It is unknown whether traditional clinical risk factors (CRFs) can be used in this population to identify individuals at higher risk of fracture. Using the Manitoba Bone Density Program database, we identified 3054 diabetic women and 9151 matched nondiabetic controls. The independent association of specific CRFs with incident osteoporotic fracture risk was assessed separately in those with diabetes and in controls, with subsequent examination of the interaction between diagnosed diabetes and each CRF. Prior major fractures were more prevalent in the diabetic group compared with the nondiabetic group (16.2% vs 14.3%, p < 0.001). During mean 4 yr of observation, 259 (8.5%) of diabetic women and 559 (6.5%) of nondiabetic women experienced an incident major osteoporotic fracture (unadjusted hazard ratio [HR] for diabetes 1.49 [95% confidence interval (CI): 1.28–1.72], p < 0.001; adjusted HR 1.14 [95% CI: 1.10–1.18], p < 0.001). There were no significant differences between the 2 groups in the HRs for incident fracture associated with any of the CRFs studied (all p-for-interaction >0.1). Diabetes is a risk factor for major fracture. The ability of traditional CRFs to predict osteoporotic fractures is not influenced by the diagnosis of diabetes.     

腰椎椎弓根螺钉固定自体骨椎间融合相关因素的临床分析

目的：了解腰椎后路椎弓根螺钉固定、自体骨椎间植骨融合术的临床效果,以及与其相关的并发症等多种因素。方法：分析本科1998年3月至2005年12月得到随访的56例,男32,女24,平均年龄52岁（25—79岁）,平均随访时间4．3年（1个月～7年）。复习围手术期并发症、植骨融合情况、平均出血量和手术时间,并通过问卷和门诊方式评价临床效果。结果：手术并发症有感觉障碍（n=4,7．1％）,硬膜囊撕裂（n=3,5．4％）,深静脉血栓（DVT）形成（n=l,1．8％）,感染（n=1,1．8％）。椎间融合率为94．3％。单节段融合平均失血330ml,双节段600ml,二次手术病例失血量平均多110ml。单节段融合平均需时150分,双节段180分,二次手术的病例需时无明显差别。临床效果为优22．5％,良60．0％,可17．5％。优良率达82．5％。结论：手术并发症轻微,术后不留严重后遗症,注意轻柔操作,严格掌握手术适应症,术后严密观察和抗炎支持治疗是避免和减轻并发症的关键。了解手术过程,熟悉脊柱解剖,同时要标准化操作程序是减少术中出血、缩短手术时间的前提。应用后路减压切除下的椎板和棘突骨粒,椎间致密植骨内固定具有融合率高,无排斥反应,成本低和并发症少等优点,并可同时处理椎管内的情况,手术操作相对安全,还可减压与固定一次完成,术后能达到即刻稳定和持久融合。     

前房积血患者采取交替左右侧卧的临床观察

７４例前房积血患者随机分为交替左、右侧卧体位和半坐卧体位。两组观察前房积血吸收时间、患者的不适应及并发症。结果１、２级前房积血患者交替左、右侧卧位比半坐卧位的积血吸收时间短，而且患者感到舒适，并发症发生率无差异。提示两侧侧卧位是治疗前房积血的较为理想的体位。     

Anesthetic Management of Posterior Fossa Surgery in the Sitting Position

From the surgical aspect, the sitting position gives good surgical access to the operative site, improves venous drainage, gives a better view of facial area for monitoring evoked responses from cranial nerve stimulation and allows for better ventilation. Conversely, the sitting position can present complications such as air emboli, postural hypotension and serious cardiac arrhythmias due to surgical stimulation of cranial nerves and brainstem.
This paper presents our clinical experience in 180 neurosurgical procedures on the posterior fossa in the sitting position. The standardized anesthetic technique consisted of narcotic, muscle relaxant, nitrous oxide and controlled ventilation. All patients were monitored with EGG, direct arterial and venous pressure, discontinuous blood gases, and expiratory CO₂ and urinary output. Air embolism was detected via Doppler ultrasonic detector and evacuated through a right atrial catheter.
Air was detected, visualized and aspirated in 45 cases for an incidence of 25%, with most episodes occurring early in the procedure. In 11 cases(6%) air was detected on closure. There were no deaths in this series.
Fifty-eight patients (32%) had a 10–20 mmHg drop in blood pressure on reaching the sitting position, 19 became temporarily hypertensive (10.5%), and the remainder were normotensive. In 46 patients (25%), bradycardia developed during retraction-manipulation-stimulation of structures on or adjacent to brain-stem as well as to cranial nerves. Surgical stress also accounted for the 13 patients(7%) having frequent premature ventricular extrasystoles. One case of profound hypotension and another case of virtual cardiac standstill were noted during the use of the bipolar electrocautery at or near the fifth nerve exit from brainstem. Additional hemodynamic data, the physiopathology, diagnosis and treatment of air embolism is discussed.