目标导向液体治疗对大面积烧伤患者术后肺功能及氧平衡的影响

目的对比分析目标导向液体治疗对大面积烧伤患者切痂术后肺功能及氧平衡的影响。方法选取2016年3月至2019年3月新乡市第二人民医院收治的100例大面积烧伤患者作为研究对象,并按照不同干预方法将其分为试验组和对照组,每组50例。切痂术中,试验组患者行目标导向液体治疗,对照组患者行常规液体治疗,对比两组患者术后第1、6、12小时的血管外肺水指数与全心舒张末期容积指数以及术后第6、12、24小时的氧合指数与血乳酸变化情况。结果术后,两组患者血管外肺水指数及氧合指数均逐渐升高(试验组:F=5.315、27.932,P=0.006、0.000;对照组:F=5.731、6.006,P=0.004、0.003),全心舒张末期容积指数无明显变化(F=0.222、0.048,P=0.801、0.953),血乳酸水平逐渐降低(F=152.849、86.746,P均=0.000)。术后第6、12小时试验组患者血管外肺水指数均明显低于对照组(t=2.222、2.272,P=0.029、0.025),全心舒张末期容积指数与对照组均无明显差异(t=1.575、1.302,P=0.118、0.196);术后第12、24小时试验组患者氧合指数均明显高于对照组(t=3.852、4.004,P均=0.000),血乳酸水平均明显低于对照组(t=4.303、18.471,P均=0.000)。结论目标导向液体治疗能够有效提高大面积烧伤患者切痂术后的肺功能,改善患者的氧平衡状态。     

跨肺压导向选择最佳呼气末正压治疗急性呼吸窘迫综合征临床效果观察

目的探讨采用跨肺压导向选择最佳呼气末正压(PEEP)治疗急性呼吸窘迫综合征(ARDS)患者的临床疗效。方法选取自2016年1月至2019年1月河池市人民医院收治的需行机械通气的65例ARDS患者为研究对象。采用随机数字表法将患者分为观察组(n=33)与常规组(n=32)。常规组患者进行常规治疗,观察组患者采用跨肺压导向选择最佳PEEP滴定法治疗。比较两组患者治疗前后的潮气量、肺顺应性、血氧饱和度、氧合指数及血浆内皮素-1(ET-1)水平。结果治疗后48 h,观察组潮气量、肺顺应性高于常规组,组间比较,差异有统计学意义(P<0.05)。治疗后48 h、72 h,观察组血氧饱和度、氧合指数高于常规组,组间比较,差异有统计学意义(P<0.05)。治疗前,两组ET-1水平比较,差异无统计学意义(P>0.05);治疗后5 d,两组ET-1水平显著低于治疗前,且观察组改善程度显著优于常规组,组间比较,差异有统计学意义(P<0.05)。结论采用跨肺压导向选择最佳PEEP治疗ARDS效果显著,可有效改善患者氧合指数、潮气量及肺顺应性等,并可改善预后。     

集束化治疗急性呼吸窘迫综合征21例临床观察

目的:集束化治疗急性呼吸窘迫综合症(ARDS) 21例的临床观察.方法:采用与历史对照的前瞻性观察对照方法,纳入新疆兵团第二师焉耆医院ICU 23-65岁,符合1994年欧美联席会议ARDS诊断标准,以2011年3月-2014年2月收治的30例病人作为常规治疗对照组,以2014年3月-2017年12月收治的为前瞻性观察期21例病人作为集束化治疗组,集束化治疗组在积极治疗原发病的基础上采用集束化治疗,包括:限制性液体管理,呼吸支持治疗,大剂量沐舒坦联合血必净注射液治疗,呼吸机相关性肺炎(VAP)的预防,制定个体化镇静镇痛方案,重症患者应用连续性血液净化治疗,比较患者治疗5d后APACHEⅡ评分和氧合指数,以及患者机械通气时间,ICU住院时间,VAP发生率及28d死亡率.结果:两组患者性别、年龄、病因构成、病情严重程度等基础特征比较差异均无统计学意义(均P＞0.05),有可比性,与对照组比较,21例集束化治疗组治疗后APACHEⅡ评分无明显变化(P=0.11),氧合指数明显增加(P=0.03)机械通气时间明显缩短(P=0.02),VAP发生率明显下降(P=0.03),28d病死率明显降低(P=0.04),但集束化治疗组和对照组ICU住院时间差异无统计学意义(P=0.11).结论:集束化治疗干预能缩短ARDS患者的机械通气时间,减少VAP的发生率,改善预后.     

