长期血透患者并发腕管综合征应用高通量透析的护理

目的 本研究旨在观察长期血透患者并发腕管综合征应用高通量透析（HFD）的疗效并总结护理体会。方法 长期血透并发腕管综合征的患者，用聚砜膜F60高通量透析器进行血液透析8个月，透析过程中检测F60血滤器经1，7，12次复用透析前后BUN，β2-MG的指标。观察腕关节疼痛改善情况。结果 HFD透析器第1，7，12次复用爱析后β2-MG，BUN水平均较透析前明显下降；病人的腕关节疼痛程度明显减轻。透析中少数病例出现低血压，抽搐等不良反应。结论 HFD可以显著清除β2-MG，显著改善关节疼痛程度；透析器复用12次不影响对小分子毒素的清除效果，降低了透析成本。     

一例长期血液透析并发腕管综合征手术治疗的护理

透析患者的腕管综合征(CTS)被认为是长期血液透析(HD)患者的主要并发症之一[1].据报道,透析患者的CTS发生率达2%～31%[2];随透析时间和患者年龄增长而增加,HD超过lO年者100%发生透析相关性淀粉样变(DRA)[3].DRA首先在患CTS的透析病人中发现,DRA的主要原因是β2-微球蛋白(β2-MG)沉积,系大量β2-MG压迫正中神经所致.近年来,透析患者CTS的治疗多局限于改用高通量透析器等保守治疗,手术治疗的相关护理文献报道较为鲜见,故将本科1例长期HD患者CTS术后的效果观察及护理报道如下.     

高通量透析治疗皮肤瘙痒血透患者的疗效观察及护理

目的本研究旨在于观察高通量血液透析(HFD)对维持性血液透析患者皮肤瘙痒的疗效观察并总结护理体会.方法选择维持性血液透析伴皮肤瘙痒患者12例,透析时间5～6年,采用聚砜膜F60高通量透析器,碳酸盐透析12个,每周2～3次,每次4.5h,透析器复用10次,血流量为250～300ml/min.检测F60血滤器复用10次,分别于复用第1、6、及10次分别测定透析前后BUN、iPTH的指标.观察皮肤瘙痒的改善情况,观察透析中低血压、抽搐、乏力等不良反应发生率.结果 HFD透析器在1、6、10次复用时透析后血iPTH水平均较透析前明显下降,患者皮肤瘙痒程度明显减轻.透析中少数患者出现低血压、抽搐等不良反应.经过补液或给予50%GS静推可以纠正.结论高通量透析可以有效清除iPTH,显著改善皮肤瘙痒程度;透析器复用10次不影响对小分子毒素的清除效果,仍能保证透析质量,降低了透析成本,值得推广.     

高通量透析治疗皮肤瘙痒血透患者的疗效观察及护理

目的　本研究旨在于观察高通量血液透析(HFD)对维持性血液透析患者皮肤瘙痒的疗 效观察并总结护理体会。方法　选择维持性血液透析伴皮肤瘙痒患者12例,透析时间5～6年,采用聚 砜膜F60高通量透析器,碳酸盐透析12个,每周2～3次,每次4.5h,透析器复用10次,血流量为 250～300ml/min。检测F60血滤器复用10次,分别于复用第1、6、及10次分别测定透析前后BUN、 iPTH的指标。观察皮肤瘙痒的改善情况,观察透析中低血压、抽搐、乏力等不良反应发生率。 结果　HFD透析器在1、6、10次复用时透析后血iPTH水平均较透析前明显下降,患者皮肤瘙痒程度 明显减轻。透析中少数患者出现低血压、抽搐等不良反应。经过补液或给予50%GS静推可以纠正。 结论　高通量透析可以有效清除iPTH,显著改善皮肤瘙痒程度;透析器复用10次不影响对小分子毒 素的清除效果,仍能保证透析质量,降低了透析成本,值得推广。     

腕管综合征行腕管松解术病人的护理

腕管综合征(carpal tunnel syndrome, CTS)是正中神经在腕管内受到卡压而出现的一组症状和体征。腕管中有正中神经和9条肌腱通过,组织排列十分紧密。长期反复的慢性损伤或某些疾病如风湿或类风湿性关节炎及糖尿病等,均可引起腕管内压力增高,使正中神经受到压迫,少数也有因腕     

慢性肾功能衰竭患者高通量透析的护理

目的 总结高通量透析的护理体会。方法 对10例CRF患者各进行8次高通量透析,观察生命体征 变化,超滤量,透析前后肾功、血离子及血浆白蛋白和血色素变化。结果 高通量透析后生命体征稳定,超滤量与体 重下降平衡,Bun、Scr下降,Ca2+升高,P3-下降,余血离子稳定,血浆白蛋白和血色素升高,透析前后各参数值比较 (P<0.05)。结论 高通量透析安全疗效好,熟练的护理技术和仔细的观察病人是成功的保证。     

透析相关性腕管综合征手术治疗的疗效观察与护理

目的 探讨透析相关性腕管综合征(DCTS)手术治疗的有效护理模式,以提高患者生活质量。方法 3例典型DCTS患者6只手先后在臂丛麻醉或局麻下行腕横韧带加屈肌支持韧带切断术,观察手术对DCTS的疗效,同时加强手术前后的护理。结果 术后6只手的握拳功能障碍、疼痛和感觉功能异常均明显改善。结论 在精心护理前提下,腕横韧带加屈肌支持韧带切断术是治疗DCTS的安全有效手段,对于药物治疗无效的DCTS患者值得尝试：     

腕管综合征松解术的护理

目的探讨腕管综合征松解术的护理方法。方珐对i5例中晚期腕管综合征患者施行松解术,并采取针对性的护理措施,观察疗效,总结护理体会。结果本组15例患者手术后随访0．5～2．5年,术后恢复优良率为93％。结论针对患者的心理状况,做好细致的心理护理及完善术前准备,术后密切观察病情、预防切口感染、及时止痛、正确的功能锻炼、适当的出院指导,是保证手术效果,改善生活质量的重要措施。     

透析相关性腕管综合征手术治疗的疗效观察

透析相关性腕管综合征(DCTS)是长期透析患者的主要并发症之一,是透析相关性淀粉样变(DRA)的重要表现,系大量β2-微球蛋白(β2-MG)沉积于腕管内压迫正中神经所致.该病随着透析持续时间的延长和年龄的增加而增加,已成为长期透析患者的主要致残并发症.     

透析相关淀粉样变致腕管综合征外科治疗20例疗效分析

目的 总结透析相关的β2微球蛋白淀粉样变,导致腕管综合征（Carpal tunnel syndrome,CTS）的临床特点,评估腕管松解术疗效.方法 回顾性调查中日友好医院从2010年3月～2014年3月完成的透析相关腕管综合征患者20例,所有患者均行腕管松解术.患者男11例、女9例,年龄58.45±8.95 （46～75）岁,血液透析时间18.05±2.60 （14～23）年.其中表现为单侧症状为主的4例（左腕2例,右腕2例）,双侧症状16例;肌电图示平均神经传导速度为18.1±3.2m/s,平均潜伏期为5.1±1.2m/s.麻醉方式：局麻、臂丛麻醉18例,全麻2例.结果 术后随访20例术后症状改善或消失,未见症状复发,手指功能逐渐恢复.肌电图提示神经传导速度及动作电位波幅逐渐恢复.所有患者BCTQ评分较术前降低.其中症状评分术前为3.67±0.19、术后为2.42±0.14（t=19.112,P＜0.01）;功能评分术前为3.5±0.26、术后为2.48±0.18（t=12.329,P＜0.01）.结论 随着长透析龄患者增多,透析相关CTS也逐渐高发.外科腕管松解术是晚期CTS的有效治疗措施,可以明显改善患者手腕症状,促进手功能恢复.     

Bifid Median Nerve in Patients With Carpal Tunnel Syndrome

Objective. The aim of this study was to investigate the frequency of the anatomic variation of a bifid median nerve in patients with carpal tunnel syndrome (CTS) and to determine the size criteria for sonography. Methods. On axial sonograms of 320 hands of 170 patients with CTS and 240 hands of 120 unaffected individuals, the median nerve was evaluated morphologically for a bifid median nerve, and the cross‐sectional area was measured at 3 levels (radial‐ulnar junction, pisiform, and hook of the hamate). Electrophysiologic studies were performed in addition to clinical and sonographic evaluations in all patients, controls with a bifid median nerve, and controls with a cross‐sectional area of greater than 0.09 cm². Results. A bifid median nerve was seen in 32 (19%) of 170 patients and 11 (9%) of 120 controls. It occurred relatively frequently in patients with CTS (P < .01). The cross‐sectional area of the bifid median nerve was relatively higher than that of the nonbifid median nerve in controls at 2 of the 3 levels (P < .001; P = .226; P < .01). The cutoff values for the cross‐sectional area at the level of the pisiform were 0.11 cm² (sensitivity, 90%; specificity, 99%; P < .001) for patients with a bifid median nerve and 0.10 cm² (sensitivity, 98%; specificity, 81%; P < .001) for patients with a nonbifid median nerve. Conclusions. A bifid median nerve occurs relatively frequently in patients with CTS. It may facilitate compression of the median nerve in the carpal tunnel because of its relatively higher cross‐sectional area compared with a nonbifid median nerve. The size criterion for CTS in patients with a bifid median nerve is slightly higher than in those with a nonbifid median nerve.     

Carpal Tunnel Syndrome

ABSTRACT

Questions from patients about analgesic pharmacotherapy and responses from the authors are presented to help educate patient sand make them more effective self-advocates. The topics addressed in this issue are the signs and symptoms of carpal tunnel syndrome and its treatment.     