高频振荡通气对早期急性呼吸窘迫综合征患者的治疗作用

目的 观察高频振荡通气(HFOV)对早期急性呼吸窘迫综合征(ARDS)患者的治疗效果.方法 通过自身对照研究,以符合纳入标准的25例ARDS患者为研究对象,记录HFOV开始前及HFOV开始后1、3、5d时患者的氧合指数(PaO2/FiO2)、平均气道压(Paw)、动脉血pH值、PaCO2、肺静态顺应性(Cst)、心脏指数(CI)、心率(HR)、中心静脉压(CVP)、分流分数(QS/QT)、氧指数(OI)的变化,以及呼吸机相关性肺损伤(VALI)、呼吸机相关性肺炎(VAP)的发生率等指标.结果 所有患者HFOV治疗5d后胸部X线检查均较前有明显好转.3例患者在治疗7d后死亡,均为基础疾病所致,但其ARDS症状明显改善.HFOV治疗3d后,患者PaO2/FiO2及Cst明显高于治疗前,OI及QS/QT显著低于治疗前(P＜0.05,P＜0.01);治疗后各时间点之间Paw、PaCO2、动脉血pH值、CVP、HR、CI等参数差异均无统计学意义(P＞0.05).结论 HFOV可改善早期ARDS的氧合及肺部并发症.     

严重胸腹伤并发急性呼吸窘迫综合征的机械通气治疗

目的 总结和探讨严重胸腹伤并发急性呼吸窘迫综合征(ARDS)的机械通气治疗方法.方法 回顾分析90例严重胸腹伤并发ARDS的诊治经过.根据机械通气策略和方法的不同将本组病例分成两组:传统机械通气组38例,肺保护性通气组52例.比较两组通气时间、氧合状况、呼吸机相关肺损伤(VALI)发生率及病死率.结果 传统机械通气组通气时间平均(7.56±2.49)天,氧合指数为276.58±24.20,VALI发生率44.74%,病死率34.21%;肺保护性通气组通气时间平均(5.47±2.81)天,氧合指数为362.38±27.66,VALI发生率19.23%,病死率13.46%.与传统机械通气相比,肺保护性通气治疗能缩短通气时间,改善氧合状况,降低VALI发生率及病死率.结论 对严重胸腹伤并发ARDS患者,肺保护性通气的治疗效果明显优于传统机械通气,值得在临床上推广应用.     

外科重症患者的氧代谢特点与监测

 目的 探讨外科重症患者的氧代谢特点,评估氧代谢监测的临床意义.方法 126例外科重症患者,根据APACHEII伤情严重度评分分成重、较重和极重3组.动态监测动脉血氧分压(PaO2)、动脉血乳酸(ABL)并计算氧合指数(OI= PaO2/FiO2)等指标,比较3组之间的差异.结果 患者氧代谢水平在重症早期即发生异常,与疾病的严重程度相关;有效的治疗后动脉血氧分压、氧合指数上升显著,动脉血乳酸下降明显(P＜0.01),治疗初期3组之间监测指标差异有统计学意义(P＜0.01),痊愈前3组之间差异无统计学意义(P＞0.05);死亡病例的乏氧代谢指标呈持续恶化趋势.结论 氧代谢水平与外科重症患者的病情严重程度密切相关,动态监测乏氧代谢指标,对外科重症患者的病情转归有一定的预警作用.     

肺动态顺应性与氧合指数动态监测在急性呼吸窘迫综合征治疗中的应用

 目的 探讨急性呼吸窘迫综合征患者肺动态顺应性(CD)与氧合指数(OI)的相关性及意义.方法 ICU ARDS患者25例,按预后不同分为治愈组(18例)和死亡组(7例).确诊为ARDS 并行机械通气开始,连续采集上机后2 h(T1)、12 h(T2)、24 h(T3)、48 h(T4)、72 h(T5)、96 h(T6)、120 h(T7)等7个时间点的CD和OI进行分析和比较.结果 (1)两组对应时间点的肺动态顺应性和氧合指数分别对照比较, T1时间点差异无统计学意义(均P＞0.05),其他时间点差异均有统计学意义(均P＜0.01).(2)治愈组,随CD升高OI升高,两者呈显著正相关(r=0.991,P＜0.05﹚;死亡组,随CD降低OI降低,两者亦呈显著正相关(r =0.992 ,P＜0.05﹚.结论 ARDS患者随其肺功能改善,OI和CD同步升高;随着肺损伤加重,OI和CD同步降低.临床可通过二者结合来评估治疗过程中的肺功能状态,从而指导ARDS治疗及判断其预后.     