80例腕管综合征患者的神经电生理测定

目的：观察神经电生理检测对腕管综合征(CTS)的诊断敏感性。方法：80例临床提示为CTS或不能除外CTS的患者进行神经电生理测定并进行回顾性分析。结果：80例116侧正中神经复合肌肉动作电位末端运动潜伏期和波幅、肘至腕的运动传导速度、指至腕部的感觉传导速度及感觉神经动作电位波幅等5项指标检测异常率分别为75．0％、19．8％、9．5％、88．8％及37．9％；45例65侧拇指正中／桡浅神经潜伏期差(MRLD)及环指正中／尺神经潜伏期差(MULD)检测异常率95．4％。结论：正中神经拇指至腕段的感觉传导速度测定是诊断CTS的敏感指标，采用MRLD及MULD测定，诊断敏感性更高。     

高频超声在腕管综合征诊断中的应用探讨

【目的】探讨高频超声在诊断腕管综合征（CTS）中的应用价值,并进一步分析神经增粗与神经传导速度及病程的相关性,并证实高频超声在诊断CTS中的临床价值。【方法】对100例健康志愿者及63例经临床和电生理检查确诊的CST进行高频超声腕管内正中神经的检查,并记录神经的横截面积（CSA）,并作CSA与神经电生理及病程的相关性分析。【结果】对照组腕管内正中神经的CSA为（8．60±2．25）mm^2,CST组CSA为（15．61±4．60）mm^2,两组相比较有显著差异（P〈0．01）。CST组CSA与神经电生理（感觉传导速速）的相关系数为-0．74（P〈0．01）,与CTS病程的相关系数为0．79（P〈0．01）。【结论】高频超声在CTS的诊断有重要应用价值,其可作为CTS及周围神经检查新的形态学诊断方法。     

19. Carpal Tunnel Syndrome

Abstract: Carpal tunnel syndrome (CTS) is a common disorder. In the majority of cases, patients with CTS can be diagnosed by means of appropriate history taking. Nerve conduction examination of the nervus medianus is the most important additional diagnostic test and is the best predictor of symptom severity and functional status in idiopathic CTS. Treatment option depends on the severity of the symptoms and the degree of functional daily limitations. If few limitations are present, splinting or corticosteroid injections are preferred. Surgical interventions are reserved for the more severe conditions resulting in significant disability. Interventional pain treatment such as pulsed radiofrequency could be an addition to the future treatment options for CTS.     

小切口显微神经松解治疗腕管综合征27例

【目的】设计及应用小切口作腕管切开术,并分析其治疗腕管综合征的疗效。【方法】在远侧腕横纹远侧1cm,大鱼肌纹尺侧0．5cm作2．5～3cm切口。直视下切开腕横韧带,切除增生水肿的屈肌腱滑膜。在放大6倍头戴式放大镜下显微松解正中神经。【结果】术后随访3个月至2年,25例症状完全消失,2例大部分症状缓解。拇、示、中指指腹两点辨别觉恢复正常。术后9例大鱼肌萎缩者,肌萎明显改善。拇指对掌功能恢复正常。无一例产生腕掌部瘢痕痛及尺神经、掌浅弓损伤等并发症。【结论】小切口直视下微创显微神经松解术是治疗腕管综合征的一种疗效确切的新方法。     

Idiopathic Carpal Tunnel Syndrome: Evaluation of the Depth of the Carpal Tunnel by Ultrasonography

The objective of the work described here was to evaluate the depth of the carpal tunnel (DCT) in patients with idiopathic carpal tunnel syndrome (CTS) and healthy volunteers by ultrasonography (US), through measurement of the distance from the flexor retinaculum to the surface of the capitate bone at the carpal tunnel outlet, and compare it with other ultrasonographic and electrophysiologic parameters in CTS. The study was conducted in 60 non-diabetic patients with idiopathic carpal tunnel syndrome (unilateral n = 37, bilateral n = 23) evidenced by electrophysiologic diagnosis according to the criteria of the American Association of Electrodiagnostic Medicine (AAEM). Furthermore, 40 hands from 20 healthy volunteers were examined. Median nerve cross-sectional area (CSA); flattening ratio (FR), the ratio of the length to the width of the median nerve; and DCT at the canal outlet were measured for all participants. The mean age was 35.6 ± 9.48 y. The female-to-male ratio was 47:13 in the CTS patients. The sensitivity and specificity were 82% and 95% for CSA, 75% and 60% for FR and 75% and 87.5% for DCT, respectively. Differences between patients and healthy controls were significant for all three parameters, greatest for DCT, followed by CSA and then FR. We conclude that DCT increased in CTS and this new parameter is comparable in sensitivity and specificity to CSA and FR. DCT increased independently of the cause of the CTS (decrease in size of canal or increase in contents).