MEBO 在大面积烧伤瘢痕复合皮移植术后创面中的应用效果分析

【摘要】 目的 探讨湿润烧伤膏(MEBO)在大面积烧伤瘢痕复合皮移植术后创面中的应用效果。方法 选取2018年2月至2019年2月郑州市骨科医院收治的80 例拟行复合皮移植术治疗的大面积烧伤瘢痕患者作为研究对象,并按照随机数表法将其随机分为 MEBO 组 (40例)和常规组(40例), MEBO组患者复合皮移植术后创面予以 MEBO 治疗, 常规组患者复合皮移植术后创面予以磺胺嘧啶银乳膏治疗, 对比观察两组患者创面愈合率、创面愈合时间、瘢痕评分以及并发症发生情况。结果 术后7、14、21 d,MEBO组患者创面愈合率均明显高于常规组 (t = 2.206、3.569、5.296,P = 0.030、P < 0.001、P < 0.001)。MEBO 组患者创面愈合时间为(13.10±4.05) d,明显短于常规组患者的创面愈合时间 (16.55±5.28) d (t = 3.279, P = 0.002)。其间,MEBO组患者并发症发生率为 5.00%,明显低于常规组患者的并发症发生率 22.50% (χ2 = 5.165,P = 0.023)?治疗结束后12周,MEBO组患者温哥华瘢痕量表 (VSS) 评分中瘢痕色泽、厚度、血管分布、柔软度评分均明显低于常规组 (t =3.406、3.559、4.322、3.320,P =0.001、P < 0.001、P < 0.001、P = 0.001)。结论 MEBO 可有效促进大面积烧伤瘢痕患者复合皮移植术后创面愈合,缩短创面愈合时间,改善瘢痕症状,降低并发症发生率,值得临床推广应用。     

单侧椎弓根螺钉内固定联合经椎间孔椎间融合治疗骨质疏松性胸腰椎骨折疗效分析

【摘要】 目的 探讨单侧椎弓根螺钉内固定联合经椎间孔椎间融合治疗骨质疏松性胸腰椎骨折的临床疗效。方法 选取 2020 年 1 月至 2022 年 1 月驻马店魏道德骨科医院收治的 96 例骨质疏松性胸腰椎骨折患者作为研究对象, 按照不同治疗方法将其分为研究组 (45 例) 与常规组 (51 例), 研究组患者采用单侧椎弓根螺钉内固定联合经椎间孔椎间融合治疗, 常规组患者单纯采用单侧椎弓根螺钉内固定治疗, 对比观察两组患者手术相关指标、椎体解剖结构及功能、疼痛程度、并发症发生情况与再骨折情况。 结果 研究组患者术中出血量明显多于常规组 (t = 39.581, P<0.001), 术后下床活动时间、住院时间均明显长于常规组 ( t = 36.312、19.972, P均<0.001); 术后 12个月, 研究组患者伤椎椎体前缘高度明显高于常规组 ( t = 4.914, P< 0.001), 椎体压缩率、Cobb 角、受压面积均明显小于常规组 (t = 8.922、16.056、8.483, P 均<0.001), Oswestry 功能障碍指数 (ODI)评分及视觉模拟评分法 (VAS) 评分均明显低于常规组 ( t = 10.633、12.680, P 均<0.001); 术后随访 12 个月,研究组患者术后并发症发生率为 2.22%, 与常规组患者的术后并发症发生率 9.80%无明显差异 (χ2 = 2.345, P =0.126), 而再骨折率为 0%, 明显低于常规组患者的再骨折率 11.76% (χ2 = 5.647, P = 0.017)。 结论 单侧椎弓根螺钉内固定联合经椎间孔椎间融合治疗骨质疏松性胸腰椎骨折, 虽可延长术后下床活动时间及住院时间, 但能有效恢复伤椎椎体解剖结构, 提高椎体功能, 减轻患者疼痛, 降低再骨折率, 疗效显著, 值得临床推广应用。     

急性呼吸窘迫综合征进展及预后的危险因素研究

目的 探讨急性呼吸窘迫综合征(ARDS)早期诊断及预后判断的危险因素,为临床干预提供参考.方法 采用前瞻队列研究的方法,纳入2013年1月-2016年3月新桥医院呼吸内科收治的64例ARDS患者和66例ARDS高危患者的临床资料.采集患者的人口学资料、APACHEⅡ评分、氧合指数、血常规、凝血六项、炎症标志物等数据,采用logistic回归分析ARDS高危患者发展成为ARDS和影响ARDS患者预后的危险因素.结果 单因素logistic回归分析显示,高危患者发展为ARDS的独立危险因素包括APACHEⅡ评分(OR=6.764,P=0.001)、低蛋白血症(OR=10.54,P=0.002)、白细胞计数(OR=3.912,P=0.012)、纤维蛋白原(OR=9.953,P=0.064)和D-二聚体(OR=4.239,P=0.029).64例ARDS患者中死亡28例,死亡率为43.75％,影响ARDS患者死亡的独立危险因素包括氧合指数(OR=6.573,P=0.014)、血小板计数(OR=9.376,P=0.003)和低蛋白血症(OR=10.738,P=0.056).多因素logistic回归分析显示:联合多项指标预测ARDS的发生风险,APACHEⅡ+低蛋白血症的敏感度为62.50％,特异度为92.42％,APACHEⅡ+D-二聚体的敏感度为62.07％,特异度为93.33％;而联合多项指标预测ARDS的死亡风险,低蛋白血症+血小板计数特异度为77.78％,敏感度为60.71％.结论 低蛋白血症或APACHEⅡ评分联合D-二聚体预测ARDS高危患者发展为ARDS的特异性较好,但敏感性较低.严重的低氧合指数、血小板减少及低蛋白血症预示着ARDS患者预后不良.     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.     

Bronchial stump fistula :treatment with covered retrievable hinged metallic stents-preliminary clinical experience

Objective To evaluate the preliminaily clinical efficacy and retrievability of a retrievable hinged covered metallic stent in the treatment of the bronchial stump fistula （BSF）. Methods Between April 2003 and March 2005, 8 patients with bronchial stump fistula after pneumonectomy or lobectomy were treated with two types （A and B） of retrievable hinged covered metallic stents. Type A stent was placed in 6 patients and type B in 2 under fluoroscopic guidance. The stent was removed with a retrieval set when BSF was healed or complications occurred. Results Stent placement in the bronchial tree was technically successful in all patients, without procedure-related complications. Immediate closure of the BSF was achieved in all patients after the procedure. Stents were removed from all patients but one. Removal of the stents was difficult in two patients due to tissue hyperplasia. Patients were followed up for 6 - 21 months. Placement of the stents remained stable in all patients except one due to severe cough. Permanent closure of BSF was achieved in 7 （87.5%） of 8 patients. Conclusion Use of a retrievable hinged covered expandable metallic stent is a simple, safe, and effective procedure for closure of the BSF. Retrieval of the stent seems to be feasible. （J Intervent Radiol, 2007, 16： 253-257）     

Prevalence and severity of hip and groin pain in sub‐elite male football: a cross‐sectional cohort study of 695 players

The purpose of this study was twofold: (a) to investigate the prevalence of hip and groin pain in sub‐elite male adult football in Denmark and (b) to explore the association between prevalence and duration of hip and groin pain in the previous season with the Copenhagen Hip and Groin Outcome Score (HAGOS) in the beginning of the new season. In total 695 respondents from 40 teams (Division 1–4) were included. Players completed in the beginning of the new season (July–Sept 2011) a self‐reported paper questionnaire on hip and/or groin pain during the previous season and HAGOS. In total 49% (95% CI: 45–52%) reported hip and/or groin pain during the previous season. Of these, 31% (95% CI: 26–36%) reported pain for >6 weeks. Players with the longest duration of pain during the previous season had the lowest HAGOS scores, when assessed at the beginning of the new season, P < 0.001. This study documents that half of sub‐elite male adult football players report pain in the hip and/or groin during a football season. The football players with the longest duration of pain in previous season displayed the lowest HAGOS scores in the beginning of the new season.